Invasive aspergillosis in a paediatric haematology department: a 15-year review.
Invasive aspergillosis (IA) is an increasingly common and often fatal fungal infection in children with haematological disorders. To describe the epidemiology, diagnosis, treatment and outcome of IA in children, retrospective review of the medical records of proven and probable IA between January 1986 and December 2000 was used. Twenty-four patients with IA were identified (10 proven and 14 probable) with a median age of 8.5 years. The incidence of IA was particularly high in acute myeloblastic leukaemia (5.35%) and leukaemia relapse (4%). Twenty-two patients presented with lung involvement. Broncho-alveolar lavage led to a diagnosis in 11 cases, but diagnosis was difficult and repeated invasive explorations were required. Antifungal therapy mainly consisted of amphotericin B. Eight patients underwent open-thorax surgery without any complication. Nine patients (37.5%) were cured of IA and three are still alive. The mortality was 87.5%. Three patients died of massive haemoptysis, including two before neutropenia recovery. Four patients presented with IA recurrence and three were cured again. Despite significant progress having been made in the treatment and diagnosis of IA, it is still a devastating complication in children with haematological disorders. New antifungal therapies and strategies are promising, but objective data are still lacking.
Crassard
Nicolas
N
Department of Pediatric Hematology, Hôpital Debrousse, Lyon, France. ncrassard@ch-bourg01.fr
Hadden
Hélène
H
Piens
Marie-Antoinette
MA
Pondarré
Corinne
C
Hadden
Richard
R
Galambrun
Claire
C
Pracros
Jean-Pierre
JP
Souillet
Gérard
G
Basset
Thierry
T
Berthier
Jean-Claude
JC
Philippe
Noel
N
Bertrand
Yves
Y
D000293:Adolescent; D000935:Antifungal Agents / Q000627:therapeutic use*; D001228:Aspergillosis / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology / Q000601:surgery; D002648:Child; D002675:Child, Preschool; D005260:Female; D019337:Hematologic Neoplasms / Q000150:complications*; D006405:Hematology; D006748:Hospital Departments; D006801:Humans; D015994:Incidence; D007223:Infant; D007938:Leukemia / Q000150:complications; D015470:Leukemia, Myeloid, Acute / Q000150:complications; D008172:Lung Diseases, Fungal / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology / Q000601:surgery; D008297:Male; D010372:Pediatrics; D011379:Prognosis; D016896:Treatment Outcome
D000935:Antifungal Agents