title: Invasive aspergillosis in a paediatric haematology department: a 15-year review.
abstract: 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.
authors.affiliation: Department of Pediatric Hematology, Hôpital Debrousse, Lyon, France. ncrassard@ch-bourg01.fr
authors.forename: Nicolas
authors.initials: N
authors.lastname: Crassard
authors.forename: Hélène
authors.initials: H
authors.lastname: Hadden
authors.forename: Marie-Antoinette
authors.initials: MA
authors.lastname: Piens
authors.forename: Corinne
authors.initials: C
authors.lastname: Pondarré
authors.forename: Richard
authors.initials: R
authors.lastname: Hadden
authors.forename: Claire
authors.initials: C
authors.lastname: Galambrun
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: Pracros
authors.forename: Gérard
authors.initials: G
authors.lastname: Souillet
authors.forename: Thierry
authors.initials: T
authors.lastname: Basset
authors.forename: Jean-Claude
authors.initials: JC
authors.lastname: Berthier
authors.forename: Noel
authors.initials: N
authors.lastname: Philippe
authors.forename: Yves
authors.initials: Y
authors.lastname: Bertrand
mesh_terms: 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
chemical_list: D000935:Antifungal Agents