Invasive Aspergillosis in Immunocompromised Children / 대한소아혈액종양학회지

ABSTRACT

PURPOSE: An increasing number of immunocompromised patients are contracting opportunistic infections caused by Aspergillus, resulting in a significant morbidity and mortality. We reviewed the clinical presentation, radiologic characteristics, histopathologic findings, treatment strategies, and outcome of invasive aspergillosis (IA) in immunocompromised children. METHODS: Thirteen children having IA were retrospectively analyzed. RESULTS: Acute myelogenous leukemia (n=9, 69.2%) was the most common underlying disease, followed by acute lymphocytic leukemia (n=2), Fanconi anemia (n=1), and chronic granulomatous disease (CGD, n=1). Pulmonary involvement was present in 12 patients (92.3%). The sinuses or nose were involved in 4 (30.8%). The patient with CGD had lung, soft tissue, and bone involvement. Central nervous system, gastrointestinal, heart involvement were not documented. Histology or culture proven IA were found in 6 patients (46.2%). In pulmonary IA, typical findings of thoracic computed tomography, such as halo sign or air-crescent sign, was observed in 6 patients. Amphotericin B was given to all patients along with itraconazole (69.2%), G- or GM-CSF (84.6%). AmBisome was subsequently substituted for Amphotericin in 4. One patient with pulmonary mycetoma underwent lobectomy. Seven patients (53.8%) were improved by antifungal measures, but no patients achieved a long term survival. IA was implicated as a cause of death in 7 (4 with massive pulmonary hemorrhage). Most of the rest succumbed to the relapse of underlying leukemia. CONCLUSION: IA remains a formidable infection in immunocompromised children despite current treatment. Lung was the most common site of infection and massive pulmonary hemorrhage might ensue. Early diagnosis and development of effective measures, including surgery, are warranted.