Clin Pediatr Hematol Oncol.  2011 Oct;18(2):109-118.

Diagnosis and Clinical Presentation of Invasive Aspergillosis in Pediatric Hematology-Oncology Patients

• Lee M
• Jung HJ
• Noh OK
• Hong CH
• Park JE

Abstract

BACKGROUND
The useful tools for early diagnosis and diagnostic criteria need to be developed for controlling invasive aspergillosis (IA) which causes life-threatening conditions in high risk group such as immunocompromised hematology-oncology patients.
METHODS
103 cases of suspected IA on the ground of pathologic or Aspergillus Galactomannan (AG) test from March 2006 to March 2011 were reviewed. The patients with IA was classified into 4 groups 'Proven', 'Probable', ('Probable-1'), 'Possible' and 'Non' based on the criteria of European Organization for Research and Treatment of Cancer/Mycoses study Group (EORT/MSG) 2008 (and 2002).
RESULTS
Of the 103 patients who underwent AG test, 16 cases were diagnosed as IA; 2 'Proven', 9 'Probable', 5 'Probable-1' and 4 'non' (false-positive). Underlying diseases were acute lymphoblastic leukemia (N=8), acute myeloid leukemia (N=5), severe aplastic anemia (N=4), neuroblastoma (N=2) and non-Hodgkin lymphoma (N=1). Risk factors were severe neutropenia for 10 days (80%), prolonged use of steroid (70%), receipt of an allogeneic stem cell transplant (45%) and treatment with immunosuppressants (40%). Major involved organs of IA were lung (N=15) and sinus (N=1). Overall sensitivity, specificity, positive predictive value and negative predictive value of the AG test were 94%, 95%, 79% and 99%, respectively. The mortality of 16 patients with IA was 50%.
CONCLUSION
A combined use of the AG test and modified criteria of EORT/MSG 2008 allows not only early diagnosis but also prompt classifying risk groups of IA so that proper antifungal agents were used in pediatric hematology-oncology patients.

Keyword

Aspergillosis; Pediatirics; Hematology; Galactomannan; Immunosuppressed; Oncology

MeSH Terms

Anemia, Aplastic
Antifungal Agents
Aspergillosis
Aspergillus
Early Diagnosis
Hematology
Humans
Immunosuppressive Agents
Leukemia, Myeloid, Acute
Lung
Lymphoma, Non-Hodgkin
Mannans
Neuroblastoma
Neutropenia
Precursor Cell Lymphoblastic Leukemia-Lymphoma
Risk Factors
Sensitivity and Specificity
Stem Cells
Transplants
Antifungal Agents
Immunosuppressive Agents
Mannans