Korean J Pediatr Hematol Oncol.  2002 Apr;9(1):72-81.

Invasive Aspergillosis in Immunocompromised Children

• Kwon HJ
• Kook H
• Kim HJ
• Kim SY
• Lee JS
• Choi IS
• Shin JH
• Hwang TJ

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.

Keyword

Invasive aspergillosis; Immunocompromised children; Treatment; Amphotericin; Outcome

MeSH Terms

Amphotericin B
Aspergillosis*
Aspergillus
Cause of Death
Central Nervous System
Child*
Early Diagnosis
Fanconi Anemia
Granulocyte-Macrophage Colony-Stimulating Factor
Granulomatous Disease, Chronic
Heart
Hemorrhage
Humans
Immunocompromised Host
Itraconazole
Leukemia
Leukemia, Myeloid, Acute
Lung
Mortality
Mycetoma
Nose
Opportunistic Infections
Precursor Cell Lymphoblastic Leukemia-Lymphoma
Recurrence
Retrospective Studies
Amphotericin B
Granulocyte-Macrophage Colony-Stimulating Factor
Itraconazole