J Korean Med Sci.  2015 Aug;30(8):1121-1128. 10.3346/jkms.2015.30.8.1121.

Clinical Features and Prognosis of Invasive Pulmonary Aspergillosis in Korean Children with Hematologic/Oncologic Diseases

• Han SB
• Kim SK
• Bae EY
• Lee JW
• Yoon JS
• Chung NG
• Cho B
• Jeong DC
• Kang JH
• Kim HK
• Lee DG
• Lee HS
• Im SA

• KMID: 2164507
• DOI: http://doi.org/10.3346/jkms.2015.30.8.1121

Abstract

Invasive pulmonary aspergillosis (IPA) is the most frequent form of invasive fungal diseases in immunocompromised patients. However, there are only a few studies on IPA in immunocompromised children in Korea. This study was designed to characterize IPA in Korean children with hematologic/oncologic diseases. Medical records of children with hematologic/oncologic diseases receiving antifungal therapy were reviewed. The enrolled children were divided into the IPA group (proven and probable IPA) and non-IPA group, and the clinical characteristics and prognosis were compared between the two groups. During the study period, 265 courses of antifungal therapy were administered to 166 children. Among them, two (0.8%) episodes of proven IPA, 35 (13.2%) of probable IPA, and 52 (19.6%) of possible IPA were diagnosed. More children in the IPA group suffered from neutropenia lasting for more than two weeks (51.4% vs. 21.9%, P<0.001) and showed halo signs on the chest computed tomography (78.4% vs. 40.7%, P<0.001) than in the non-IPA group. No other clinical factors showed significant differences between the two groups. Amphotericin B deoxycholate was administered as a first line antifungal agent in 33 (89.2%) IPA group episodes, and eventually voriconazole was administered in 27 (73.0%) episodes. Ten (27.0%) children in the IPA group died within 12 weeks of antifungal therapy. In conclusion, early use of chest computed tomography to identify halo signs in immunocompromised children who are expected to have prolonged neutropenia can be helpful for early diagnosis of IPA and improving prognosis of children with IPA.

Keyword

Invasive Pulmonary Aspergillosis; Immunocompromised Host; Child

MeSH Terms

Antifungal Agents/*therapeutic use
Child
Child Health/statistics & numerical data
Comorbidity
Female
Hematologic Diseases/*mortality
Humans
Incidence
Invasive Pulmonary Aspergillosis/*diagnosis/drug therapy/*mortality
Male
Neoplasms/*mortality
Prognosis
Republic of Korea/epidemiology
Risk Factors
Survival Rate
Tomography, X-Ray Computed/statistics & numerical data
Treatment Outcome
Antifungal Agents

Figure

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  Fig. 1 Yearly distribution of the incidence of invasive pulmonary aspergillosis (P = 0.603).

• 

  Fig. 2 Comparison of cumulative survival between the IPA and non-IPA groups.

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