| Popis: |
Background: Invasive aspergillosis is a major cause of morbidity and mortality in immunocompromised children. The aim of our study was to evaluate the in-hospital mortality over a period of 21 years (January 1st, 1997, to December 31st, 2017) and identify factors affecting the outcomes. Methods: We retrospectively examined hospital records of all patients younger than 18 years of age with proven, probable or possible invasive aspergillosis defined by the European Organization for Research and Treatment of Cancer-Mycoses Study Group criteria. Results: We identified 12 patients with invasive aspergillosis ; 4 had proven, 6 probable and 2 had a possible disease. The majority of the children had a hematologic malignancy. All patients had invasive pulmonary aspergillosis. Aspergillus fumigatus was the species most frequently identified (75.0%). Galactomannan antigen was analyzed in 83.3% of our patients and found positive in 60.0%. The most frequent radiologic pulmonary finding was bilateral opacity and infiltrations (66.6%). After the diagnosis, all but one child were treated with voriconazole ; however, 75.0% received concomitant antifungal agents. Outcome was poor ; overall mortality was 83.3%. Conclusion: Hematologic malignancy and chronic granulomatous disease are risk factors for development of invasive aspergillosis. In children, the disease most commonly involves the lungs. Frequently, children do not manifest specific radiologic signs which can significantly postpone diagnosis. Galactomannan assay and BALF culture may facilitate the diagnosis as shown in our case series. The high in-hospital mortality is affected by the diagnostic delay possibly leading to a disseminated infection with worse prognosis, side effects of chemotherapy and other comorbidities, as well as therapeutic delay in administrating voriconazole as the drug of choice. |
