Clinical Features and Prognosis of Invasive Pulmonary Aspergillosis in Korean Children with Hematologic/Oncologic Diseases.
10.3346/jkms.2015.30.8.1121
- Author:
Seung Beom HAN
1
;
Seong Koo KIM
;
E Young BAE
;
Jae Wook LEE
;
Jong Seo YOON
;
Nack Gyun CHUNG
;
Bin CHO
;
Dae Chul JEONG
;
Jin Han KANG
;
Hack Ki KIM
;
Dong Gun LEE
;
Hyun Sil LEE
;
Soo Ah IM
Author Information
1. Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Korea. pedjsyoon@catholic.ac.kr
- Publication Type:Original Article
- Keywords:
Invasive Pulmonary Aspergillosis;
Immunocompromised Host;
Child
- MeSH:
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
- From:Journal of Korean Medical Science
2015;30(8):1121-1128
- CountryRepublic of Korea
- Language:English
-
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.
