Diagnosis and Clinical Presentation of Invasive Aspergillosis in Pediatric Hematology-Oncology Patients
- Author:
Minjoo LEE
1
;
Hyun Joo JUNG
;
O Kyu NOH
;
Chang Ho HONG
;
Jun Eun PARK
Author Information
1. Department of Pediatric, Ajou University School of Medicine, Suwon, Korea. pedpje@ajou.ac.kr
- Publication Type:Original Article
- Keywords:
Aspergillosis;
Pediatirics;
Hematology;
Galactomannan;
Immunosuppressed;
Oncology
- MeSH:
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
- From:Clinical Pediatric Hematology-Oncology
2011;18(2):109-118
- CountryRepublic of Korea
- Language:Korean
-
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.
