Petit A, Tabone M D, Moissenet D, Auvrignon A, Landman-Parker J, Boccon-Gibod L, Leverger G
Service d'hématologie et d'oncologie pédiatrique, hôpital d'enfants Armand-Trousseau, Assistance-publique-Hôpitaux de Paris, France.
Arch Pediatr. 2005 Jul;12(7):1116-9. doi: 10.1016/j.arcped.2005.03.046.
Disseminated fusariosis in children is a rare and serious fungal infection, that occurs especially in neutropenic immunosuppressed patients, treated for malignant hemopathy, or bone marrow transplant recipient. Treatment is difficult and mortality is estimated between 50 and 70% in adult patients. CASE REPORT 1: A ten-year-old boy, treated for an acute lymphoblastic leukemia in second relapse, presented a disseminated fusarium spp infection, that occurred during neutropenia. He died due to fusariosis infection in spite of amphotericin B treatment. CASE REPORT 2: A ten-year-old neutropenic girl, treated for an acute myeloïd leukemia, presented disseminated fusariosis, uncontrolled by amphotericin B. Recovery was observed after voriconazole introduction and resolution of neutropenia. Ten months later, she presented a leukemia's relapse, treated by new intensive chemotherapy with secondary prophylaxis by voriconazole, without fusariosis's recurrence.
Voriconazole, a new triazole agent, seems to be an alternative antifungal agent to amphotericin B for disseminated fusarium infection, either at the acute phase or for secondary prophylaxis.
儿童播散性镰刀菌病是一种罕见且严重的真菌感染,尤其发生在因恶性血液病接受治疗的中性粒细胞减少的免疫抑制患者或骨髓移植受者中。治疗困难,成年患者的死亡率估计在50%至70%之间。病例报告1:一名10岁男孩,在急性淋巴细胞白血病第二次复发时接受治疗,在中性粒细胞减少期间出现播散性镰刀菌属感染。尽管接受了两性霉素B治疗,但他仍死于镰刀菌病感染。病例报告2:一名10岁中性粒细胞减少的女孩,因急性髓细胞白血病接受治疗,出现播散性镰刀菌病,两性霉素B无法控制。在引入伏立康唑并中性粒细胞减少症得到缓解后观察到康复。10个月后,她出现白血病复发,接受了新的强化化疗,并使用伏立康唑进行二级预防,未再出现镰刀菌病复发。
伏立康唑,一种新型三唑类药物,似乎是两性霉素B用于播散性镰刀菌感染急性期或二级预防的替代抗真菌药物。