Kaya Zuhre, Gursel Turkiz, Kocak Ulker, Aral Yusuf Ziya, Kalkanci Ayse, Albayrak Meryem
Pediatric Hematology Unit of Department of Pediatrics, Medical School of Gazi University, Ankara, Turkey.
Pediatr Blood Cancer. 2009 Apr;52(4):470-5. doi: 10.1002/pbc.21868.
Children with acute leukemia have increased risk for invasive fungal infections (IFI) but the role of long term antifungal prophylaxis (AFP) in morbidity and mortality of IFI is not well-known.
Medical records of 154 children with acute leukemia who received AFP with fluconazole during intensive chemotherapy were retrospectively reviewed to determine risk factors, clinical characteristics and outcome of IFI.
The overall incidence of IFI was 13.6%. Frequencies of proven, probable and possible infections were 7.2%, 2.6%, and 3.8%, respectively. The causative agent was Candida in 12 (57.2%) and Aspergillus in 9 (42.8%) children. There were 10 children with candidemia (47.6%), 7 with pulmonary aspergillosis (33.4%), 2 with hepatosplenic candidiasis (10.0%), one with sinopulmonary aspergillosis (4.5%) and one with sinus aspergillosis (4.5%). IFI was twice as common in acute myeloid leukemia (AML) (20.7%) than in acute lymphoblastic leukemia (ALL) (10.2%). Duration of profound neutropenia (P = 0.01) and steroid medications (P = 0.001) were significantly associated with IFI in univariate but not in multivariate analysis. Liposomal amphotericin B (L-AMB) was successful in 15 of 21 children as a single agent. Voriconazole produced complete response in four children with invasive aspergillosis and two with hepatosplenic candidiasis, who were unresponsive to L-AMB. The rate of IFI attributable death was 5%.
Our results indicate that AFP with fluconazole and early empirical antifungal therapy may be effective in reducing the incidence and mortality of IFI in children with acute leukemia.
急性白血病患儿发生侵袭性真菌感染（IFI）的风险增加，但长期抗真菌预防（AFP）在IFI发病率和死亡率中的作用尚不清楚。
回顾性分析154例在强化化疗期间接受氟康唑AFP的急性白血病患儿的病历，以确定IFI的危险因素、临床特征和结局。
IFI的总体发病率为13.6%。确诊、很可能和可能感染的频率分别为7.2%、2.6%和3.8%。病原体为念珠菌的患儿有12例（57.2%），曲霉菌的患儿有9例（42.8%）。有10例念珠菌血症患儿（47.6%），7例肺曲霉菌病患儿（33.4%），2例肝脾念珠菌病患儿（10.0%），1例鼻窦肺曲霉菌病患儿（4.5%）和1例鼻窦曲霉菌病患儿（4.5%）。急性髓系白血病（AML）患儿的IFI发生率（20.7%）是急性淋巴细胞白血病（ALL）患儿（10.2%）的两倍。在单因素分析中，严重中性粒细胞减少持续时间（P = 0.01）和类固醇药物（P = 0.001）与IFI显著相关，但在多因素分析中并非如此。脂质体两性霉素B（L-AMB）作为单一药物在21例患儿中有15例治疗成功。伏立康唑使4例侵袭性曲霉菌病患儿和2例对L-AMB无反应的肝脾念珠菌病患儿完全缓解。IFI所致死亡率为5%。
我们的结果表明，氟康唑AFP和早期经验性抗真菌治疗可能有效降低急性白血病患儿IFI的发病率和死亡率。
