Thomas Lyn, Baggen Lonneke, Chisholm Julia, Sharland Mike
Pediatric Infectious Diseases Unit St George's Hospital, Blackshaw Road, London, SW17 0QT, UK.
Expert Rev Anti Infect Ther. 2009 May;7(4):461-72. doi: 10.1586/eri.09.19.
Invasive fungal infections cause significant morbidity and mortality in immunocompromised children. The prevalence of invasive aspergillosis (IA) is increasing as a reflection of the rising numbers of immunocompromised patients and the increasing use of aggressive immunosuppressive treatment regimes for hematologic malignancies and transplantation. IA is almost exclusively seen in severely immunocompromised or critically ill children, including those with the classic risk factors (particularly neutropenia, hematopoietic stem cell transplant or solid-organ transplantation, hematological malignancies, use of systemic immunosuppressive agents or cytotoxic therapies). Early treatment improves survival rates, but the diagnosis of aspergillosis remains difficult and, while IA has been relatively well-characterized in adults, far fewer studies have described optimal treatment for the pediatric population. This article reviews and compares the newer, less-invasive diagnostic techniques that are becoming available and focuses on the data specifically from pediatric trials regarding efficacy, safety and pharmacokinetics of the antifungals used for IA.
侵袭性真菌感染在免疫功能低下的儿童中会导致显著的发病率和死亡率。侵袭性曲霉病（IA）的患病率正在上升，这反映出免疫功能低下患者数量的增加以及对血液系统恶性肿瘤和移植采用的积极免疫抑制治疗方案的增多。IA几乎仅见于严重免疫功能低下或危重症儿童，包括那些具有典型危险因素的儿童（特别是中性粒细胞减少、造血干细胞移植或实体器官移植、血液系统恶性肿瘤、使用全身性免疫抑制剂或细胞毒性疗法）。早期治疗可提高生存率，但曲霉病的诊断仍然困难，而且虽然IA在成人中已有相对充分的特征描述，但针对儿科人群的最佳治疗方法的研究要少得多。本文回顾并比较了现有的更新的、侵入性较小的诊断技术，并重点关注来自儿科试验的关于用于IA的抗真菌药物的疗效、安全性和药代动力学的具体数据。
