Papachristou Savvas, Iosifidis Elias, Roilides Emmanuel
Infectious Diseases Unit, 3rd Department of Pediatrics, Faculty of Medicine, Aristotle University School of Health Sciences, Konstantinoupoleos 49, 54642 Thessaloniki, Greece.
J Fungi (Basel). 2019 Feb 11;5(1):14. doi: 10.3390/jof5010014.
The purpose of this article is to review and update the strategies for prevention and treatment of invasive aspergillosis (IA) in pediatric patients with leukemia and in patients with hematopoietic stem cell transplantation. The major risk factors associated with IA will be described since their recognition constitutes the first step of prevention. The latter is further analyzed into chemoprophylaxis and non-pharmacologic approaches. Triazoles are the mainstay of anti-fungal prophylaxis while the other measures revolve around reducing exposure to mold spores. Three levels of treatment have been identified: (a) empiric, (b) pre-emptive, and (c) targeted treatment. Empiric is initiated in febrile neutropenic patients and uses mainly caspofungin and liposomal amphotericin B (LAMB). Pre-emptive is a diagnostic driven approach attempting to reduce unnecessary use of anti-fungals. Treatment targeted at proven or probable IA is age-dependent, with voriconazole and LAMB being the cornerstones in >2yrs and <2yrs age groups, respectively.
本文旨在回顾并更新白血病患儿及造血干细胞移植患者侵袭性曲霉病（IA）的预防和治疗策略。将描述与IA相关的主要危险因素，因为对其的识别是预防的第一步。预防措施进一步细分为化学预防和非药物方法。三唑类药物是抗真菌预防的主要药物，而其他措施主要围绕减少接触霉菌孢子展开。已确定了三个治疗级别：（a）经验性治疗，（b）抢先治疗，以及（c）靶向治疗。经验性治疗用于发热性中性粒细胞减少患者，主要使用卡泊芬净和脂质体两性霉素B（LAMB）。抢先治疗是一种基于诊断的方法，旨在减少抗真菌药物的不必要使用。针对确诊或疑似IA的治疗取决于年龄，伏立康唑和LAMB分别是2岁以上和2岁以下年龄组的治疗基石。
