Research Department, Children's Hospital of Mexico Federico Gómez, Mexico City, Mexico.
Leukemia Cell Research Biobank, Children's Hospital of Mexico Federico Gómez, Mexico City, Mexico.
Front Public Health. 2023 Mar 22;11:1056489. doi: 10.3389/fpubh.2023.1056489. eCollection 2023.
Acute leukemia accounts for more than 30% of all pediatric cancer cases, and of these, 15-20% are acute myeloid leukemia (AML). Children who super from AML are more likely to develop infections due to the humoral and cellular immune deficits generated by the disease and its treatment. The incidence of fungal infections is underestimated; reports show that up to 75% of fungal infections go undiagnosed until autopsy. In only 30 years, the incidence of invasive candidiasis has increased by 40-fold. Thus, the high morbidity and mortality associated with fungal infections in hematological patients make it necessary to adopt preventive measures.
This work aimed to retrospectively identify pediatric patients with acute myeloid leukemia and invasive fungal diseases (IFDs) in a Latin American tertiary care hospital. A retrospective analysis of 36 clinical records of pediatric patients diagnosed with AML from 2007 to 2017 was carried out.
One hundred and twenty-nine hospitalizations were associated with infectious events. Thirteen patients in our study presented 15 infectious events associated with IFDs (11.6%). Two patients died because of complications related to IFDs (15.3%). The most frequent IFD type was aspergillosis, which was observed in 7 cases, followed by Candidemia, which was observed in 4 cases. The most frequent clinical manifestations were fever and respiratory distress.
Mortality due to IFD can be prevented with effective pharmacotherapy. An appropriate antifungal prophylaxis strategy still needs to be developed through larger prospective studies in Latin America.
急性白血病占所有儿科癌症病例的 30%以上，其中 15-20%为急性髓系白血病（AML）。患有 AML 的儿童由于疾病及其治疗引起的体液和细胞免疫缺陷，更容易发生感染。真菌感染的发病率被低估；报告显示，高达 75%的真菌感染在尸检前未被诊断。仅在 30 年内，侵袭性念珠菌病的发病率就增加了 40 倍。因此，血液系统患者中真菌感染的高发病率和死亡率使得采取预防措施成为必要。
本研究旨在回顾性确定拉丁美洲三级护理医院中患有急性髓系白血病和侵袭性真菌病（IFD）的儿科患者。对 2007 年至 2017 年间诊断为 AML 的 36 例儿科患者的 36 份临床记录进行了回顾性分析。
129 次住院与感染事件相关。在我们的研究中，有 13 名患者出现了 15 次与 IFD 相关的感染事件（11.6%）。有 2 名患者因与 IFD 相关的并发症而死亡（15.3%）。最常见的 IFD 类型是曲霉菌病，有 7 例，其次是念珠菌血症，有 4 例。最常见的临床表现是发热和呼吸窘迫。
IFD 导致的死亡率可以通过有效的药物治疗来预防。在拉丁美洲，仍需要通过更大规模的前瞻性研究来制定适当的抗真菌预防策略。
