Invasive aspergillosis in children in debut of acute myeloid leukemia

Abstract

Invasive aspergillosis (IA) is a life-threatening complication in pediatric patients with hematological malignancies. The highest incidence rates of IA were found in pediatric patients with acute myeloid leukemia (AML). We presented a case of successful treatment of IA in a patient with debut of AML with Down syndrome, analysis of IA cases in children with AML according data of the register and a literature review. 46 pediatric patients with IA were included, among them 16 (34.7%) with AML. In 3 (18.75%) pts AML was diagnosed in presentation of AML. Risk factors of IA were prolonged neutropenia (100%) and lymphocytopenia (81%). The most common clinical signs were: fever > 38.5 ºС (93.7%), cough (75%) and respiratory failure (43.7%). The lung involvement was diagnosed in 93.7% of pts, more than 2 sites of IA – in 12.5%, endophthalmitis – in 6.25%. Typical imaging finding was «halo sign» – 37.5%. According received results «probable IA» was diagnosed in 87.5% of pts and «proven» in 12.5%. Antifungal treatment received 100% of patients, with voriconazole only – 50%, combined antifungal therapy – 33.3%. Overall 12-week survival was 87.5%. Parents patients agreed to use personal data in research and publications.