Invasive aspergillosis in children and adolescents with solid tumors: clinical cases and registry analysis

Abstract

We presented two cases of invasive aspergillosis (IA) in children with solid tumors, data of IA patients register, and a literature review. In theregister of patients with IA (1997–2018), we found 57 patients with IA from 0 to 18 years. It was established that the number of patients with solid tumors was 15.7 %. Background diseases were: central nervous system tumors – 33.5 %, neuroblastoma – 33.5 %, osteosarcoma – 11.0 %, Wilms tumor – 11.0 %, hemangioblastoma – 11.0 %. Chemotherapy-induced neutropenia was reported in 100 % of IA cases in children and adolescents with solid tumors. The additional risk factors were treatment in intensive care unit – 22.2 %, high-dose chemotherapy with autologous hematopoietic stem cell transplantation – 22.2 %, concomitant bacterial infection – 33.0 %. Surgical intervention for the underlying disease was performed in 77.7 % of patients. The most common clinical site of IA was the lungs – 88.9 %. The predominant clinical sign was fever – 66.7 %, cough and respiratory failure were seen less frequently – 33.4 % and33.4 %, respectively. The etiologicalagents of IA were Aspergillus fumigatus – 33.3 %, Aspergillus nidulans – 33.3 % and Aspergillus ustus – 33.3 %. 88.9 % of patients received antimycotic therapy, voriconazole predominantly – 66.7 %. Combination therapy was used in 33.3 % of patients. The overall 12-week survival in children and adolescents with IA in case of solid tumors was 77.8 %.

Breakthrough invasive candidiasis in pediatric patient with Ewing’s sarcoma: dinical case report and literature review

“…Случаи инвазивных микозов (ИМ) при терапии солидных опухолей у детей описываются как спорадические и, по данным зарубежных эпидемиологических исследований, в среднем составляют 4,6 (0,5-12) %, при этом частота инвазивного кандидоза (ИК) -1,6 % [3,4]. Основным фактором риска ИМ у пациентов с неонкогематологическими заболеваниями является постцитостатическая аплазия кроветворения, степень и длительность которой определяется объемом проводимой химиотерапии [5][6][7]. Следует подчеркнуть нередкую недооценку риска ИМ у пациентов с солидными опухолями, что влечет за собой позднюю диагностику, неверную трактовку результатов проведенного обследования и позднюю антифунгальную терапию, что ухудшает результаты лечения [5].…”