Invasive Aspergillosis in Children: A Review of 12 Patients

Objective: Aspergillus is an important cause of opportunistic pathogens in normal or immunocompromised children. It may cause respiratory or systemic infections, and can caused life-threatening complications. Invasive respiratory aspergillosis in immunocompromised children has a high morbidity and mortality. In the study, we analyzed the clinical manifestations and outcomes of invasive pulmonary aspergillosis of immunocompromised children in the hematology and oncology unit in a tertiary children facility in northern Taiwan. Methods: We performed a computer analysis of patients with a discharge diagnosis of aspergillosis in Chang Gung Children’s Hospital between August, 2004 and May, 2010. According to the amended EORTC/MSG criteria, children with the diagnoses of proven, probable or possible invasive aspergillosis (IA) were enrolled into this study. Demographic data, clinical presentations, radiographic findings, Galactomannan test, fungal culture, antifungal therapy, and clinical outcomes were analyzed. Results: A total of 12 patients with proven, probable and possible invasive IA were enrolled. The median age was 13.5 years (range 5 to 17 years). Eighty-three percent of children had underlying hematological malignancy and 17% had solid tumor. Fever was the most common (92%) symptom and followed by cough (75%), hemoptysis (50%), chest pain (33.3%) and dyspnea (33.3%). The most frequent diagnostic radiographic finding of the lung was pulmonary nodules (58.3%). Cavitation was seen in 16.7% of patients, the air crescent sign and the halo sign were found in each of 8.3% of these children. Only 16.6% of cultures yielded a growth of Aspergillus species from specimens of sputum and pleural effusion. All patients received Voriconazole treatment before the diagnosis of IA. Eight out of 12 patients (66.7%) died during treatment for IA. Conclusions: For children with hematologic and oncologic disorders and neutropenia, who presented with chest pain, hemoptysis and fever lasted for more than 72 hours, with the presence of pulmonary nodules and consolidations. IA should be highly suspected. IA had high mortality in such children and adequate antifungal medications did not enhance survival rate. Early diagnosis of IA is crucial and prophylactic antifungal medication should be prescribed before confirmation in such immunocompromised children with abovementioned clinical features and radiographic findings.