Invasive apergillosis in children with oncohaematological diseases in Saint Petersburg, Russia

Ref ID: 19206

Author:

N. Klimko*, S. Khostelidi, Y. Borzova, O. Shadrivova, E. Desyatic, A. Volkova, M. Popova, T. Bogomolova, S. Ignatyeva, A. Kolbin, E. Boychenko, M. Belogurova, N. Medvedeva, N. Vasilyeva, L. Zubarovskaya, B. Afanasyev

Author address:

St. Petersburg, RU

Full conference title:

23rd European Congress of Clinical Microbiology and
Infectious Diseases

Date: 27 April 2014

Abstract:

Invasive aspergillosis (IA) is a severe opportunistic infection with high mortality. Publications about IA in children are limited.
Objectives: We analyzed the risk factors, aetiology, clinical signs and symptoms, results of treatment of IA in children with oncohematological diseases in St. Petersburg, Russia.
Methods: The prospective study was conducted during the period 2002-2012 y.y. Diagnosis of IA was made according to EORTC/MSG criteria, 2008.
Results: We observed 87 pediatric patients with probable and proven IA. The mean age of patients was 10 years (range 0-17), male/female ratio 1/1. Main underlying diseases in children with IA were: acute lymphoblastic leukemia – 44%, acute myeloid leukemia – 27%, aplastic anemia – 7%, chronic myeloid leukemia – 6%, oncological diseases – 6%, acute undifferentiated leukemia – 5%, Hodgkin’s lymphoma – 4%, myelodysplastic syndrome – 1%. The main sites of infection were lungs – 90%, sinuses – 10% and CNS – 8%. Two and more organs were affected in 12% of patients. The aetiology of IA: A. fumigatus – 55%, A. niger – 30%, A. flavus – 15%, and í€. terreus – 15%. All patient received antifungal therapy: voriconazole (57%), amphotericin B deoxycholate (43%), itraconazole (24%), caspofungin (17%), liposomal amphotericin B (13%), posaconazole (4%), and amphotericin B lipid complex (6%). Combination therapy was used for 20% of patients (voriconazole+caspofungin, amphotericin B+caspofungin). Duration of treatment was 2-300 days (median – 39). Surgery was used in 5% of patients. Overall survival at 12 week was 71%. In multifactory analysis positive prognostic factors of the 12th week survival were antifungal treatment with voriconazole (p=0,06) and caspofungin (p=0,02), combination antifungal therapy (p=0,03), and secondary antifungal prophylaxis (p=0,01).
Conclusion: The main underlying diseases in children with IA were – acute lymphoblastic leukemia and acute myeloid leukemia (71%). The main aetiology agent was A. fumigatus (55%). Voriconazole was the main antifungal agent (57%). Twelve week overall survival was 71%. Positive prognostic factors of the 12th week survival were: treatment with voriconazole and caspofungin, combination antifungal therapy and secondary antifungal prophylaxis.

Abstract Number: P1049

Conference Year: 2013

Link to conference website: http://registration.akm.ch/einsicht.php?XNABSTRACT_ID=162103&XNSPRACHE_ID=2&XNKONGRESS_ID=180&XNMASK

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