Evaluation of Diagnostic Tools for Invasive Aspergillosis in Children with Cancer

Polyzo Kazila, Eleni Kaitsa, Joanna Trelinska, Malgorzata Stolarska, Beata Zalewska-Szewczyk, Wojciech Mlynarski.

Author address: 

Oncohaematology Unit, Department of Pediatrics, Medical University of Lodz, Poland

Abstract: 

Introduction: Fungal infections are one of the most serious complications of anti-cancer treatment. The highest mortality rate is blamed on invasive aspergillosis (IA). Clinical symptoms of Aspergillus infection are usually unspecific and its diagnostic procedure still causes large problems. The aim of the study was an analysis of the IA in terms of clinical symptoms, required diagnostic tools and the application of treatment and prognosis. Materials: The retrospective analysis of clinical records from our Oncoahematology Unit between 2005-2007 revealed that among 28 pediatric neutropenic patients with symptoms of sepsis five children had IA The records of these patients were analyzed to define the most useful method which gave the most reliable diagnosis of IA. Among diagnostic methods computer tomography (CTG) or magnetic resonance where considered, as well as galactomannan antigen and fungal DNA by PCR method were assessed on serial blood samples. Results: The most common clinical form of IA was pulmonary aspergillosis (3 of 5 cases), one had CNS involvement and one liver localization. Three patients needed to be treated in ICU, and two of them died. Treatment regimen consists of 2 antifungal drugs: voriconazol with amphotericin B or voriconazol with caspofungin. Based on symptoms-to-treatment time in our cases the most reliable method was computed tomography or magnetic resonance imaging. Fungal DNA had only supportive role in diagnosis (2 of 5 were positive) and galactomannan antigen assessment had less useful test for diagnosis of IA because of many false positive results. However, serial measurement of galactomannan antigen seems to be a very good marker of the treatment efficacy. Conclusions: The application of all diagnostic tools is needed for proper assessment of invasive aspegillosis. Some of these methods may additionally serve for evaluation of treatment strategies.
2008

abstract No: 

S71

Full conference title: 

15th International Symposium on Infections in the Immunocompromised Host
    • ISIIH 15th