Objective: Invasive aspergillosis (IA) is an opportunistic infection caused by species of the genus Aspergillus, mainly Aspergillus fumigatus. The major risk factor predisposing to this infection is neutropenia induced by strong immunosuppresive therapeutic regimes like chemotherapeutic drugs commonly used to treat hematologic neoplasia. Current established protocols to diagnose IA include tomography and galactomannan detection in serum. Our objective is to describe the case of two child, who suffered from invasive aspergillosis as well as the methods used in diagnosis. Methods: Patient 1: The patient was affected with pre-B acute lymphoblastic leukemia. She started treatment with prednisone. Subsequently, she received vincristine, daunorubicin and cyclophosphamide following protocol PETHEMA LAL-96. 18 days later, she had fever that was treated with meropenem and teicoplanine. In 4 days, she developed tachypnea. Patient 2: Patient was affected with acute myeloid leukemia. He developed high fever 3 days later after chemotherapy treatment (cytarabine and clofarabine). He received empiric treatment with cefepyme and amikacina and profilaxis with fluconazol. In the physical exploration, there was edema in left part of the face. In both patients, serum samples are sent to our laboratory to investigate galactomannan detection. Results: Serum samples were positive in two patients using Platelia Aspergillus by ELISA (BioRad). Patient 1: Five of the nine follow-up serum samples were again positive (range 0.515.9). After the galactomanann positivity, computed tomography (CT) was made. It showed multiple small inflammatory masses. Voriconazole and caspofugin were given as treatment. She recovered satisfactorily and, at present, she remains asymptomatic and follows the treatment guidelines. Patient 2: Eight serum samples were positive (range: 0.912.1). Voriconazole was given as treatment but it was changed to caspofugin and Amphotericin B due persistent fever. Three days later, the CT showed inflammation in ethmoid and frontal sinuses, being the left maxillar sinus specially affected. He recovered satisfactorily to follow the treatment guidelines. Conclusions: Detection of Aspergillus galactomannan is an early marker of invasive aspergillosis. In our cases, the positivity of galactomannan were previous to the radiological images. It may be interesting a follow-up in the immunocompromised children with malignant diseases as its been stablished in our hospital in the adult poblation.
Full conference title:
Trends in Medical Mycology, 5th
- TIMM 5th (2013)