Invasive pulmonary aspergillosis in children: clinical analysis of nine patients

Abstract

Objective To investigate the diagnosis and treatment of invasive pulmonary aspergillosis (IPA) in children. Methods From January 2004 to July 2016, nine children with proven IPA or possible IPA in West China Second University Hospital, Sichuan University were included into this study. The risk factors, clinical manifestations, chest radiographic findings, microbiological and pathological evidence, treatment and prognosis were retrospectively reviewed in nine patients. Results Among nine patients (four boys, five girls), four cases were proven IPA, and five cases were possible IPA.The risk factors were found in seven cases. Pulmonary tuberculosis coexisted in three cases. Cough, fever, moist rales were the most common manifestations, and only two cases had hemoptysis. The most common chest imaging was nodules and patchy shadow. Halo sign was found in three cases, and air crescent sign was not found. Blood culture was negative in all nine patients. The positive children of sputum and bronchoalveolar lavage fluid (BALF) culture were two cases and four cases, respectively. Lung biopsy was conducted in three cases. Eight cases were treated with anti-fungal therapy (voriconazole, itraconazole, micafungin used alone), and only one case was treated with combination therapy (voriconazole and liposomal amphotericin B). Seven cases recovered, and two cases are still receiving treatment. Conclusions The clinical manifestations and chest imaging of IPA are nonspecific. Repeated sputum and BALF culture are essential to clinical diagnosis of IPA. The patients in whom the antifungal therapy are initiated early have a good outcome. Key words: Invasive pulmonary aspergillosis; Diagnosis; Treatment; Child