Pediatric Hematology/Oncology and ImmunopathologyPediatric Hematology/Oncology and ImmunopathologyВопросы гематологии/онкологии и иммунопатологии в педиатрии1726-17082414-9314Fund Doctors, Innovations, Science for Children26510.24287/1726-1708-2019-18-3-88-95CLINICAL OBSERVATIONSКЛИНИЧЕСКИЕ НАБЛЮДЕНИЯInvasive aspergillosis in children in debut of acute myeloid leukemiaИнвазивный аспергиллез у детей в дебюте острого миелобластного лейкозаhttps://orcid.org/0000-0002-2003-0982DinikinaY. V.ДиникинаЮ. В.
Russian Federation

Yulia V. Dinikina, MD, PhD, Head of the Department of pediiatric oncohematology and SCT Almazov National Medical Research Centre, St. Petersburg

197341, St. Petersburg, Аkkuratova st., 2

Диникина Юлия Валерьевна, кандидат медицинских наук, заведующая отделением химиотерапии онкогематологических заболеваний и ТКМ для детей НМИЦ им. В.А. Алмазова Минздрава России

197341, Санкт-Петербург, ул. Аккуратова, 2

dinikina_yuv@almazovcentre.ruShadrivovaO. V.ШадривоваО. В.
Russian Federation

Saint-Petersburg

Санкт-Петербург

https://orcid.org/0000-0002-7471-7181BelogurovaM. B.БелогуроваМ. Б.
Russian Federation

Saint-Petersburg

Санкт-Петербург

DokhinaN. N.ДохинаН. Н.
Russian Federation

Saint-Petersburg

Санкт-Петербург

KhostelidiS. N.ХостелидиС. Н.
Russian Federation

Saint-Petersburg

Санкт-Петербург

https://orcid.org/0000-0002-0306-3694IgnatyevaS. M.ИгнатьеваС. М.
Russian Federation

Saint-Petersburg

Санкт-Петербург

https://orcid.org/0000-0002-2450-687XBogomolovaT. S.БогомоловаТ. С.
Russian Federation

Saint-Petersburg

Санкт-Петербург

https://orcid.org/0000-0001-6095-7531KlimkoN. N.КлимкоН. Н.
Russian Federation

Saint-Petersburg

Санкт-Петербург

Almazov National Medical Research Centre of the Ministry of Healthcare of the Russian FederationФГБУ «Национальный медицинский исследовательский центр им. В.А. Алмазова» Минздрава РоссииSt. Petersburg State Pediatric Medical University, Ministry of Health of RussiaФГБОУ ВПО «Санкт-Петербургский государственный педиатрический медицинский университет», Минздрава РоссииNorth-Western State Medical University named after I.I. MechnikovФГБУ ВО «Северо-Западный государственный медицинский университет им. И.И. Мечникова»1309201918388951309201913092019Copyright ©; 2019, «D. Rogachev NMRCPHOI»Copyright ©; 2019, ФГБУ «НМИЦ ДГОИ им. Дмитрия Рогачева» Минздрава России2019«D. Rogachev NMRCPHOI»ФГБУ «НМИЦ ДГОИ им. Дмитрия Рогачева» Минздрава Россииhttps://creativecommons.org/licenses/by/4.0https://hemoncim.com/jour/article/view/265

Invasive aspergillosis (IA) is a life-threatening complication in pediatric patients with hematological malignancies. The highest incidence rates of IA were found in pediatric patients with acute myeloid leukemia (AML). We presented a case of successful treatment of IA in a patient with debut of AML with Down syndrome, analysis of IA cases in children with AML according data of the register and a literature review. 46 pediatric patients with IA were included, among them 16 (34.7%) with AML. In 3 (18.75%) pts AML was diagnosed in presentation of AML. Risk factors of IA were prolonged neutropenia (100%) and lymphocytopenia (81%). The most common clinical signs were: fever > 38.5 ºС (93.7%), cough (75%) and respiratory failure (43.7%). The lung involvement was diagnosed in 93.7% of pts, more than 2 sites of IA – in 12.5%, endophthalmitis – in 6.25%. Typical imaging finding was «halo sign» – 37.5%. According received results «probable IA» was diagnosed in 87.5% of pts and «proven» in 12.5%. Antifungal treatment received 100% of patients, with voriconazole only – 50%, combined antifungal therapy – 33.3%. Overall 12-week survival was 87.5%. Parents patients agreed to use personal data in research and publications.

Инвазивный аспергиллез (ИА) – угрожающее жизни осложнение у детей с онкогематологическими заболеваниями. Риск развития ИА наиболее высок у больных с острым миелоидным лейкозом (ОМЛ). В статье представлен случай успешного лечения ИА в дебюте ОМЛ у пациента с синдромом Дауна, а также анализ ИА у детей с ОМЛ по данным регистра и обзор литературы. Общее число пациентов – 46, из них с ОМЛ – 16 (34,7%); ИА диагностировали в дебюте ОМЛ у 3 (18,75%) пациентов. Факторами риска развития ИА были длительный агранулоцитоз (100%) и лимфоцитопения (81%). Основные клинические проявления: повышение температуры тела выше 38,5 ºС (93,7%), кашель (75%) и дыхательная недостаточность (43,7%). Поражение легких отмечено у 93,7% больных; более двух очагов поражения – у 12,5%; эндофтальмит – у 6,25%. На основании результатов обследования «вероятный» ИА был диагностирован у 87,5%, «доказанный» – у 12,5% больных. Антимикотическую терапию получили 100% пациентов, монотерапию вориконазолом – 50%, комбинацию антимикотиков – 33,3%. Общая 12-недельная выживаемость составила 87,5%. Родители дали согласие на использование информации в научных исследованиях и публикациях.

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