Diagnosis, Clinical Picture, And Treatment Of Invasive Aspergillosis In Children With Acquired Aplastic Anemia: A Retrospective Analysis Of 20 Cases.

Invasive aspergillosis (IA) is one of the main causes of death of patients with acquired aplastic anemia (AA). Twenty (10%) of 201 patients with AA, treated at Russian Pediatric Clinical Hospital in 1992-2004, developed IA. The lungs were the primary focus of involvement in 15 (75%) of these patients, in 3 patients the nasal sinuses, and in 2 soft tissues of the vestibule of the nose and oral cavity were involved. The process was disseminated in 14 patients. All patients were treated by amphotericin B, 9 (45%) received a combination of several antimycotic drugs, 10 (50%) received therapeutic transfusions of granulocytes, and 16 (80%) received granulocytic colony-stimulating factor (G-CSF). Surgical treatment was carried out in 5 (25%) patients. Complete resolution of IA was attained in 6 (30%) cases: it was attained in all patients after recovery of spontaneous granulocytopoiesis; an appreciable reduction of the primary focus was observed in 1 child. Fifteen (75%) patients died, IA being the direct cause of death in 13. Early diagnosis and aggressive treatment strategy using a complex of measures (prolonged antimycotic therapy by several drugs, G-CSF, therapeutic transfusions of granulocytes) lead to cure of AA patients from IA.