Source: Annual Congress 2006 - Pneumonia and other invasive pulmonary infections in children
Disease area: Respiratory infections

Abstract

Invasive respiratory aspergillosis (IRA) is a fulminant and highly fatal infection in patients with malignancy. This study aims to evaluate the outcome of IRA cases during febrile neutropenia (FNP) episodes. Between 2003 and 2005 there were 158 FNP episodes which were evaluated with thorax and sinus computerized tomography (CT) on their fifth febrile day. Fungal infection rate was 14%, while IRA was detected in 16 (10%) patients. Seven of these 16 IRA patients were female and twelve patients had hematological malignancies. All patients had absolute neutrophil count of zero with respiratory symptoms for 5 to 30 days (median 9 days). IRA cases were classified as definite (n:6), probable (n:3) and possible (n:7) according to European Organization for Research and Treatment of Cancer/Invasive Fungal Infections Cooperative Group and the National Institute of Allergy and Infectious Diseases Mycoses Study Group. Amphotericin B was administered initially to all cases and continued as a single agent in 7 patients. Caspofungin, voriconazole or itraconazole were added in 7, 6 and 2 patients, respectively. At present, nine patients are in complete remission, while 4 patients are in partial remission for a median of 85 days (range: 17-527 days). One of these patients underwent lobectomy due to failure of medical therapy. In conclusion, contrary to the previous reports, we suggest that IRA is a treatable disease with aggressive antifungal therapy and it is worthwhile to screen all FNP patients with thorax and sinus CT for early diagnosis of IRA.

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B. Cakir, E. Cakir, S. G. Berrak, Z. S. Uyan, B. Beker, F. Karakoc, C. Canpolat, E. Dagli (Istanbul, Turkey). Invasive respiratory aspergillosis is a treatable disease with early diagnosis and aggressive therapy. Eur Respir J 2006; 28: Suppl. 50, 1785

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