Инвазивный аспергиллез у детей в дебюте острого миелобластного лейкоза

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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