| Objective To investigate the diagnosis and treatment of pulmonary aspergillosis(PA) in children.Method The clinical data of 18 cases of proven or probable PA who had been in the Pediatric Department of the First Affiliated Hospital of Guangxi Medical University from January 2003 to June 2014 were retrospectively analyzed.Result (1)1 child was proven PA and 17 children were probable PA.16 children were classified as acute invasive pulmonary aspergillosis(AIPA), who had been further divided into the neutropenia group(9 cases) and non-neutropenia group(7 cases). The rest 2 children were classified as chronic necrotizing pulmonary aspersillosis(CNPA). (2)Host risk factors of AIPA:long duration use of multiple broad-spectrum antibiotics in 16 cases, neutropenia in 9 cases, invasive mechanical ventilation in 3 cases, primary immunodeficiency disease in 2 cases, long duration use of glucocorticoids in 2 cases, measles in 2 cases, congenital pulmonary hypoplasia in 1 case. Host risk factors of CNPA: Both of the children had underlying disease of pulmonary tuberculosis and history of long duration use of multiple broad-spectrum antibiotics. (3)Fever, cough and expectoration were present in all the children with AIPA, in which 5 children didn’t improve and 11 children recurred when having received long duration use of antibiotics. There were no significant difference in the symptoms or signs between the neutropenia group and non-neutropenia group(P>0.05). Both of the children with CNPA had hemoptysis. (4)At the onset of diagnosis of AIPA, patchy high density shadow was seen in 12 children(75%), which was the most common sign on chest CT. As follows, nodules or masses like consolidation was seen in 9 children (56.3%), subpleural wedge-shaped consolidation shadow was seen in 8 children (50.0%), the halo sign was seen in 5 children (31.3%), pleural adhesions was seen in 4 children (25.0%), pleural effusion was seen in 3 children (18.8%), cavities were seen in 2 children (12.5%), however the "air-crescent sign" was none in any children. The halo sign and subpleural wedge consolidation shadows were more common in neutropenia group than that in non-neutropenia group(P<0.05).15 days to 1 month later when the children had been treated with anti-aspergillosis drugs, the most common signs were nodules or masses like consolidation, subpleural wedge-shaped consolidation shadow and cavity, each of which were seen in 5 cases (55.6%), following by pleural adhesion which was seen in 4 cases (44.4%), patchy high density shadow, the halo sign and "air-crescent sign", each of which was seen in 3 cases (33.3%). Finally, pleural effusion could be seen in 1 case (11.1%). Cavities with high density shadow inside and patchy high density shadow around, the "air-crescent sign" could be seen in both of the children with CNPA and were more common in the upper lobes. (5)The positive rate of serum GM test was higher than that of sputum culture and serum G test in the children with AIPA(P<0.05). There was no significant difference in the positive rate of sputum culture, serum G test and GM test between the neutropenia group and non-neutropenia group(P>0.05). (6) 4 children with AIPA had received lung biopsy, among which 1 child was diagnosed as the proven case and presented with fungal granulomatous inflammation, tissue fibrosis and aspergillus hyphae in PAS staining. (7)Among the 16 children with AIPA,14 children had received treatment with anti-aspergillosis drugs only, in which 13 children received voriconazole and 1 children received amphotericin B,2 children not only received treatment with anti-aspergillosis drugs but also surgery. In the 13 children having treated with voriconazole,7 children were effective,3 children were ineffective, and 3 children gave up treatment. Also, the child having treated with amphotericin B was effective. Both of the children having treated in combination with anti-aspergillosis drugs and surgery were effective. Both of the children with CNPA were effective after having received treatment with oral itraconazole.Conclusion (1)The rate of diagnosing proven PA in children was low. AIPA accounted for the most cases of PA in children and CNPA accounted for a small part of PA in children. (2)Long duration use of multiple broad-spectrum antibiotics and neutropenia were the common host risk factors in children with AIPA. (3) Subpleural wedge consolidation shadows, the halo sign and the "air-crescent" sign highly demonstrated the diagnosis of AIPA in children. Subpleural wedge consolidation shadows and the halo sign were more common in neutropenia group than that in non-neuropenia group. The "air-crescent" sign appeared during the late course of the disease and with low positive rate. (4) Serum GM test played an important role in the diagnosis of AIPA in children. (5)The majority of the children with AIPA can be cured when treated with voriconazole. |
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