OncohematologyOncohematologyОнкогематология1818-83462413-4023Publishing House ABV Press33410.17650/1818-8346-2019-14-1-40-48INFECTION PROBLEMS IN ONCOHEMATOLOGYПРОБЛЕМЫ ИНФЕКЦИЙ В ОНКОГЕМАТОЛОГИИInvasive aspergillosis in children and adolescents with solid tumors: clinical cases and registry analysisИнвазивный аспергиллез у детей и подростков с солидными опухолями: описание клинических случаев и анализ регистра больныхhttps://orcid.org/0000-0002-2003-0982DinikinaYu. V.ДиникинаЮ. В.
Russian Federation
dinikina_yuv@almazovcentre.ruShadrivovaO. V.ШадривоваO. В.
Russian Federation
https://orcid.org/0000-0002-7471-7181BelogurovaM. B.БелогуроваМ. Б.
Russian Federation
MelekhinaYu. E.МелехинаЮ. Э.
Russian Federation
IgnatyevaS. M.ИгнатьеваС. M.
Russian Federation
BogomolovaT. S.БогомоловаT. С.
Russian Federation
BoychenkoE. G.БойченкоЭ. Г.
Russian Federation
KulevaS. A.КулеваС. A.
Russian Federation
https://orcid.org/0000-0002-1919-2909KolbinA. S.КолбинA. С.
Russian Federation
https://orcid.org/0000-0001-6095-7531KlimkoN. N.КлимкоН. Н.
Russian Federation
V.A. Almazov National Medical Research Centre, Ministry of Health of RussiaФГБУ «Национальный медицинский исследовательский центр им. В.А. Алмазова» Минздрава России, 197341 Санкт-Петербург, ул. Аккуратова, 22 Akkuratova St., Saint-Petersburg 197341ФГБОУ ВО «Санкт-Петербургский государственный педиатрический медицинский университет» Минздрава России, 194100 Санкт-Петербург, ул. Литовская, 2Saint-Petersburg State Pediatric Medical University, Ministry of Health of RussiaФГБОУ ВО «Северо-Западный государственный медицинский университет им. И.И. Мечникова» Минздрава России2 Litovskaya St., Saint-Petersburg 194100Россия, 194291 Санкт-Петербург, ул. Сантьяго-де Куба, 1/28I.I. Mechnikov North-Western State Medical University, Ministry of Health of RussiaФГБУ «Национальный медицинский исследовательский центр им. В.А. Алмазова» Минздрава России, 197341 Санкт-Петербург, ул. Аккуратова, 21/28 Sant’yago-de-Kuba St., Saint-Petersburg 194291ФГБОУ ВО «Санкт-Петербургский государственный педиатрический медицинский университет» Минздрава России, 194100 Санкт-Петербург, ул. Литовская, 2V.A. Almazov National Medical Research Centre, Ministry of Health of RussiaФГБОУ ВО «Северо-Западный государственный медицинский университет им. И.И. Мечникова» Минздрава России2 Akkuratova St., Saint-Petersburg 197341Россия, 194291 Санкт-Петербург, ул. Сантьяго-де Куба, 1/28I.I. Mechnikov North-Western State Medical University, Ministry of Health of RussiaФГБОУ ВО «Северо-Западный государственный медицинский университет им. И.И. Мечникова» Минздрава России1/28 Sant’yago-de-Kuba St., Saint-Petersburg 194291Россия, 194291 Санкт-Петербург, ул. Сантьяго-де Куба, 1/28I.I. Mechnikov North-Western State Medical University, Ministry of Health of RussiaСПб ГБУЗ «Детская городская больница № 1»1/28 Sant’yago-de-Kuba St., Saint-Petersburg 194291Россия, 198205 Санкт-Петербург, ул. Авангардная, 14I.I. Mechnikov North-Western State Medical University, Ministry of Health of RussiaФГБУ «Национальный медицинский исследовательский центр онкологии им. Н.Н. Петрова» Минздрава России1/28 Sant’yago-de-Kuba St., Saint-Petersburg 194291Россия, 194356 Санкт-Петербург, Выборгское шоссе, 40Municipal Children Hospital № 1СПб ГБУЗ «Детская городская больница № 1»14 Avangardnaya St., Saint-Petersburg 198205Россия, 198205 Санкт-Петербург, ул. Авангардная, 14N.N. Petrov National Medical Research Center of Oncology, Ministry of Health of RussiaФГБОУ ВО «Северо-Западный государственный медицинский университет им. И.И. Мечникова» Минздрава России40 Vyborgskoe Shosse, Saint-Petersburg 194356Россия, 194291 Санкт-Петербург, ул. Сантьяго-де Куба, 1/28Municipal Children Hospital № 114 Avangardnaya St., Saint-Petersburg 198205I.I. Mechnikov North-Western State Medical University, Ministry of Health of Russia1/28 Sant’yago-de-Kuba St., Saint-Petersburg 1942911004201914140481004201910042019https://oncohematology.abvpress.ru/ongm/article/view/334

We presented two cases of invasive aspergillosis (IA) in children with solid tumors, data of IA patients register, and a literature review. In the register of patients with IA (1997–2018), we found 57 patients with IA from 0 to 18 years. It was established that the number of patients with solid tumors was 15.7 %. Background diseases were: central nervous system tumors – 33.5 %, neuroblastoma – 33.5 %, osteosarcoma – 11.0 %, Wilms tumor – 11.0 %, hemangioblastoma – 11.0 %. Chemotherapy-induced neutropenia was reported in 100 % of IA cases in children and adolescents with solid tumors. The additional risk factors were treatment in intensive care unit – 22.2 %, high-dose chemotherapy with autologous hematopoietic stem cell transplantation – 22.2 %, concomitant bacterial infection – 33.0 %. Surgical intervention for the underlying disease was performed in 77.7 % of patients. The most common clinical site of IA was the lungs – 88.9 %. The predominant clinical sign was fever – 66.7 %, cough and respiratory failure were seen less frequently – 33.4 % and 33.4 %, respectively. The etiological agents of IA were Aspergillus fumigatus – 33.3 %, Aspergillus nidulans – 33.3 % and Aspergillus ustus – 33.3 %. 88.9 % of patients received antimycotic therapy, voriconazole predominantly – 66.7 %. Combination therapy was used in 33.3 % of patients. The overall 12-week survival in children and adolescents with IA in case of solid tumors was 77.8 %.

Представлены 2 случая инвазивного аспергиллеза (ИА) у детей c солидными опухолями, анализ регистра больных ИА и обзор научной литературы. При анализе регистра больных ИА (1997–2018 гг., 57 больных в возрасте 0–18 лет) установлено, что доля пациентов с солидными опухолями составила 15,7 %. Из них опухоли центральной нервной системы – 33,5 %, нейробластома – 33,5 %, остеосаркома – 11,0 %, опухоль Вилмса – 11,0 % и гемангиобластома – 11,0 %. У 100 % детей и подростков с солидными опухолями ИА развился на фоне постцитостатического агранулоцитоза. Другие факторы риска – сопутствующая бактериальная инфекция (33,0 %), проведение высокодозной химиотерапии с аутологичной трансплантацией гемопоэтических стволовых клеток (22,2 %), а также пребывание в отделении реанимации и интенсивной терапии (22,2 %). Хирургическое вмешательство по поводу основного заболевания выполнили 77,7 % больных. Основной локализацией ИА были легкие (88,9 %), преобладающим клиническим симптомом – лихорадка (66,7 %), реже – кашель (33,4 %) и дыхательная недостаточность (33,4 %). Возбудители ИА: Aspergillus fumigatus (33,3 %), Aspergillus nidulans (33,3 %) и Aspergillus ustus (33,3 %). Антимикотическую терапию получили 88,9 % больных, преимущественно вориконазол – 66,7 %, комбинированную антимикотическую терапию – 33,3 %. Общая 12-недельная выживаемость детей и подростков с ИА на фоне солидных опухолей составила 77,8 %.

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