Clinical Analysis Of Invasive Fungal Infections In Children With Acute Lymphoblastic Leukaemia

Objective To analyze the clinical features and high risk factors of invasive fungal infection(IFI) in children with acute lymphoblastic leukaemia(ALL) who had received CCLG-2008 chemotherapy in our hospital, and to guide our clinical practice.Methods The medical records of 454 cases of children with ALL, who were received chemotherapy in our hospital between January 2008 and December 2014, were reviewed. One hundred and twenty-first IFI were detected in 105 patients, of which 10 episodes were proven, 31 probable, and 81 possible IFI. And analyze the risk factors, clinical features, pathogen, treatment and prognosis of the IFI.Results 1.The incidence of IFI in the childhood ALL was 19.3%. The incidence rate of IFI was obviously higher in the high-risk(HR) childhood(28.7%) compared to standard-risk(SR) childhood(15.5%). The IFI episodes occurred mainly in the induction phase(57.3%) of the SR and intermediate-risk(IR) childhood, however in the HR childhood IFI episodes occurred mainly at the consolidation phase(50.0%). 2.The primary IFI location was lower respiratory tract. The representation of chest CT was multiform and subtypical. The rate of profound neutropenia was 81.0%, and prolonged neutropenia was 52.9% of the IFI episodes. The positive rate of fungal G test was 36.5%, and the positive rate of fungal GM test was 18.3%. 3. 0ne(10%) Aspergillus were isolated, nine(90%) Candida was isolated, and albicans Candida(n=5, 55.6%) predominated in our study. 4. The total cure rate was 86.8%, crude mortality was 17/105(16.2%), with IFIs being the direct cause of death in twelve patients(11.4%). Age(less than 1 year, greater than or equal to 10 year), HR, CRP greater than 82 mg/L, and digestive tract infection were found to be major risk factors for IFI mortality.Conclusions IFI is a major cause of morbidity and mortality in pediatric ALL. Prolonged neutropenia, profound neutropenia, HR and to be in the induction and consolidation(HR) phase of chemotherapy were found to be major risk factors for IFI. The primary IFI location was lower respiratory tract. The primary pathogen is albicans Candida. The total cure rate of IFI was 86.8%, crude and attributable mortality was 16.2% and 11.4% respectively. Improved prevention, early detection, and advanced treatment strategies are the key to improve curative effect. To age(less than 1 year, greater than or equal to 10 year), HR, CRP greater than 82 mg/L, and digestive tract infection patient of IFI advanced treatment strategies are needed to improved the outcome.