Although the outcomes of childhood leukemia and severe aplastic anemia (SAA) have improved, infectious complications are still the major concern. Particularly worrisome are invasive fungal diseases (IFDs), one of the most common causes of infectious-related deaths in patients with prolonged neutropenia. A retrospective study was conducted of IFDs in pediatric patients with newly diagnosed or relapsed acute leukemia, or with SAA, at Siriraj Hospital, Mahidol University, Thailand. There were 241 patients: 150 with acute lymphoblastic leukemia (ALL), 35 with acute myeloid leukemia (AML), 31 with relapsed leukemia, and 25 with SAA. Their median age was 5.4 years (range, 0.3-16.0 years). The overall IFD prevalence was 10.7%, with a breakdown in the ALL, AML, relapsed leukemia, and SAA patients of 8%, 11.4%, 19.3%, and 16%, respectively. Pulmonary IFD caused by invasive aspergillosis was the most common, accounting for 38.5% of all infection sites. Candidemia was present in 34.6% of the IFD patients; Candida tropicalis was the most common organism. The overall case-fatality rate was 38.5%, with the highest rate found in relapsed leukemia (75%). The incidences of IFDs in patients with relapsed leukemia and SAA who received fungal prophylaxis were significantly lower than in those who did not (P = N/A and 0.04, respectively). IFDs in Thai children with hematological diseases appeared to be prevalent, with a high fatality rate. The usage of antifungal prophylaxes should be considered for patients with SAA to prevent IFDs.

中文翻译：

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急性白血病和严重再生障碍性贫血儿童的侵袭性真菌病。

尽管儿童白血病和严重再生障碍性贫血 (SAA) 的结局有所改善，但感染性并发症仍然是主要问题。特别令人担忧的是侵袭性真菌病 (IFD)，这是导致中性粒细胞长期减少症患者感染相关死亡的最常见原因之一。在泰国玛希隆大学 Siriraj 医院对患有新诊断或复发急性白血病或患有 SAA 的儿科患者进行了 IFD 的回顾性研究。共有241名患者：150名急性淋巴细胞白血病（ALL），35名急性髓性白血病（AML），31名复发性白血病和25名SAA。他们的中位年龄为 5.4 岁（范围为 0.3-16.0 岁）。总体 IFD 患病率为 10.7%，其中 ALL、AML、复发性白血病和 SAA 患者的分解率分别为 8%、11.4%、19.3% 和 16%。侵袭性曲霉病引起的肺 IFD 最为常见，占所有感染部位的 38.5%。34.6% 的 IFD 患者存在念珠菌血症；热带念珠菌是最常见的生物。总病死率为 38.5%，复发率最高（75%）。接受真菌预防的复发性白血病和 SAA 患者的 IFD 发生率显着低于未接受真菌预防的患者（分别为P = N/A 和 0.04）。患有血液病的泰国儿童的 IFD 似乎很普遍，死亡率很高。对于 SAA 患者，应考虑使用抗真菌预防剂以预防 IFD。