儿童急性白血病合并中枢神经系统真菌感染5例并文献复习

目的通过5例儿童急性白血病合并中枢神经系统(CNS)真菌感染的临床总结及相关文献复习,提高对本病的认识。方法回顾性分析北京儿童医院收治的5例急性白血病合并CNS真菌感染患儿的临床特点及诊治经过并文献复习。结果(1)4例急性淋巴细胞白血病(ALL)患儿均接受强化疗,1例为急性非淋巴细胞白血病(AML-M2)半相合造血干细胞移植术后,发生CNS真菌感染前均有肺部真菌感染病史,其中2例合并肝、脾、肾真菌感染,1例合并下肢皮肤真菌感染(2)实验室检查3例有病原学依据,1例烟曲霉菌,2例念珠菌,2例无病原学依据。(3)影像学5例患儿均作头颅CTMRI,表现脓肿、梗塞、颅内出血。(4)治疗及预后1例患儿伊曲康唑+脂溶性两性霉素B治疗,2例患儿伏立康唑治疗,2例患儿伏立康唑和两性霉素B联合抗真菌治疗,抗真菌治疗均有效,4例存活,1例死于严重移植物抗宿主病(GVHD)。结论儿童急性白血病合并CNS真菌感染为侵袭性真菌感染的表现形式之一,多半有其他脏器感染,临床表现不典型,可有脑膜炎或脑脓肿症状和体征,诊断困难,CT、MRI影像学检查重要,伏立康唑、两性霉素B抗真菌治疗有效。

5 cases of children acute leukemia complicated with central nervous system fungal infection and the review of literature

Objective To improve the comprehension about children acute leukemia complicated with central nervous system fungal infection through a clinical summary on 5 cases of this disease and the review of related literature.Methods The clinical data and treatment of 5 cases of acute leukemia complicated with central nervous system fungal infection treated in Beijing children's hospital were analyzed retrospectively.Results(1) 4 acute lymphoblastic leukemia(ALL) were treated with aggressive chemotherapy and one acute nonlymphocytic leukemia(AML-M2) was treated with hematopoietic stem cell transplantation.Before they suffered from CNS fungal infection,all had pulmonary fungal infection,two of whom were complicated with fungal infection in liver,spleen,kidney,and one in lower limb skin.(2) Laboratory examination: The results of microbiology check were that one patient was proved aspergillosis infection,two candida infection and there were no significant etiology basis on two patients.(3)Cranial CT and MRI were done in all patients.it showed abscess,infarction and intracranial hemorrhage.(4)One children was treated with itraconazole and liposomal-amphotericin two of them were treated with voriconazole and the other two with combined treatment of voriconazole and amphotericin.All pations were treated effectively.Four children were all survival,one died of serious GVHD.Conclusion Children acute leukemia complicated with CNS fungal infection was one manifestation of invasive fungal infection,most likely accompanied by infections in other organize.The clinical manifestation was atypical that patients could have symptoms and signs of meningitis or brain abscess.It is hard to diagnose.The imaging examination of CT and MRI may be very important. Antifungal therapy with voriconazole and amphotericin had certain curative effect.