儿童白血病化疗后合并全身性真菌感染诊断及治疗体会

目的积累和交流白血病化疗病人合并深部真菌感染时临床经验。方法总结2年中明确诊断深部霉菌感染病人的诊断过程、方法、临床特征、治疗反应和转归。结果确诊深部真菌感染者共5例,均为白血病患儿,感染前或感染中白血病达完全缓解,特征性表现为发热,抗菌素治疗>5天无效,轻中度压痛的多发性硬性皮下小结(2/5例)和肝脾肾散布性低密度病灶(3/5例),需四周以上二性霉素治疗,有明显但可以处理的毒性反应。结论发热、抗菌素治疗无效、硬性皮下小结和肝脾肾散布性低密度病灶时应考虑深部真菌感染,并给予4周以上二性霉素治疗。

Diagnosis and treatment of fungal infection for children with leukemia and chemotherapy

Objective Accumulate and exchange the experience of disseminated fungal infection in children with leukemia and chemotherapy. Method Analyze the process of diagnosis,clinic characters,respones to treatment and prognosis of fungal infection. Result All the 5 disseminated fungal were leukemias who were in complete leukemia remission before or during fungal infection period.Clinic characters included antibiotics uncontrollable fever,subcutaneous solid nodules,spreading low density lesions in hepatosplenic and kidney.More than four weeks amphotericin B were needed.The side effects of amphotericin B is apparent but manageable.Conclusion Antibiotics uncontrollable fever,subcutaneous solid nodules,spread low density lesions in hepatosplenic and kidney are strongly indicate disseminated fungal infection.It needs more than 4 weeks amphotericin B therapy.