Aspergillosis in immunocompromised children acute myeloid leukemia and bone marrow aplasia.: Report of two cases

Aquino, Maria Zilda de; Brasaciner, Alberto; Cristófani, Lilian Maria; Maluf, Paulo Taufic; Odone Filho, Vicente; Marques, Heloisa Helena de Souza; Heins-Vaccari, Elisabeth Maria; Lacaz, Carlos da Silva; Melo, Natalina Takahashi de

doi:10.1590/S0036-46651994000500012

Abstracts

Two cases of Aspergillosis in immunocompromised children are reported. Both were caused by Aspergillns flavus. Early diagnosis and treatment led to the remission of the process. One patient had acute myeloid leukemia; the fungus was isolated from the blood. The other patient with bone marrow aplasia, presented an invasive aspergillosis of the paranasal sinuses with dissemination of fungal infection; the diagnosis was obtained by histology and culture of biopsied tissue from a palatal ulceration.

Aspergillosis; Aspergillus flavus; Leukemia; Bone marrow aplasia

No presente trabalho são registrados dois casos de aspergilose em crianças imunocomprometidas. O estudo micológico completo identificou Aspergillus flavus como agente dos dois processos. A presença cada vez mais frequente da aspergilose invasiva deve-se ao número crescente de pacientes imunocomprometidos, muitos com hemopatias graves submetidos à quimioterapia. O diagnóstico precoce em um dos casos possibilitou remissão do processo. Tratava-se de paciente com leucemia mielóide aguda, tendo sido isolado o fungo do sangue circulante. O segundo caso evoluiu para óbito, com infecção fúngica generalizada.

CASE REPORT

Aspergillosis in immunocompromised children acute myeloid leukemia and bone marrow aplasia. Report of two cases

Aspergilose em crianças imunocomprometidas com leucemia mielóide aguda e aplasta de medula óssea. Registro de 2 casos

Maria Zilda de Aquino^I; Alberto Brasaciner^I; Lilian Maria Cristófani^I; Paulo Taufic Maluf^I; Vicente Odone Filho^I; Heloisa Helena de Souza Marques^I; Elisabeth Maria Heins-Vaccari^II; Carlos da Silva Lacaz^II; Natalina Takahashi de Melo^II

^ICentro de Onco-Hematologia do Instituto da Criança do Hospital das Clínicas de São Paulo, São Paulo, S.P., Brasil

^IILaboratórios de Micologia Médica do Instituto de Medicina Tropical de São Paulo e do LIM-53 HC-FMUSP, São Paulo, S.P., Brasil

^{Correspondence to} Correspondence to: Prof. Carlos da Silva Lacaz Instituto de Med. Trop. São Paulo Av. Dr. Enéas de Carvalho Aguiar 470 05403-000 São Paulo, SP, Brasil

SUMMARY

Two cases of Aspergillosis in immunocompromised children are reported. Both were caused by Aspergillns flavus. Early diagnosis and treatment led to the remission of the process. One patient had acute myeloid leukemia; the fungus was isolated from the blood. The other patient with bone marrow aplasia, presented an invasive aspergillosis of the paranasal sinuses with dissemination of fungal infection; the diagnosis was obtained by histology and culture of biopsied tissue from a palatal ulceration.

Keywords: Aspergillosis; Aspergillus flavus; Leukemia; Bone marrow aplasia.

RESUMO

No presente trabalho são registrados dois casos de aspergilose em crianças imunocomprometidas. O estudo micológico completo identificou Aspergillus flavus como agente dos dois processos. A presença cada vez mais frequente da aspergilose invasiva deve-se ao número crescente de pacientes imunocomprometidos, muitos com hemopatias graves submetidos à quimioterapia. O diagnóstico precoce em um dos casos possibilitou remissão do processo.

Tratava-se de paciente com leucemia mielóide aguda, tendo sido isolado o fungo do sangue circulante. O segundo caso evoluiu para óbito, com infecção fúngica generalizada.

Full text available only in PDF format.

Texto completo disponível apenas em PDF.

ACKNOWLEDGEMENTS

Creusa Paes Siqueira for typing the manuscript.

Recebido para publicação em 10/02/1994.

Aceito para publicação em 04/07/1994.

1. AXELSSON, H.; CARLSÖÖ, B.; WEIBRING, J. & WINBLAD, B. - Aspergillosis of the maxillary sinus. Acta Otolaryngol., 86: 303-308, 1978.
2. BODEY, G.; BUELTMANN, B.; DUGUID, W. et al. - Fungal infection in cancer patients: an international autopsy survey. Europ. J. clin. Microbiol. infect. Dis., 11: 99-109, 1992.
3. BODEY, G.P. - Infections in cancer patients. II. Fungal infections. Rev. bras. Pesq. méd. biol., 7: 567-572, 1974.
4. GEISSMAN, F.; HENNEQUIN, C.; MAAREK, H. & VIARD, J.P. - Sinusite ŕ Aspergillus fumigatus au cours du SIDA. Presse méd., 22: 1792, 1993.
5. HORA, J.F. - Primary aspergillosis of the paranasal sinuses and associated areas. Laryngoscope (St. Louis), 75: 768-773, 1965.
6. KEMPER, C.; HOSTETLER, J.S.; FOLLANSBEE, S.E. et al. - Ulcerative and plake-like tracheobronchitis due to infection with Aspergillus in patient with Aids. Clin. infect. Dis., 17: 344-352, 1993.
7. KWON-CHUNG, K.L. & BENNETT, J.E. - Medical mycology. Philadelphia, Lea & Febiger, 1992.
8. LACAZ, C. da S.; AZEVEDO, M.L. de; VARGAS, A.A.; PORTO, E. & SALEBIAN, A. - Aspergilose orbitária por Aspergillus flavus. Rev. paul. Med., 91: 64-67, 1978.
9. LOEUILLE, G.A.; BERTHOU, C.; HILMARSDOTTIR, I. et al. - Aspergilloses traitées par l'itraconazole: analyse de 64 cas. Revue de la littérature. J. Mycol. méd., 3: 1-13, 1993.
10. LOWE, J. & BRADLEY, J. - Cerebral and orbital Aspergillus infection due to invasive aspergillosis of ethmoid sinus. J. clin. Path., 39: 774-778, 1986.
11. MARTINSON, F.D.; ALLI, A.F. & CLARK, B.M. - Aspergilloma of the ethmoid. J. Laryngol. Otol., 84: 857-861, 1970.
12. McGILL, T.J.; SIMPSON, G. & HEALY, G.B. - Fulminant aspergillosis of the nose and paranasal sinuses: a new clinical entity. Laryngoscope (St. Louis), 90: 748-754, 1980.
13. McWHINNEY, P.H.M.; KIBBLER, C.C.; HAMON, M.D. et al. - Progress in the diagnosis and management of Aspergillosis in bone marrow transplantation: 13 years' experience. Clin. infect. Dis., 17: 397-404, 1993.
14. MILOSEV, B.; MAHGOUB, E.S.; ABDEL AAL, O. & EL HASSAN, A.M. - Primary aspergilloma of paranasal sinuses in the Sudan. Brit. J. Surg., 56: 132-137, 1969.
15. MILROY, C.M.; BLANSHARD, J.D.; LUCAS, S. & MICHAELS, L. - Aspergillosis of the nose and paranasal sinuses. J. clin. Path., 42: 123-127, 1989.
16. MUSIAL, C.E.; COCKERILL III, F.R. & ROBERTS, G.D. - Fungal infections of the immunocompromised host: clinical and laboratory aspects. Clin. Microbiol. Rev., 1: 349-364, 1988.
17. RIPPON, J.W. - Medical mycology. The pathogenic fungi and the pathogenic actinomycetes. 2. ed., Philadelphia, W.B. Saunders, 1988.
18. SAAH, D.; DRAKOS, P.E.; ELIDAN, J. et al. - Rhinocerebral aspergillosis in patients undergoing bone marrow transplantation. Ann. Otol. Rhinol. Laryngol., 103: 306-310, 1994.
19. SWERDLOW, B. & DERESINSKI, S. - Development of Aspergillus sinusitis in a patient receiving amphotericin B. Treatment with granulocyte transfusions. Amer. J. Med., 76: 162-166, 1984.
20. YOUNG, R.C.; JENNINGS, A. & BENNETT, J.E. - Species identification of invasive Aspergillosis in man. Amer. J. clin. Path., 58: 554-557, 1972.
21. WARDER, F.R.; CHIKES, P.G. & HUDSON, W.R. - Aspergillosis of the paranasal sinuses. Arch. Otolaryngol., 101: 683-685, 1975.
22. WELLER, W.A.; JOSEPH, D.J. & HORA, J.F. - Deep mycotic involvement of the right maxillary and ethmoid sinuses, the orbit and adjacent structures. Laryngoscope (St. Louis), 70: 999-1016, 1960.

Correspondence to:

Prof. Carlos da Silva Lacaz

Instituto de Med. Trop. São Paulo

Av. Dr. Enéas de Carvalho Aguiar 470

05403-000 São Paulo, SP, Brasil

Publication Dates

Publication in this collection
21 Sept 2006
Date of issue
Oct 1994

History

Accepted
04 July 1994
Received
10 Feb 1994

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

[1] 1. AXELSSON, H.; CARLSÖÖ, B.; WEIBRING, J. & WINBLAD, B. - Aspergillosis of the maxillary sinus. Acta Otolaryngol., 86: 303-308, 1978.

[2] 2. BODEY, G.; BUELTMANN, B.; DUGUID, W. et al. - Fungal infection in cancer patients: an international autopsy survey. Europ. J. clin. Microbiol. infect. Dis., 11: 99-109, 1992.

[3] 3. BODEY, G.P. - Infections in cancer patients. II. Fungal infections. Rev. bras. Pesq. méd. biol., 7: 567-572, 1974.

[4] 4. GEISSMAN, F.; HENNEQUIN, C.; MAAREK, H. & VIARD, J.P. - Sinusite ŕ Aspergillus fumigatus au cours du SIDA. Presse méd., 22: 1792, 1993.

[5] 5. HORA, J.F. - Primary aspergillosis of the paranasal sinuses and associated areas. Laryngoscope (St. Louis), 75: 768-773, 1965.

[6] 6. KEMPER, C.; HOSTETLER, J.S.; FOLLANSBEE, S.E. et al. - Ulcerative and plake-like tracheobronchitis due to infection with Aspergillus in patient with Aids. Clin. infect. Dis., 17: 344-352, 1993.

[7] 7. KWON-CHUNG, K.L. & BENNETT, J.E. - Medical mycology. Philadelphia, Lea & Febiger, 1992.

[8] 8. LACAZ, C. da S.; AZEVEDO, M.L. de; VARGAS, A.A.; PORTO, E. & SALEBIAN, A. - Aspergilose orbitária por Aspergillus flavus. Rev. paul. Med., 91: 64-67, 1978.

[9] 9. LOEUILLE, G.A.; BERTHOU, C.; HILMARSDOTTIR, I. et al. - Aspergilloses traitées par l'itraconazole: analyse de 64 cas. Revue de la littérature. J. Mycol. méd., 3: 1-13, 1993.

[10] 10. LOWE, J. & BRADLEY, J. - Cerebral and orbital Aspergillus infection due to invasive aspergillosis of ethmoid sinus. J. clin. Path., 39: 774-778, 1986.

[11] 11. MARTINSON, F.D.; ALLI, A.F. & CLARK, B.M. - Aspergilloma of the ethmoid. J. Laryngol. Otol., 84: 857-861, 1970.

[12] 12. McGILL, T.J.; SIMPSON, G. & HEALY, G.B. - Fulminant aspergillosis of the nose and paranasal sinuses: a new clinical entity. Laryngoscope (St. Louis), 90: 748-754, 1980.

[13] 13. McWHINNEY, P.H.M.; KIBBLER, C.C.; HAMON, M.D. et al. - Progress in the diagnosis and management of Aspergillosis in bone marrow transplantation: 13 years' experience. Clin. infect. Dis., 17: 397-404, 1993.

[14] 14. MILOSEV, B.; MAHGOUB, E.S.; ABDEL AAL, O. & EL HASSAN, A.M. - Primary aspergilloma of paranasal sinuses in the Sudan. Brit. J. Surg., 56: 132-137, 1969.

[15] 15. MILROY, C.M.; BLANSHARD, J.D.; LUCAS, S. & MICHAELS, L. - Aspergillosis of the nose and paranasal sinuses. J. clin. Path., 42: 123-127, 1989.

[16] 16. MUSIAL, C.E.; COCKERILL III, F.R. & ROBERTS, G.D. - Fungal infections of the immunocompromised host: clinical and laboratory aspects. Clin. Microbiol. Rev., 1: 349-364, 1988.

[17] 17. RIPPON, J.W. - Medical mycology. The pathogenic fungi and the pathogenic actinomycetes. 2. ed., Philadelphia, W.B. Saunders, 1988.

[18] 18. SAAH, D.; DRAKOS, P.E.; ELIDAN, J. et al. - Rhinocerebral aspergillosis in patients undergoing bone marrow transplantation. Ann. Otol. Rhinol. Laryngol., 103: 306-310, 1994.

[19] 19. SWERDLOW, B. & DERESINSKI, S. - Development of Aspergillus sinusitis in a patient receiving amphotericin B. Treatment with granulocyte transfusions. Amer. J. Med., 76: 162-166, 1984.

[20] 20. YOUNG, R.C.; JENNINGS, A. & BENNETT, J.E. - Species identification of invasive Aspergillosis in man. Amer. J. clin. Path., 58: 554-557, 1972.

[21] 21. WARDER, F.R.; CHIKES, P.G. & HUDSON, W.R. - Aspergillosis of the paranasal sinuses. Arch. Otolaryngol., 101: 683-685, 1975.

[22] 22. WELLER, W.A.; JOSEPH, D.J. & HORA, J.F. - Deep mycotic involvement of the right maxillary and ethmoid sinuses, the orbit and adjacent structures. Laryngoscope (St. Louis), 70: 999-1016, 1960.

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