The radiologic diagnosis of invasive fungal infections in neutropenic children.

Abstract

Fungal infections have substantially increased in incidence over the past two decades, especially among patients with cancer who have received high doses of chemotherapy. Diagnosis is based on clinical observations, radiological and laboratory methods and molecular biological techniques. Early diagnosis is important and increases overall response rates, so high-risk patients should be treated empirically, based on the clinical picture and radiologic findings alone. The aim of the study was the analysis of the early clinical picture and radiologic findings of systemic fungal infections. The subjects of this study were patients with childhood cancers and fungal systemic infections. The early symptoms of fungal infection and the radiologic findings were analyzed. The systemic fungal infections were recognized in eight children, treated due to ALL--in four patients, AML--in two and NHL--in two. In all, manifestations of fungal infection were observed during bone marrow suppression secondary to chemotherapy treatment of neoplasm. In all, X-ray examination was normal. Radiological pulmonary changes were found in CT scans in seven patients, in one MRI showed marked abnormnalities of the brain. All patients received intensive antifungal drugs, six patients had a complete or partial response and they were able to continue chemotherapy for treatment of neoplasm. The regression of pulmonary nodules was observed-in the control CT scans. Progression of fungal infection was noticed in two patients, these children died, Conclusions: The early diagnosis of fungal infection in neutropenic patients is important and increases overall response rates. The pulmonary fungal infection should be considered in the differential diagnosis of solitary or multiple pulmonary nodules, particularly in immunocompromised patients.