| 朱成琳,许喆,王敏,等.儿童急性白血病合并毛霉病 5例临床分析[J].安徽医药,2025,29(4):815-819. |
| 儿童急性白血病合并毛霉病 5例临床分析 |
| Pediatric acute leukemia complicated with mucormycosis: a clinical analysis of 5 cases |
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| DOI：10.3969/j.issn.1009-6469.2025.04.037 |
| 中文关键词: 急性白血病 毛霉病 宏基因组二代测序 儿童 化疗 |
| 英文关键词: Acute leukemia Mucormycosis Metagenomic next-generation sequencing Children Chemotherapy |
| 基金项目:安徽省卫生健康科研项目( AHWJ2023Bba20030) |
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| 中文摘要: |
| 目的探讨 5例急性白血病合并毛霉病病儿的临床特点及治疗过程，以期为临床诊治提供参考。方法回顾性分析 2022年 5月至 2023年 7月 5例因急性白血病在安徽省儿童医院接受治疗并发生毛霉病病儿的临床资料，所有病儿均经 G试验、影像学检查并结合临床症状确诊，总结其临床特征、诊疗及预后。结果 5例病儿中，男 3例，女 2例，中位年龄 12(5，13)岁。 3例为急性淋巴细胞白血病， 2例为急性髓系白血病。 )例为肺型毛霉病， 1例为皮肤型毛霉病。 5例病人均通过宏基因组二代测序(mNGS)检测出病原菌，其中 3例为灰色小克银汉霉属， 1例为小孢根霉， 1例为德氏根霉。 4例肺型毛霉病病儿表现为发热、咳嗽，肺部影像改变前期主要为团块状高密度影，后期出现空气新月征及中央坏死腔。 1例皮肤型毛霉病临床表现为发热、黑色焦痂样皮损。 3例给予静脉两性霉素 B脱氧胆酸盐( AmBd)联合泊沙康唑口服治疗， 1例给予 AmBd联合伏立康唑口服， 1例给予艾沙康唑口服。 5例病儿中 1例痊愈， 3例好转， 1例好转后死于原发病进展。结论急性白血病儿童合并毛霉病病情进展迅速， mNGS可为启动目标治疗提供方向。 |
| 英文摘要: |
| Objective To investigate the clinical characteristics and treatment process of 5 children with acute leukemia complicatedwith mucormycosis, in order to provide reference for clinical diagnosis and treatment.Methods Clinical data of 5 children with mucor. mycosis who received treatment for acute leukemia in Anhui Provincial Children's Hospital from May 2022 to July 2023 were retrospec.tively analyzed. All patients were confirmed by G test, imaging examination and clinical symptoms. The clinical features, diagnosis,treatment and prognosis were summarized.Results Among the five children, there were three boys and two girls, with a median age of12 (5, 13) years. Three cases had acute lymphoblastic leukemia, while two had acute myelogenous leukemia. Four children sufferedfrom pulmonary mucormycosis, and one had cutaneous mucormycosis. All five patients had pathogens detected by metagenomic next-generation sequencing (mNGS), of which three were identified as Cunninghamella bertholletiae, one as Rhizopus microsporus, and one as Rhizopus delemar. The four patients with pulmonary mucormycosis mainly presented with fever and cough, with early pulmonary im. aging showing mass-like high-density shadows, while later-stage imaging showing air crescent signs and central necrotic cavities. Thepatient with cutaneous mucormycosis presented with fever and black eschar-like skin lesions. Initial treatment for three patients includ.ed intravenous administration of amphotericin B deoxycholate (AmBd) in combination with oral posaconazole, one patient received ad.ministration of AmBd combined with voriconazole orally, and one patient was treated with oral isavuconazole. Of the five patients, onewas cured, three improved, and one died due to progression of leukemia after initial improvement.Conclusion The clinical presenta.tion of children with acute leukemia complicated with mucormycosis progresses rapidly, and mNGS can provide guidance for initiatingtargeted therapy promptly. |
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