Reactions 1290 - 27 Feb 2010

infection was controlled. Subsequent CT scan revealedinvasive aspergillosis, and voriconazole was started. Her SAntineoplasticssymptoms and CT results improved, and she commencedconsolidation therapy with CAM. Itraconazole replacedInvasive aspergillosis in children: 4 case reportsvoriconazole after 6 weeks of antifungals. Further coursesFour children developed invasive aspergillosis [times toof chemotherapy were administered, and she receivedreactions onset not stated] during treatment withconcomitant voriconazole or itraconazole. After 6 monthsantineoplastics [dosages not stated] for acute myeloidof antifungals, lesions had resolved.leukaemia (AML) or acute lymphoblastic leukaemia (ALL).

A girl aged 2 years and 4 months was diagnosed with Liu Y, et al. Treatment of acute leukemia complicated by invasive aspergillosis inAML. She received two courses of pirarubicin, cytarabine children. Zhongguo Dang Dai Er Ke Za Zhi 11: 901-904, No. 11, Nov 2009

[Chinese; summarised from a translation] - China 803006360and etoposide. During her third course, which consisted ofcytarabine and daunorubicin, fever and leucopeniadeveloped. She received anti-infectives for 3 days; her feverresolved and her WBC count improved. Invasiveaspergillosis was diagnosed from CT scan. She commencedamphotericin B, but was switched to voriconazole due toelevated BUN levels. After 2 weeks, CT scan showedimprovement. Bone marrow suppression and septicaemiadeveloped during her fourth course (cytarabine,etoposide). Antibacterials and voriconazole were started.After 8 weeks of antifungals, her condition improved.During her next five courses of chemotherapy (cytarabinewith omacetaxine mepesuccinate or etoposide), hercondition remained unchanged. After completingchemotherapy, itraconazole replaced voriconazole. Fourmonths later, CT scan showed complete resolution;antifungal treatment ceased. No further fungal infectionsoccurred.

A 9-year-old boy commenced vincristine, pirarubicin,asparaginase and prednisone (VDLP) for ALL. Mucositis andhypoproteinaemia developed. Treatment consisted ofantibacterials and itraconazole for 14 days, but feverdeveloped. CT scan and liver biopsy indicated invasiveaspergillosis. Amphotericin B was started, but feverpersisted 2 weeks later. CT scan showed new lesions, andtreatment was switched to amphotericin B liposomal. After5 weeks, his fever resolved and CT results had improved.After 8 weeks of antifungals, voriconazole was started.Further chemotherapy including cyclophosphamide,cytarabine and etoposide (CAM), followed bymethotrexate, then VDLD [sic], then dexamethasone,vincristine, asparaginase and cytarabine. After 4 months ofantifungals, lung lesions had resolved. After 6 months, hisliver lesion had shrunk. Maintenance chemotherapycommenced; antifungal treatment was changed toitraconazole. Hepatic lesions completely resolved after1 year of antifungals. No further fungal infections wereobserved.

A 6-year-old girl started VDLP for ALL. She developedvaricella 12 days later. Chemotherapy was stopped, andshe commenced aciclovir. Itraconazole was added onday 17. Diffuse intravascular coagulation (DIC) and feverdeveloped on day 21; vancomycin was started, andganciclovir replaced aciclovir. On day 23, invasiveaspergillosis was diagnosed from CT scan. Fever resolved,and herpes transformed to scabs. Two weeks later, CT scanshowed improvement of existing lesions, but formation ofnew lesions. She had a mild fever, cough, and increasedWBC and neutrophil counts. After voriconazole treatment,her symptoms improved. Significant improvement in herlesions was observed on follow-up CT scan. She receivedfurther chemotherapy with concomitant voriconazole oritraconazole. After 7 months of antifungals, CT scanshowed complete resolution of pulmonary lesions. Nofungal infections recurred.

A 12-year-old girl received VDLP for ALL. Subsequently,tumour lysis syndrome, DIC, intestinal infection,intracranial haemorrhages, and septic shock developed.Meropenem, itraconazole and vancomycin were given for15 days. Intracranial haemorrhages resolved, and intestinal

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