Clinical characteristics and efficacy analysis of childhood acute lymphoblastic leukemia complicated with invasive fungal infection
Objective The clinical characteristics,etiological distribution characteristics,treatment methods,etc.of children with acute lymphoblastic leukemia complicated with invasive fungal infection(IFI)were analyzed,in order to provide effective prevention and treatment strategies for clinical practice.Methods A retrospective analysis was conducted on the clinical data of 41 children with acute lymphoblastic leukemia complicated with IFI treated in our hospital from 2019 to 2023.A data collection questionnaire was designed to comprehensively collect clinical data of the children through the hospital's internal electronic medical record system.41 children with IFI were randomly divided into two groups by a random number table method.One group was treated with voriconazole,while the other group was treated with amphotericin B.After two weeks of medication,the treatment effect and adverse reactions of the two groups of children were evaluated.Results Among 41 children with acute lymphoblastic leukemia complicated with IFI,24 were diagnosed with IFI,10 were clinically diagnosed,and 7 were suspected.Among the 24 confirmed cases,a total of 24 strains of pathogenic bacteria were detected.Among them,there were 13 strains of Candida albicans,7 strains of Candida tropicalis,3 strains of Aspergillus,and 1 strain of Mucor.There were statistically significant differences in the comparison of granulocytopenia,length of hospital stay,hemoglobin,and albumin levels between children with IFI and those without IFI(P＜0.05),while there was no statistically significant difference in the comparison of age and gender composition ratio(P＞0.05).Among the 41 children with IFI,23 cases were lower respiratory tract infections,7 cases were upper respiratory tract infections,4 cases were gastrointestinal tract infections,3 cases were central nervous system infections,2 cases were laryngeal infections,1 case was skin and soft tissue infection,and 1 case was fungemia.Among the children in the voriconazole group,11 cases were cured,6 cases were markedly effective,2 cases were improved,and 2 cases were ineffective.The total effective rate was 80.95％(17/21).Among the children in the amphotericin B group,4 cases were cured,4 cases were markedly effective,7 cases were improved,and 5 cases were ineffective.The total effective rate was 40％(8/20).Among the children in the two groups,the proportion of cured and improved children and the comparison of the total effective rate were statistically significant(P＜0.05).Adverse reactions in the voriconazole group mainly included 1 case each of visual impairment,gastrointestinal tract impairment,liver function impairment,and kidney function impairment,1 case of neurotoxicity,and 2 cases of hypokalemia.Adverse reactions in the amphotericin B group mainly included 1 case of visual impairment,3 cases of gastrointestinal tract impairment,1 case of liver function impairment,2 cases of kidney function impairment,1 case of neurotoxicity,and 7 cases of hypokalemia.The overall incidence of adverse reactions in the amphotericin B group was higher than that in the voriconazole group.The main difference lies in the incidence of hypokalemia,and the difference was statistically significant(P＜0.05).Conclusion The pathogenic bacteria detected in confirmed cases of acute lymphoblastic leukemia complicated with IFI were mainly Candida albicans.Most of the children with co infection had granulocyte deficiency,long hospital stay,and low levels of hemoglobin and albumin.The infection site was mainly in the lower respiratory tract.Voriconazole showed better efficacy and a relatively lower incidence of adverse reactions in the treatment of children with acute lymphoblastic leukemia complicated with IFI.It was superior to amphotericin B and provides a new reference for clinical treatment.
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