Đặc điểm lâm sàng, xét nghiệm ở bệnh nhi lơ xê mi cấp nhiễm nấm xâm lấn sau điều trị hóa chất do vi nấm candida và aspergillus tại Viện Huyết học – Truyền máu Trung ương=Clinical, paraclinical features between pediatric acute leukemia patients with invasive fungal infection caused by candida and aspergillus at the National Institute of Hematology and Blood Transfusion

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Tác giả: Thị Vân Nga Bùi, Hoàng Hải Đặng, Thị Hồng Hoàng, Khánh Quỳnh Lê, Lan Mai, Thị Diệu Ngân Tạ, Quỳnh Mai Trần, Thị Kiều My Trần

Ngôn ngữ: vie

Ký hiệu phân loại:

Thông tin xuất bản: Tạp chí Y học Việt Nam (Tổng hội Y học Việt Nam), 2024

Mô tả vật lý: tr.208-214

Bộ sưu tập: Metadata

ID: 478237

Thêm vào giỏ

Nhiễm nấm xâm lấn là một trong những nguyên nhân gây tử vong hàng đầu trong điều trị lơ xê mi cấp trẻ em. Phát hiện sớm các dấu hiệu, triệu chứng nhiễm nấm để điều trị góp phần nâng cao hiệu quả điều trị. Mục tiêu: Mô tả đặc điểm lâm sàng, xét nghiệm ở bệnh nhi Lơ xê mi (LXM) cấp nhiễm nấm xâm sau điều trị hóa chất lấn do vi nấm Candida và Aspergillus. Đối tượng và phương pháp nghiên cứu: Nghiên cứu mô tả cắt ngang 99 bệnh nhi LXM cấp nhiễm Candida và Aspergillus xâm lấn sau điều trị hóa chất tại khoa Bệnh máu trẻ em, Viện Huyết học – Truyền máu Trung ương từ tháng 01/2022 đến tháng 06/2024. Kết quả: Phần lớn bệnh nhi nhiễm nấm xâm lấn thuộc nhóm LXM cấp tái phát/ kháng trị (Candida - 48,6%, Aspegillus - 48,3%). Nhóm bệnh nhi nhiễm Candida xâm lấn có tỷ lệ xuất hiện triệu chứng ban nấm và suy hô hấp cao hơn, 61,4% so với 31% và 65,7% so với 37,9%. Nhóm bệnh nhi nhiễm Aspergillus xâm lấn có tỷ lệ xuất hiện triệu chứng ran ẩm, ran nổ cao hơn, 48,3% so với 20%. Những sự khác biệt này có ý nghĩa thống kê với chỉ số p <
0,05. Sự khác biệt về tỷ lệ giảm bạch cầu hạt trung tính (BCHTT), giảm BCHTT khi nhiễm nấm, thời gian phục hồi BCHTT, tăng CRP giữa hai nhóm căn nguyên không có ý nghĩa thống kê. Tỷ lệ xuất hiện tổn thương kẽ phổi, hang, đông đặc và biểu hiện ở cả 2 bên phổi trên phim X – Quang tim phổi thẳng của nhóm nhiễm Aspergillus cao hơn nhóm nhiễm Candida. Kết luận: Nghiên cứu phát hiện sự khác biệt về một số triệu chứng lâm sàng và tỷ lệ xuất hiện tổn thương trên phim X-Quang ở nhóm bệnh nhi nhiễm nấm Candida và Aspergillus. Cần kết hợp yếu tố nguy cơ, triệu chứng lâm sàng, xét nghiệm trong chẩn đoán phân biệt nhiễm nấm Candida xâm lấn và Aspegillus xâm lấn.To describe the clinical and paraclinical features between pediatric acute leukemia patients with invasive fungal infection after chemotherapy caused by Candida and Aspergillus species at the Pediatric department, National Institute of Hematology and Blood transfusion. Subjects and methods: Descriptive cross-sectional study on 99 Pediatric acute leukemia patients with invasive fungal infection after chemotherapy caused by Candida and Aspergillus species at the Pediatric department, National Institute of Hematology and Blood transfusion from 01/2022 to 06/2024. Results: Majority of patients had Relapsed/ Refractory diseases (Candida – 48.6%, Aspegillus – 48.3%). Comparison of clinical features between two groups showed that the rate of rash and respiratory distress symptoms in invasive invasive candidiasis group was higher than invasive aspergillosis group (61.4% vs 31% and 65.7% vs 37.9%) but the rate of moist rales was lower (20% vs 48.3%), the differences was statistically significant with p <
0.05. The differences in peripheral blood indices and CRPhs was not statistically significant. Comparison of features of X – Rays image showed that the rate of interstitial opacities, cavity, consolidation and abnormalities in both lungs in invasive aspergillosis group was higher than invasive candidiasis group Conclusion: The study thoroughly described clinical and paraclinical features of invasive fungal infection of pediatrics acute leukemia patients. There were differences in some clinical symptoms and the rate of lesions appearing on X-rays in the group of pediatric patients infected with Candida and Aspergillus fungi. The incorporation of clinical and paraclinical features in differential diagnosis between invasive candidiasis and invasive aspergillosis is essential in the clinical setting.

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