ĐẶC ĐIỂM LÂM SÀNG, CẬN LÂM SÀNG NẤM PHỔI ASPERGILLUS XÂM LẤN Ở TRẺ EM TẠI BỆNH VIỆN PHỔI TRUNG ƯƠNG

Abstract

Invasive pulmonary aspergillosis (IPA) is increasingly prevalent among immunocompromised patients and is associated with high mortality; however, its diagnosis in children remains challenging. Objective: To describe the clinical and paraclinical characteristics of pediatric patients with invasive pulmonary aspergillosis treated at the Department of Pediatrics, National Lung Hospital. Methods: A descriptive case series study with both retrospective and prospective data collection was conducted on 31 patients aged 1 to 16 years who were diagnosed with IPA between January 2022 and April 2025. Results: The mean age was 8.06 ± 4.9 years. Risk factors defined by EORTC/MSG were present in 93.5% of patients, predominantly hematologic malignancies (64.5%) and chronic granulomatous disease (19.4%). The most common chest CT findings were consolidation (71%), nodules (48.4%), cavitation and ground-glass opacity (32.3%), often involving multiple lobes bilaterally. Microbiological evidence included positive sputum or bronchoalveolar lavage cultures (30%), serum galactomannan (85.7%), and bronchoalveolar lavage galactomannan (96%). The mean pre-treatment white blood cell count was significantly lower in patients with hematologic malignancies compared to those without (7.5 ± 7.1 G/L vs. 18.1 ± 10.0 G/L, p < 0.05). Mean C-reactive protein levels were 87.7 ± 59.7 mg/L and 37.1 ± 26.7 mg/L, respectively, with a statistically significant difference (p < 0.05). Conclusion: The diagnosis of pediatric IPA remains challenging as lung tissue biopsy is often not feasible. A combination of host factors, microbiological evidence, and radiological findings is essential to avoid missed diagnoses.