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Archives de pédiatrie
Volume 18, n° S1
pages 3-7 (mai 2011)
Doi : 10.1016/S0929-693X(11)70934-4
Mycoses invasives au cours du traitement des maladies malignes de l’enfant
Fungal infections in children with malignant disease
 

G. Michel
Service d’hématologie et oncologie pédiatrique, CHU de Marseille, 1, bd Jean-Moulin, 13005 Marseille, France 

Résumé

L’intensification des chimiothérapies et l’utilisation de greffes de cellules souches hématopoïétiques au cours du traitement de certaines maladies malignes de l’enfant entraînent des aplasies médullaires profondes et prolongées qui favorisent l’émergence de mycoses invasives. Les deux principales espèces pathogènes sont Candida et Aspergillus . Les principales manifestations des infections par Candida sont la candidose oro-pharyngée et oesophagienne, la candidose hépatosplénique ou candidose chronique disséminée et les candidémies. Aspergillus est surtout responsable de pneumopathies sévères mais d’autres localisations sont possibles, cérébrales et sinusiennes notamment. Du fait de l’extrême gravité des infections fongiques invasives déclarées, des stratégies préventives et empiriques ont été mises au point. L’éventail des médicaments antifongiques s’est manifestement amélioré au cours des 20 dernières années avec la mise à disposition de formulations lipidiques de l’amphotéricine B, notamment l’amphotéricine B liposomale, de dérivés azolés puissants et dont la biodisponibilité est améliorée, et des échinocandines.

The full text of this article is available in PDF format.
Summary

Intensified chemotherapy and hematopoietic stem cell transplantation result in severe and prolonged granulocytopenia with an increased risk of invasive fungal infections. The major fungal species that cause serious infections in cancer patients are Candida species and Aspergillus species. The main features of Candida infection in this context are oropharyngeal candidiasis and Candida esophagitis, chronic disseminated candidiasis, also known as hepatosplenic candidiasis, and candidemia. Aspergillus can cause severe lung infection but also sinusal or CNS infection. Because invasive fungal infections are severe and often life-threatening, preventive and empirical managements have become standard practice. An increasing number of antifungal drugs is now available, notably lipid formulations of amphotericin B (liposomal amphotericin B), new azoles with broad spectrum of activity and echinocandin.

The full text of this article is available in PDF format.


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