Abstract Objective To investigate the clinical features of invasive pulmonary fungal infections (IPFIs) after biliary atresia (BA) surgery and related risk factors.Methods A retrospective analysis was performed for the clinical data of 49 children with IPFIs after BA surgery, including clinical features, lung imaging findings, and pathogenic features. The risk factors for IPFIs after BA surgery were also analyzed.Results The most common pathogens of IPFIs after BA surgery was Candida albicans (17 strains, 45%), followed by Candida tropicalis (7 strains, 18%), Aspergillus (6 strains, 16%), Candida krusei (3 strains, 8%), Candida glabrata (3 strains, 8%), and Candida parapsilosis (2 strains, 5%). Major clinical manifestations included pyrexia, cough, and shortness of breath, as well as dyspnea in severe cases; the incidence rate of shortness of breath reached 78%, and 35% of all children had no obvious rale. The multivariate logistic regression analysis showed that age at the time of surgery, time of glucocorticoid application, cumulative time of the application of broad-spectrum antibiotics, and recurrent cholangitis were major risk factors for IPFIs after BA surgery.Conclusions The three most common pathogens of IPFIs after BA surgery are Candida albicans, Candida tropicalis, and Aspergillus. It is important to perform surgery as early as possible, avoid recurrent cholangitis, and shorten the course of the treatment with broad-spectrum antibiotics and glucocorticoids for decreasing the risk of IPFIs.
CHEN Xiu-Qi,TAN Wen-Hai,JIANG Fang-Fang et al. A clinical analysis of children with invasive pulmonary fungal infections after biliary atresia surgery[J]. CJCP, 2018, 20(2): 121-124.
CHEN Xiu-Qi,TAN Wen-Hai,JIANG Fang-Fang et al. A clinical analysis of children with invasive pulmonary fungal infections after biliary atresia surgery[J]. CJCP, 2018, 20(2): 121-124.
Livesey E, Cortina Borja M, Sharif K, et al. Epidemiology of biliary atresia in England and Wales (1999-2006)[J]. Arch Dis Child Fetal Neonatal Ed, 2009, 94(6):F451-455.
[2]
Yoon PW, Bresee JS, Olney RS, et al. Epidemiology of biliary atresia:a population-based study[J]. Pediatrics, 1997, 99(3):376-382.
[3]
Lin JS, Chen SC, Lu CL, et al. Reduction of the ages at diagnosis and operation of biliary atresia in Taiwan:A 15-year population-based cohort study[J]. World J Gastroenterol, 2015, 21(46):13080-13086.
[4]
Tyraskis A, Davenport M. Steroids after the Kasai procedure for biliary atresia:the effect of age at Kasai portoenterostomy[J]. Pediatr Surg Int, 2016, 32(3):193-200.
Saracli MA, Fothergill AW, Sutton DA, et al. Detection of triazole resistance among Candida species by matrix-assisted laser desorption/ionization-time of flight mass spectrometry (MALDI-TOF MS)[J]. Med Mycol, 2015, 53(7):736-742.
[19]
Wiederhold NP. Antifungal resistance:current trends and future strategies to combat[J]. Infect Drug Resist, 2017, 10:249-259.
[20]
Verweij PE, Zhang J, Debets AJM, et al. In-host adaptation and acquired triazole resistance in Aspergillus fumigatus:a dilemma for clinical management[J]. Lancet Infect Dis, 2016, 16(11):e251-e260.