Respiratory and systemic infections in children with severe aplastic anemia on immunosuppressive therapy.

In the present study we investigated the occurrence of systemic and respiratory infections in a cohort of 123 children with severe acquired aplastic anemia (SAA) on immunosuppressive therapy (IST). We recorded 101 episodes of infection in 77 patients (62.6 %). Pneumonia was among the most frequently observed clinical forms of infection (17 cases - 16.8 %). In the entire group, 23 children died, mostly in the course of fatal sepsis (15/23) and in 3 cases because of pneumonia complications. All patients were treated with horse (h-ATG) or rabbit antithymocyte globulin (r-ATG) supplemented with cyclosporine and corticosteroids. The crude incidence rate for serious infections in h-ATG group and r-ATG group was comparable. The relative risk of infectious complications was lower in patients treated with granulocyte colony stimulating factors (G-CSF) by 36 % (RR 0.64; p < 0.0001). The analysis confirmed that respiratory tract and disseminated infections comprise a very serious clinical problem and are the leading cause of death of SAA children. Active surveillance and the analysis of associated risk factors are required to detect opportunistic infections in this group of patients.