Abstract
Invasive aspergillosis (IA) is a major cause of morbidity and mortality in children with hematological malignancies and those undergoing hematopoietic stem cell transplantation. Similar to immunocompromised adults, clinical signs, and symptoms of IA are unspecific in the pediatric patient population. As early diagnosis and prompt treatment of IA is associated with better outcome, imaging and non-invasive antigen-based such as galactomannan or ß-D-glucan and molecular biomarkers in peripheral blood may facilitate institution and choice of antifungal compounds and guide duration of therapy. In patients in whom imaging studies suggest IA or another mold infection, invasive diagnostics such as bronchoalveolar lavage and/or bioptic procedures should be considered. Here we review the current data of diagnostic approaches for IA in the pediatric setting and highlight the major differences of performance and clinical utility of the tests between children and adults.
Highlights
Invasive fungal disease (IFD), in particular invasive aspergillosis (IA), is a major cause of morbidity and mortality in immunocompromised children and adults (Pagano et al, 2007; Sung et al, 2007; Upton et al, 2007)
As compared to studies with adult patients, considerably less data are available in the pediatric population, it has been recognized that the performance and the usefulness of diagnostic tools to detect IA may differ between children and adults
The performance and clinical utility of these tests may be different between children and adults, and they may be different for invasive diagnostic procedures such as bronchoalveolar lavage (BAL) or biopsy
Summary
Invasive fungal disease (IFD), in particular invasive aspergillosis (IA), is a major cause of morbidity and mortality in immunocompromised children and adults (Pagano et al, 2007; Sung et al, 2007; Upton et al, 2007). As compared to studies with adult patients, considerably less data are available in the pediatric population, it has been recognized that the performance and the usefulness of diagnostic tools to detect IA may differ between children and adults This has led to several pediatric specific guidelines for the diagnosis and treatment of IFD (Groll et al, 2014; Science et al, 2014; Lehrnbecher et al, 2017b), and at present, the European Organisation for Research and Treatment of Cancer (EORTC) and the Mycosis Study Group (/MSG) (EORTC/MSG) consensus definitions for the diagnosis of IFD undergo a second revision in which pediatric specific diagnostic considerations will be included. The present review will focus on the value of diagnostic tests to detect IA in the pediatric setting and highlight major differences between children and adults
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