International Pediatric Fungal Network: Changing the World for Pediatric Invasive Fungal Infections

Abstract

The incidence of pediatric invasive fungal disease is increasing. Coordinated clinical and laboratory investigative efforts have enhanced our understanding of fungal disease and improved the treatment of adult patients. However, most of these efforts have not incorporated children and neonates. Children have long suffered exclusion from studies by individual investigators (often adult subspecialists), and pharmaceutical companies. This has led to delays in obtaining pediatric drug pharmacokinetic and dosing data as well as delays in licensing newer therapies. The number of studies devoted to pediatric fungal disease is staggeringly small. Effective treatment studies require a multi-institutional setting in order to achieve adequate power to generate guidelines for clinicians and demonstrate comparative effectiveness for optimal therapeutic choices. A cooperative study group allows investigators to conduct clinical trials for drug development and testing and also understand the biology, etiology, and pathology of the disease through outcome data and laboratory observations which can be far more informative than the sum of the results of individual trials. Pediatric-dedicated consortiums in other disciplines have been successful. Notable examples that have dramatically improved healthcare are the NCI-funded Children’s Oncology Group (COG), the NICHD-funded International Maternal-Pediatric-Adolescent AIDS Clinical Trials (IMPAACT) Group, the NIAID-funded Collaborative Antiviral Study Group (CASG), the NICHD-funded Neonatal Network, and the NICHD-funded Pediatric Trials Network (PTN). The resulting networks have been used to develop organized and effective treatment protocols for patient populations and subpopulations. Presently there is not a child at any major medical center in the United States with cancer or HIV not receiving treatment as part of an organized protocol jointly designed by experts in the field through these consortiums. As pediatric invasive fungal infections emerge as significant causes of morbidity and mortality in immunocompromised children, we need a formalized system to evaluate and deliver effective treatment. The growing rate of childhood fungal disease and the present poor understanding with high mortality, akin to childhood cancer in years past, no longer allows the earlier luxury of individual clinicians or centers using their own unstudied treatment strategies. The rising incidence of pediatric invasive fungal infections necessitated the creation of a systematic model to combine existing resources, data, and experience. The National Institute for Allergy and Infectious Diseases (NIAID)-sponsored Mycoses Study Group (MSG) was Curr Fungal Infect Rep (2012) 6:138–139 DOI 10.1007/s12281-012-0088-8