Abstract
Invasive aspergillosis (IA) is a disease of increasing importance in pediatrics due to growth of the immunocompromised populations at risk and improvements in long-term survival for many of these groups. While general principles of diagnosis and therapy apply similarly across the age spectrum, there are unique considerations for clinicians who care for children and adolescents with IA. This review will highlight important differences in the epidemiology, clinical manifestations, diagnosis, and therapy of pediatric IA.
Highlights
Invasive aspergillosis (IA) is one of the most common and serious infectious complications occurring in immunocompromised children
Micafungin and anidulafungin are not licensed for IA but have in vitro activity similar to caspofungin.; d PK; pharmacokinetics; d IDSA; Infectious Diseases Society of America; combined adult and pediatric guidelines, evidence levels based on adult data [138]; e ECIL-4; Fourth European Conference on Infections in Leukemia; pediatric-specific guidelines [139]; f RCT; randomized controlled trial; g Voriconazole is approved by the European Medications Agency for children age 2–11 years
12 years, voriconazole is recommended as primary therapy for pediatric IA based on pediatric safety data and a non-comparative compassionate use study demonstrating complete or partial response to voriconazole in 45% of children with IA and other IFIs who were refractory to or intolerant of conventional therapy [118,139]
Summary
Invasive aspergillosis (IA) is one of the most common and serious infectious complications occurring in immunocompromised children. The incidence of IA appears to be increasing in children as it has in adults [1,2,3,4,5]. Significant advances have occurred in the diagnosis and therapy of IA in the last 15 years, and more recent studies indicate that clinical outcomes have improved during this time period [6,7]. The evidence that informs care for children with IA is largely extrapolated from adult studies or based on small non-comparative pediatric studies, predominantly including children with malignancy and/or hematopoietic stem cell transplant (HSCT) recipients. This review will describe the known differences in epidemiology, clinical manifestations, diagnosis and therapy of pediatric IA, and will highlight areas of opportunity for further research
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