[Emerging invasive fungal infections]

Area of Science:

• Pediatric Infectious Diseases
• Mycology
• Immunocompromised Hosts

Context:

• Increasing frequency and diversity of invasive fungal infections (IFIs) in children over 25 years.
• Expanded pediatric populations at risk, including cancer patients, transplant recipients, and those on immunosuppressive therapy.
• Rising incidence of fusariosis and phaeohyphomycosis (Dematiaceous fungi) in at-risk children.

Purpose:

• To highlight the challenges in diagnosing and managing IFIs in pediatric patients.
• To emphasize the need for awareness of optimal and timely diagnostic and therapeutic strategies.
• To address the lack of specific pediatric guidelines for IFIs.

Summary:

• IFIs caused by less common fungi like fusariosis and phaeohyphomycosis are increasing in vulnerable children.
• Diagnosis is challenging due to the absence of simple antigen or serological tests.
• Treatment outcomes for disseminated IFIs in neutropenic and transplant patients are poor, necessitating early, aggressive therapy.
• Limited pediatric data and reliance on adult guidelines complicate treatment decisions.

Impact:

• Improved awareness among pediatricians and sub-specialists regarding emerging fungal pathogens.
• Potential for earlier diagnosis and more effective management of pediatric IFIs.
• Highlights the need for pediatric-specific clinical trials and treatment guidelines.
• Advances in antifungal agents offer improved tolerability and broader activity, enhancing treatment options.