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Updated: Mar 30, 2026
Noninvasive Sampling of Mucosal Lining Fluid for the Quantification of In Vivo Upper Airway Immune-mediator Levels
Published on: August 7, 2017
A Prospective, International Cohort Study of Invasive Mold Infections in Children
Rachel L Wattier1, Christopher C Dvorak1, Jill A Hoffman2
1Department of Pediatrics, University of California-San Francisco.
Background:
Invasive mold infections (IMIs) are a leading cause of mortality in immunocompromised children, yet there has never been an international epidemiologic investigation of pediatric IMIs.
Methods:
This international, prospective cohort study was performed to characterize the epidemiology, antifungal therapy, and outcomes of pediatric IMIs. Children (≤18 years) with proven or probable IMIs were enrolled between August 2007 and May 2011 at 22 sites. Risk factors, underlying diagnoses, and treatments were recorded. Outcomes were assessed at 12 weeks after diagnosis using European Organization for Research and Treatment of Cancer/Mycoses Study Group response criteria.
Results:
One hundred thirty-one pediatric patients with IMIs were enrolled; the most common IMI was invasive aspergillosis ([IA] 75%). Children with IA and those with other types of IMIs had similar underlying risk factors, except that children with IMIs caused by non-Aspergillus species were more likely to have received mold-active antifungal agents preceding diagnosis. The most commonly used antifungal classes after diagnosis were triazoles (82%) and polyenes (63%). Combination therapy was used in 53% of patients. Use of combination therapy was associated with an increased risk of adverse events (risk ratio, 1.98; 95% confidence interval, 1.06-3.68; P = .031), although there was no detectable difference in outcome.
Conclusions:
Although risk factors for IMIs are similar across specific subtypes, preceding antifungal therapy may be an important modifier. Combination antifungal therapy requires further study to determine its true risks and benefits.
Insights
Invasive mold infections (IMIs) in children are common, with invasive aspergillosis being the most frequent. Preceding antifungal use may alter risk, and combination therapy requires more research for safety and efficacy.
Area of Science:
- Pediatric Infectious Diseases
- Mycology
- Clinical Epidemiology
Background:
- Invasive mold infections (IMIs) are a significant cause of mortality in immunocompromised children.
- Previous international epidemiologic data on pediatric IMIs were lacking.
Purpose of the Study:
- To characterize the epidemiology of pediatric IMIs.
- To investigate antifungal therapy and outcomes in children with IMIs.
- To identify risk factors and treatment patterns for pediatric IMIs.
Main Methods:
- An international, prospective cohort study enrolled children (≤18 years) with proven or probable IMIs.
- Data on risk factors, diagnoses, and treatments were collected from August 2007 to May 2011 across 22 sites.
- Outcomes were assessed at 12 weeks using standardized criteria.
Main Results:
- 131 pediatric patients were enrolled; invasive aspergillosis (IA) accounted for 75% of IMIs.
- Risk factors were similar across IMI subtypes, but prior antifungal use was more common in non-Aspergillus IMIs.
- Triazoles and polyenes were common treatments; combination therapy (53%) increased adverse events but showed no outcome difference.
Conclusions:
- Risk factors for IMIs are similar across subtypes, but prior antifungal therapy may influence outcomes.
- Combination antifungal therapy's risks and benefits warrant further investigation in pediatric populations.
