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Fungal infections in pediatric patients: challenges and considerations in treatment

Elio Castagnola1, Marcelo Mariani1, Erica Ricci1

  • 1Department of Medical-Pediatric Sciences, Infectious Diseases Unit IRCCS Istituto Giannina Gaslini, Genoa, Italy.

Expert Review of Anti-Infective Therapy
|October 13, 2025
PubMed
Abstract

Insights

Invasive fungal diseases (IFDs) in children are challenging to diagnose and treat. This review highlights the need for improved pediatric-specific research, diagnostic tools, and standardized treatment protocols for better outcomes.

Area of Science:

  • Pediatric Infectious Diseases
  • Mycology
  • Clinical Pharmacology

Background:

  • Invasive fungal diseases (IFDs) pose significant risks in children, stemming from unique factors like prematurity and genetic conditions, alongside shared adult risks such as chemotherapy and intensive care.
  • Pediatric IFD diagnosis is complicated by challenges in sample collection, variable performance of antigen detection, and nonspecific imaging.
  • Treatment of pediatric IFD is complex due to age-dependent pharmacokinetics, limited pediatric formulations, and drug interactions requiring therapeutic drug monitoring.

Purpose of the Study:

  • To provide a narrative review of the epidemiology, diagnosis, and treatment of IFD in pediatric patients.
  • To highlight the challenges and complexities in managing IFD in children.
  • To emphasize the need for improved pediatric-specific strategies.

Main Methods:

  • Narrative review of existing literature on pediatric invasive fungal diseases.
  • Synthesis of information on epidemiological factors, diagnostic modalities, and therapeutic approaches.
  • Analysis of challenges in diagnosis and treatment specific to the pediatric population.

Main Results:

  • IFDs contribute significantly to child morbidity and mortality.
  • Diagnostic difficulties include obtaining adequate samples, limitations of current antigen tests, and nonspecific imaging.
  • Therapeutic challenges involve pharmacokinetics, drug availability, drug interactions, and the necessity for therapeutic drug monitoring.

Conclusions:

  • Therapeutic drug monitoring for antifungal drugs in children is essential and likely to increase.
  • Prioritizing pediatric-specific research and standardized treatment protocols is crucial.
  • Regulatory reforms are needed to accelerate access to novel diagnostic and treatment strategies for pediatric IFD.
Keywords:
Invasive fungal infectionsdiagnosisdrug registration modalitiesoff label treatmentspediatricstherapy

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