Pediatric Invasive Aspergillosis: a Retrospective Review of 59 Cases

Jpn J Infect Dis. 2023 Mar 24;76(2):113-119. doi: 10.7883/yoken.JJID.2022.346. Epub 2022 Nov 30.

Abstract

Invasive aspergillosis (IA) is a major cause of morbidity and mortality. This study aimed to present our 10-year IA experience at a single center. Fifty-nine pediatric patients with IA were included in this study. The male-to-female ratio was 42/17. The median age was 8.75 years. Hematologic malignancy was present in the majority of the patients (40/59, 68%). The mean neutropenia duration was 18.5 days. Cytosine arabinoside was the most common immunosuppressive therapy directed at T cells during IA diagnosis. IA cases were categorized as proven (27%), probable (51%), or possible (22%) according to the 2008 European Organization for Research and Treatment of Cancer/Invasive Fungal Infections Cooperative Group and the National Institute of Allergy and Infectious Diseases Mycoses Study Group (EORTC/MSG) criteria. The lungs (78%) were the most common site of IA, and nodules were the most frequent radiological findings (75.5%). In 38 patients (64.4%) receiving antifungal prophylaxis, prophylactic agents included fluconazole (30.5%), liposomal amphotericin B (23.7%), posaconazole (8.5%), and voriconazole (1.7%). Initial treatment was most commonly administered as monotherapy (69.5%). The median antifungal treatment duration was 67 days. Eleven deaths (18.6%) were due to aspergillosis. With the increased use of corticosteroids, biological agents, and intensive immunosuppressive chemotherapy, IA will most likely continue to occur frequently in pediatric patients.

Keywords: bone marrow transplantation; febrile neutropenia; hematologic malignancy; invasive aspergillosis; solid organ transplantation.

MeSH terms

  • Antifungal Agents / therapeutic use
  • Aspergillosis* / diagnosis
  • Aspergillosis* / drug therapy
  • Aspergillosis* / epidemiology
  • Child
  • Female
  • Humans
  • Invasive Fungal Infections* / drug therapy
  • Invasive Fungal Infections* / epidemiology
  • Male
  • Retrospective Studies
  • Voriconazole

Substances

  • Antifungal Agents
  • Voriconazole