The Challenge of Diagnosing Invasive Pulmonary Aspergillosis in Children: A Review of Existing and Emerging Tools

Daniel K Yeoh; Brendan J McMullan; Julia E Clark; Monica A Slavin; Gabrielle M Haeusler; Christopher C Blyth

doi:10.1007/s11046-023-00714-4

The Challenge of Diagnosing Invasive Pulmonary Aspergillosis in Children: A Review of Existing and Emerging Tools

Mycopathologia. 2023 Oct;188(5):731-743. doi: 10.1007/s11046-023-00714-4. Epub 2023 Apr 8.

Authors

Daniel K Yeoh^{1

2

3

4

5}, Brendan J McMullan^{6

7

8}, Julia E Clark^{9

10}, Monica A Slavin^{6

11

12}, Gabrielle M Haeusler^{6

11

13

12

14

15}, Christopher C Blyth^{16

17

18

19}

Affiliations

¹ Department of Infectious Diseases, Perth Children's Hospital, 15 Hospital Avenue, Perth, WA, 6009, Australia. daniel.yeoh@health.wa.gov.au.
² Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, VIC, Australia. daniel.yeoh@health.wa.gov.au.
³ National Centre for Infections in Cancer, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia. daniel.yeoh@health.wa.gov.au.
⁴ Murdoch Children's Research Institute, Parkville, VIC, Australia. daniel.yeoh@health.wa.gov.au.
⁵ Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth, WA, Australia. daniel.yeoh@health.wa.gov.au.
⁶ Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, VIC, Australia.
⁷ Department of Immunology and Infectious Diseases, Sydney Children's Hospital, Randwick, NSW, Australia.
⁸ School of Women's and Children's Health, UNSW, Sydney, NSW, Australia.
⁹ Infection Management Service, Queensland Children's Hospital, Brisbane, QLD, Australia.
¹⁰ School of Clinical Medicine, Children's Health Queensland Clinical Unit, The University of Queensland, Brisbane, QLD, Australia.
¹¹ National Centre for Infections in Cancer, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia.
¹² Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia.
¹³ Murdoch Children's Research Institute, Parkville, VIC, Australia.
¹⁴ Department of Infectious Diseases, Royal Children's Hospital, Parkville, VIC, Australia.
¹⁵ The Paediatric Integrated Cancer Service, Melbourne, VIC, Australia.
¹⁶ Department of Infectious Diseases, Perth Children's Hospital, 15 Hospital Avenue, Perth, WA, 6009, Australia.
¹⁷ Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth, WA, Australia.
¹⁸ Department of Microbiology, PathWest Laboratory Medicine WA, Nedlands, WA, Australia.
¹⁹ School of Medicine, University of Western Australia, Perth, WA, Australia.

Abstract

Invasive pulmonary aspergillosis remains a major cause of morbidity and mortality for immunocompromised children, particularly for patients with acute leukaemia and those undergoing haematopoietic stem cell transplantation. Timely diagnosis, using a combination of computed tomography (CT) imaging and microbiological testing, is key to improve prognosis, yet there are inherent challenges in this process. For CT imaging, changes in children are generally less specific than those reported in adults and recent data are limited. Respiratory sampling by either bronchoalveolar lavage or lung biopsy is recommended but is not always feasible in children, and serum biomarkers, including galactomannan, have important limitations. In this review we summarise the current paediatric data on available diagnostic tests for IPA and highlight key emerging diagnostic modalities with potential for future use.

Keywords: Aspergillus; Children; Diagnostic imaging; Diagnostic mycology; Invasive pulmonary aspergillosis.

Publication types

Review

MeSH terms

Adult
Biomarkers
Bronchoalveolar Lavage Fluid / microbiology
Child
Humans
Invasive Pulmonary Aspergillosis* / diagnosis
Invasive Pulmonary Aspergillosis* / etiology
Mannans
Prognosis
Sensitivity and Specificity
Tomography, X-Ray Computed / adverse effects

Substances

Biomarkers
Mannans