Pediatric fungal infections

Ref ID: 17427

Author: E. Roilides

Author address:

3rd Dept Pediatrics, Aristotle Unviersity, Thessaloniki, Greece

Full conference title:

Trends in Medical Mycology, 5th

Date: 2 October 2014

Abstract:

Invasive fungal infections (IFI) are important complications in various
fields of contemporary Pediatrics. The increase of immunocompromised
and intensely treated patients surviving is one of the causes for this.
Candida spp. are almost always the causes of IFI in pre-mature
neonates. Rarely other fungi including Trichosporon, Malassezia,
Aspergillus, Zygomycetes may also cause IFI in these patients. Candida
albicans is the most frequent species with Candida parapsilosis following
it. Indeed, C. parapsilosis is a more frequent isolate in neonates than
adults and is usually associated with horizontal transmission in the
NICU. Candida is also a significant problem in children hospitalized in
PICU and those with other risk factors, such as central vascular
catheters, GI surgery and administration of multiple antibiotics.
Aspergillus spp. and other rare filamentous fungi, such as Scedosporium
and Fusarium are an important problem in older children with either
primary or acquired immunodeficiencies. For example, patients with
chronic granulomatous disease are very susceptible to Aspergillus
infections. Patients with hematological malignancies, hematopoietic
stem cell transplantation, solid organ transplantation or corticosteroid
therapy are also differentially susceptible to filamentous fungi. A
category of patients that has become more important recently is the
cystic fibrosis patients, who may be either colonized by Aspergillus spp.
or sometimes with rare moulds in their respiratory tract, or develop
allergic bronchopulmonary aspergillosis or rarely invasive pulmonary
aspergillosis.
Favorable outcome of IFI requires early diagnosis and prompt
treatment. It has been shown that the earlier the diagnosis the better
the outcome of IFI. Early diagnosis, however, is a difficult task
especially in pediatric patients. Conventional methods of culture and
histology are not sensitive and particularly specific. More recently,
detection of serological markers (galactomannan for Aspergillus, bglucan
and others) have been under study in pediatric patients. Highresolution
CT has been an advancement in pulmonary aspergillosis but
it is not specific especially in pediatric patients.
Most therapeutic trials have not included pediatric patients. The
therapeutic trials for infants and children are rather few and many
pediatric practices are inferred from adult data. A major difference
between children and adults is the difference in pharmacokinetics
(usually more rapid clearance) in young children as compared to
adults. Voriconazole is an important example of this difference. Thus,
the doses of voriconazole required to administer to children in order
to achieve the same exposure of the organism are larger than those
required in adults. In very-low-birth-weight infants and in NICU with
high incidence of Candida infections, fluconazole prophylaxis is
recommended. Amphotericin B (either deoxycholate or liposomal)
or fluconazole (if not used prophylactically) are first-line therapies in
neonates. Catheter removal is necessary, especially in neonates.
Voriconazole, first line for aspergillosis, is not recommended under
the age of 2 years. Among echinocandins, micafungin has been
mostly studied in young ages followed by caspofungin and anidulafungin.
Invasive zygomycosis (mucormycosis) is rare in pre-mature neonates
but if it occurs has very high mortality requiring aggressive
surgery (if feasible) and antifungal therapy with amphotericin B.
Posaconazole has not been adequately studied in children.

Abstract Number: PS2.2

Conference Year: 2011

Link to conference website: NULL

New link: NULL


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