Management of pulmonary aspergillosis in children: a systematic review
Abstract Invasive pulmonary aspergillosis (IPA) is a severe condition in immunocompromised children, but the optimal management is still under debate. In order to better clarify this issue, a literature search was performed through MEDLINE/PubMed database to describe current risk factors and diagnos...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2023-03-01
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| Series: | Italian Journal of Pediatrics |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s13052-023-01440-9 |
| _version_ | 1827974409967632384 |
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| author | Vito Terlizzi Marco Antonio Motisi Roberta Pellegrino Luisa Galli Giovanni Taccetti Elena Chiappini |
| author_facet | Vito Terlizzi Marco Antonio Motisi Roberta Pellegrino Luisa Galli Giovanni Taccetti Elena Chiappini |
| author_sort | Vito Terlizzi |
| collection | DOAJ |
| description | Abstract Invasive pulmonary aspergillosis (IPA) is a severe condition in immunocompromised children, but the optimal management is still under debate. In order to better clarify this issue, a literature search was performed through MEDLINE/PubMed database to describe current risk factors and diagnostic, therapeutic and prophylactic tools for invasive pulmonary aspergillosis (IPA) in the paediatric age. Observational studies and clinical trials regarding diagnosis, treatment and prophylaxis were considered, and results were summarised. Five clinical trials and 25 observational studies (4453 patients) were included. Haematological malignancies, previous organ transplant and other primary or acquired immunodeficiency were identified as risk factors for IPA in children. Current diagnostic criteria distinguish between "proven", "probable" and "possible" disease. Consecutive galactomannan assays have good sensitivity and specificity, especially when performed on broncho-alveolar lavage. At the same time, β-D-glucan should not be used since cut-off in children is unclear. PCR assays cannot currently be recommended for routine use. Voriconazole is the recommended first-line agent for IPA in children older than 2 years of age. Liposomal amphotericin B is preferred in younger patients or cases of intolerance to voriconazole. Its plasma concentrations should be monitored throughout the treatment. The optimal duration of therapy has yet to be determined. Posaconazole is the preferred prophylactic agent in children older than 13 years old, whereas oral voriconazole or itraconazole are the drugs of choice for those between 2–12 years. Further good-quality studies are warranted to improve clinical practice. |
| first_indexed | 2024-04-09T19:53:55Z |
| format | Article |
| id | doaj.art-23e914c4e79c437fab2379b6298df4cb |
| institution | Directory Open Access Journal |
| issn | 1824-7288 |
| language | English |
| last_indexed | 2024-04-09T19:53:55Z |
| publishDate | 2023-03-01 |
| publisher | BMC |
| record_format | Article |
| series | Italian Journal of Pediatrics |
| spelling | doaj.art-23e914c4e79c437fab2379b6298df4cb2023-04-03T05:34:48ZengBMCItalian Journal of Pediatrics1824-72882023-03-0149111710.1186/s13052-023-01440-9Management of pulmonary aspergillosis in children: a systematic reviewVito Terlizzi0Marco Antonio Motisi1Roberta Pellegrino2Luisa Galli3Giovanni Taccetti4Elena Chiappini5Cystic Fibrosis Regional Reference Center, Department of Paediatric Medicine, Meyer Children’s Hospital IRCCSPediatrics resident, Department of Health Sciences, Meyer Children’s University Hospital IRCCS, University of FlorencePediatrics resident, Department of Health Sciences, Meyer Children’s University Hospital IRCCS, University of FlorenceInfectious Diseases Unit, Department of Health Sciences, Meyer Children’s University Hospital IRCCS, University of FlorenceCystic Fibrosis Regional Reference Center, Department of Paediatric Medicine, Meyer Children’s Hospital IRCCSInfectious Diseases Unit, Department of Health Sciences, Meyer Children’s University Hospital IRCCS, University of FlorenceAbstract Invasive pulmonary aspergillosis (IPA) is a severe condition in immunocompromised children, but the optimal management is still under debate. In order to better clarify this issue, a literature search was performed through MEDLINE/PubMed database to describe current risk factors and diagnostic, therapeutic and prophylactic tools for invasive pulmonary aspergillosis (IPA) in the paediatric age. Observational studies and clinical trials regarding diagnosis, treatment and prophylaxis were considered, and results were summarised. Five clinical trials and 25 observational studies (4453 patients) were included. Haematological malignancies, previous organ transplant and other primary or acquired immunodeficiency were identified as risk factors for IPA in children. Current diagnostic criteria distinguish between "proven", "probable" and "possible" disease. Consecutive galactomannan assays have good sensitivity and specificity, especially when performed on broncho-alveolar lavage. At the same time, β-D-glucan should not be used since cut-off in children is unclear. PCR assays cannot currently be recommended for routine use. Voriconazole is the recommended first-line agent for IPA in children older than 2 years of age. Liposomal amphotericin B is preferred in younger patients or cases of intolerance to voriconazole. Its plasma concentrations should be monitored throughout the treatment. The optimal duration of therapy has yet to be determined. Posaconazole is the preferred prophylactic agent in children older than 13 years old, whereas oral voriconazole or itraconazole are the drugs of choice for those between 2–12 years. Further good-quality studies are warranted to improve clinical practice.https://doi.org/10.1186/s13052-023-01440-9PULMONARY aspergillosisChildrenGalactomannanβ-D-glucanVoriconazole |
| spellingShingle | Vito Terlizzi Marco Antonio Motisi Roberta Pellegrino Luisa Galli Giovanni Taccetti Elena Chiappini Management of pulmonary aspergillosis in children: a systematic review Italian Journal of Pediatrics PULMONARY aspergillosis Children Galactomannan β-D-glucan Voriconazole |
| title | Management of pulmonary aspergillosis in children: a systematic review |
| title_full | Management of pulmonary aspergillosis in children: a systematic review |
| title_fullStr | Management of pulmonary aspergillosis in children: a systematic review |
| title_full_unstemmed | Management of pulmonary aspergillosis in children: a systematic review |
| title_short | Management of pulmonary aspergillosis in children: a systematic review |
| title_sort | management of pulmonary aspergillosis in children a systematic review |
| topic | PULMONARY aspergillosis Children Galactomannan β-D-glucan Voriconazole |
| url | https://doi.org/10.1186/s13052-023-01440-9 |
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