Management of pediatric pulmonary aspergillosis

Invasive pulmonary aspergillosis (IPA) illustrates a severe illness in immunocompromised children; however, its optimal management still remains arguable. To better clarify this issue, the present study performed a literature search through reputed databases to identify current risk factors and diagnostic, therapeutic, and prophylactic methods for invasive pulmonary aspergillosis (IPA) in the pediatric population. It searched for observational studies and clinical trials regarding diagnosis, treatment, and prophylaxis and summarised the results. The study included five clinical trials and 25 observational studies (4453 patients).

The study observed-

• Hematological malignancies, previous organ transplants, and other primary or acquired immunodeficiencies are risk factors for children's IPA.
• Current diagnostic criteria differentiate between "proven," "probable," and "possible" disease. 
• Consecutive galactomannan assays hold good sensitivity and specificity, mainly when executed on broncho-alveolar lavage. 
• Simultaneously, β-D-glucan should not be used as the cut-off in children is unclear. 
• PCR assays are not currently advised to use routinely.
• Voriconazole remains the first-line agent for IPA in children aged >2 years. 
• Liposomal amphotericin B is advised in younger patients or cases intolerant to voriconazole. 
• Plasma concentrations of Liposomal amphotericin B should be monitored throughout the treatment. 
• The optimal duration of therapy still needs to be established.
• Posaconazole is the preferred prophylactic agent in children >13 years old, while oral voriconazole or itraconazole are the drugs of choice for those between 2–12 years. 
• Further good-quality studies are needed to improve clinical practice.

Terlizzi V, Motisi MA, Pellegrino R. et al. Management of pulmonary aspergillosis in children: a systematic review. Ital J Pediatr. 2023; 49. https://doi.org/10.1186/s13052-023-01440-9