Invasive fungal infections in children.

The past two decades have seen a considerable increase in both frequency and importance of opportunistic invasive fungal infections in pediatric hospitals. At the same time, major advances have been made in the diagnosis of fungal diseases, the development of algorithms of antifungal interventions, and the design and implementation of pediatric clinical trials. Most importantly, several new antifungal agents have entered clinical practice with the result that antifungal therapy has become safer, more effective, but also more complicated. This article reviews the current epidemiology of invasive fungal infections in pediatric patients, new emerging diagnostic modalities and concepts for their treatment and prevention. CURRENT EPIDEMIOLOGY Invasive fungal infections (IFIs) occur in neonates and children with compromised immune system or in critical condition. These include premature neonates, patients in pediatric intensive care units, with implants and burns, with congenital immunodeficiencies, neutropenia, hematopoietic stem cell transplantation (HSCT), solid organ transplantation, HIV infection and treated with immunosuppressants. Infections in these patients are due to Candida spp., Aspergillus spp., Cryptococcus spp. and other, less frequent opportunistic fungi.