Diagnosis of invasive fungal disease in children: a narrative review

ABSTRACT

Introduction: Invasive fungal diseases (IFD) represent important causes of morbidity and mortality in pediatrics. Early diagnosis and treatment of IFD is associated with better outcome and this entails the need to use fast and highly sensitive and specific methods that can support clinicians in the management of IFD.

Areas covered: A narrative review was performed on conventional diagnostic methods such as culture, microscopy and histopathology are still gold standard but are burdened by a lack of sensitivity and specificity; on the other hand, imaging and noninvasive antigen-based such as beta-D-glucan, galactomannan and molecular biomarkers are the most convenient nonculture methods for diagnosis and monitoring effects of therapy. Aim of the present review is to summarize what is available in these fields at end of the second decade of the third millennium and look for future perspectives.

Expert opinion: Promising and useful diagnostic methods have been applied in infectious disease diagnosis in clinical practice or in designing platforms. Unfortunately, most of them are not standardized or validated in pediatric population. However, clinicians should be aware of all innovative diagnostic tools to use in combination with conventional diagnostic methods for a better management of pathology and patient.

KEYWORDS:

• Invasive fungal infection
• pediatric patients
• diagnostic methods
• diagnosis
• treatment

Article highlights

• Conventional diagnostic methods such as culture, microscopy and histopathology are still gold standard but are burdened by not high sensitivity and specificity and sometimes require invasive procedures to obtain samples.

• Non-invasive antigen-based tests such as beta-D-glucan, galactomannan and molecular biomarkers are the most convenient nonculture methods for diagnosing of symptomatic patients and for monitoring effects of therapy.

• Imaging is widely used in management strategies of IFD in pediatrics, alone or in combination with biomarkers, but sometimes in children its use is limited by radiation exposure

• Prediction rules, i.e. scoring system can help to detect patients with a high probability of developing or being already affected by an IFD, but there is none of such items validated in pediatrics

• Future perspectives in diagnosis of IFD are promising but limited by absence of data in pediatric setting.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.