Pediatric populations at risk for invasive infections

The pediatric populations at risk can be defined by specific predisposing defects in host defenses and several additional, non-immunological factors. In general, deficiencies in the number or function of phagocytic cells are associated with invasive infections by opportunistic fungi, such as Candida spp., Aspergillus spp., zygomyces spp. and a large variety of other, less frequently encountered yeasts and molds. In contrast, deficiencies or imbalances of T lymphocyte function are linked to mucocutaneous candidiasis and invasive infections by Cryptococcus neoformans and the dimorphic moulds (Fig. 1). Non-immunological factors include the necessary exposure to the organism, preexisting tissue damage, and, limited to Candida spp., the presence of indwelling vascular catheters, colonization of mucous membranes, the use of broad-spectrum antibiotics, parenteral nutrition, and complicated intra-abdominal surgery [28].

In extension of this classification, the pediatric populations at risk for invasive fungal infections include neonates, in particular preterm neonates; pediatric patients with congenital immunodeficiencies involving phagocytic or T lymphocyte functions; pediatric patients with acquired immunodeficiencies such as HIV infection, cancer, hematopoietic stem cell transplantation (HSCT) or solid organ transplantation, and immunosuppressive treatment with corticosteroids; children of all age groups beyond the neonatal period that are hospitalized for severe acute illnesses; and those with chronic-destructive lung disease (Tab. 1).

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