Azole-Resistant Aspergillosis: An Emerging Diagnostic and Therapeutic Challenge in Paediatrics.

Authors

Natalia Mendoza-Palomar, Carlos Grasa Lozano, Begoña Carazo-Gallego, Elena María Rincón-López, Maria Pinyol-Sarrias, Anna Creus-Costa, Ana Méndez-Echevarría, Alfredo Maldonado-Barrueco, Yasmina Mozo, Diego Lozano-Durán, Maria Luisa Navarro Gómez, Jesús Guinea, Maria Concepción Mediavilla Gradolph, Pere Soler-Palacín, María Teresa Martín-Gómez

Published in

Mycoses. Volume 69. Issue 11.

Abstract

Invasive aspergillosis (IA) represents one of the most frequent invasive fungal infections in paediatric patients with risk factors. An increase in cases of azole-resistant IA has been reported in adult patients. The aim of this study is to present a series of 11 cases of paediatric patients with this pathology.
A retrospective descriptive study including paediatric patients with probable or proven azole-resistant IA treated between January 2019 and June 2024 in four tertiary hospitals in Spain.
Eleven cases are reported, all patients with risk factors for IA, mainly with haematopoietic stem cell transplantation (HCT) due to haematological malignancies and heart transplant in the early post-transplant period. These patients represent 22% of all proven or probable paediatric IA cases (n = 50) diagnosed in the study centres during the period. Five were previously receiving azole-based antifungal prophylaxis. The most frequently isolated species was Aspergillus fumigatus. Despite receiving at least partially active antifungals plus adjunctive treatment therapy from diagnosis, attributable mortality was high (8/11 patients).
Azole-resistant IA should be suspected in paediatric patients with risk factors, especially if they show poor clinical course or have received azole prophylaxis. The performance of invasive tests, as well as species identification and resistance testing, is essential to optimise treatment. In breakthrough IA it should be considered empirical treatment with an antifungal from a different class than the one used for prophylaxis, alone or in combination.

PMID:
42958853
Bibliographic data and abstract were imported from PubMed on 30 Oct 2026.

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