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Abstract

Vol.68 No.2 March 2020

Deep-seated mycoses in children~According to the management guidelines for deep-seated mycoses 2014 in the pediatric field (Supplementary edition)~

Masaaki Mori

Department of Lifetime Clinical Immunology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, Japan

Abstract

We recognize that the risk of developing a deep-seated mycoses has recently increased more than before due to the advancement of aggressive immunotherapy for underlying diseases, in addition to the immature immune system associated with growth in children. The diagnosis of deep-seated mycoses in children is difficult, but fungemia, meningitis, respiratory infections (pneumonia, lung abscess, interstitial pneumonia, etc.), and gastrointestinal tract infections have been reported. In addition to the existence of unknown causes or antibiotic-associated refractory fever, it is possible to detect and identify the primary disease (chromosomal abnormality, immunodeficiency, malignancy, etc.), family history (increased susceptibility to infection), and patient-associated risk factors (using corticosteroids, immunosuppressive drugs or an artificial respirator).
In recent years, a total of five antifungal drugs have been approved for use in children in Japan including voriconazole and caspofungin in addition to the three agents, micafungin, liposomal amphotericin B, and fluconazole. When considering sensitivity and tolerability, it is necessary to pay attention to medicines that are used outside of the indication (off label) in children who need to be treated. The administration of antifungal drugs in the pediatric field needs to be carefully monitored for side effects while taking effectiveness into consideration. In many cases, a deep-seated mycoses is caused by various immunologic disorders in the host. The combination of adequate adjuvant therapy against these disorders is also important to obtain efficacy in treating the mycosis.
In view of the above situation, in September 2015, a supplementary edition to the existing guidelines was created by adding newly acquired drugs in the pediatric field. In the supplementary guidelines, the descriptions in the pediatric field are focused in detail on "immunodeficiency disease", "pediatric blood/neoplastic disease", and "newborn", in addition to the background of "deep-seated mycoses", risk factors, diagnosis, and treatment in each field.

Key word

deep-seated mycoses, Japanese guideline, child

Received

October 16, 2018

Accepted

November 6, 2019

Jpn. J. Chemother. 68 (2): 216-222, 2020