CHOP-led Research Network Assesses Utility of Diagnostic Tools and Treatment Options for Pediatric Fungal Infection

Two recent studies by the International Pediatric Fungal Network, a group co-led by researchers at Children’s Hospital of Philadelphia (CHOP), have assessed a variety of diagnostic tests as well as antifungal therapy options for the diagnosis and initial treatment of invasive candidiasis, a yeast infection that can be life-threatening for children and adolescents.  

Brian Fisher, DO, MPH, MSCE Although professional guidelines exist for the treatment of adults with invasive candidiasis, such parameters do not exist for pediatric patients. In order to improve on the initial diagnostic approach and therapy decisions for invasive candidiasis in this population, the research network, co-led by Brian Fisher, DO, MPH, MSCE, attending physician in the Department of Infectious Diseases at CHOP, conducted two separate studies.

The first study, published in Clinical Infectious Diseases, focused on improving the time to detection of invasive candidiasis in pediatric patients by assessing the utility of certain fungal  biomarkers. Given that fungal infections can initially present similarly to bacterial infections, clinicians cannot rely on symptomatic presentation alone and need additional testing to confirm the diagnosis. However, the current standard of care is a blood culture, which can take 24 or more hours to detect the infection, delaying initial therapy. New diagnostic fungal biomarkers are approved for diagnosis of invasive candidiasis in adults, but their use in children and adolescents has not been studied to date.

The research team analyzed the utility of four commercially available fungal biomarkers in pediatric patients between 4 months and 18 years of age at risk for invasive candidiasis. Of the four tests, the researchers found that T2Candida alone or in combination with Platelia Candida Ag Plus provided the most reliable rapid detection of Candida species in children with concern for invasive candidiasis.

In the second study, published in the Journal of the Pediatric Infectious Diseases Society, the researchers compared echinocandins to triazoles or amphotericin B formulations (triazole/amphotericin B) as the initial treatment for invasive candidiasis. Analyzing patients between the ages of 4 months and 18 years at 43 International Pediatric Fungal Network sites, the researchers included 541 participants in the study who had been diagnosed with invasive candidiasis between 2014 and 2017.

Of those patients, 235 received an echinocandin as initial therapy and 306 were in the triazoles/amphotericin B group. The researchers found that initial directed therapy with an echinocandin was associated with reduced failure rate at 14 days but not 30 days, suggesting echinocandins may be preferable as initial directed therapy for invasive candidiasis in children and adolescents.

“Together, these studies provide data on diagnosis and treatment of pediatric patients with invasive candidiasis, which will hopefully lead to evidence-based guidelines specific to children and adolescents,” Dr. Fisher said.

Learn more about the International Pediatric Fungal Network.