Evaluation of the Clinical Characteristics and Survival of Pediatric Patients with Invasive Aspergillosis: A 12-year Retrospective Cohort Study.

BACKGROUND

Invasive aspergillosis (IA) is a major cause of morbidity and mortality in immunocompromised children. Pediatric data are limited, and treatment guidelines often rely on adult studies. This study aimed to assess clinical characteristics and treatment outcomes of pediatric IA.

METHODS

We conducted a retrospective cohort study of pediatric patients (0-18 years) diagnosed with IA at a tertiary center in Türkiye between 2010 and 2022. Data on demographics, underlying conditions, Aspergillus species, antifungal susceptibility, treatment regimens, and outcomes were analyzed. Survival analysis was performed using Kaplan-Meier curves.

RESULTS

Fifty-five children met criteria for proven (69%) or probable (31%) IA after excluding 22 possible cases. Median age was 8.6 years; mortality did not differ significantly by age, sex, or underlying condition. Hematologic malignancies were the most common comorbidity (35%). Aspergillus fumigatus was the predominant species (57%), and no antifungal resistance was detected. Classical risk factors; central venous catheter use (53%), neutropenia (51%), and recent chemotherapy (35%) were frequent but showed no association with mortality. Lung involvement was the most common presentation (71%), followed by sinus (31%) and central nervous system involvement (13%). Thirty-day mortality was 11%, 12-week mortality was 20% (11/55), and overall mortality reached 29%.

CONCLUSIONS

Pediatric IA remains associated with substantial morbidity and mortality, although outcomes in this cohort were more favorable than those reported in many prior pediatric series. No single clinical, microbiological, or radiological factor reliably predicted mortality, underscoring the complexity of risk stratification. Early diagnosis and timely antifungal therapy remain essential, and multicenter prospective studies are needed to optimize treatment approaches.