Diagnosis of fungal respiratory infections in immunocompetent children.

Fungal respiratory infections are rare in immunocompetent children, and their recognition remains challenging since clinical features are often subacute and overlapping with other causes of respiratory disease. A structured diagnostic approach is fundamental to facilitating earlier diagnosis and prompt targeted therapy, thereby improving outcomes. Fungal spores are ubiquitous in the environment and fungal colonisation of skin and mucosal membranes is common, hence differentiation of infection from colonisation is key to an accurate diagnosis and a prudent approach to management. The diagnosis of invasive fungal infection should prompt consideration of underlying immunocompromise where appropriate. Approaches to the diagnosis of invasive fungal infections in children with known immune defects, particularly in the haematology and oncology setting, are covered extensively elsewhere and are not the subject of this review.