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Investigating the child with possible immunodeficiency 

Investigating the child with possible immunodeficiency
Chapter:
Investigating the child with possible immunodeficiency
DOI:
10.1093/med/9780198729228.003.0034
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date: 26 June 2019

The management of invasive fungal infections is hampered by poor diagnostic measures and a restricted arsenal of antifungal drugs, while the incidence of invasive fungal infections in children is rising due to an increasing number of immunocompromised children. Children particularly at risk are those prematurely born or requiring intensive care treatment, those undergoing intensive chemotherapy or haematopoietic stem cell transplantation for the treatment of malignancies, those with primary immune disorders, and those receiving extensive immunosuppressive treatment, including the use of monoclonal antibodies for the prevention and treatment of graft-versus-host disease and for the treatment of rheumatological, autoinflammatory, and autoimmune conditions. Aspergillus and Candida species have been the commonest pathogens isolated, but, over the past few decades, there has been an emergence of invasive infections caused by Cryptococcus species, Mucorales, Fusarium species, and Scedosporium species, among other filamentous fungi (moulds). Mortality related to invasive fungal infections remains high, despite the development of new management strategies, and depends strongly on the reversal of the underlying immune dysfunction.

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