In addition to the mycoses listed by individual agents (aspergillosis, blastomycosis, candidiasis, coccidioidomycosis, cryptococcosis, paracoccidioidomycosis, and sporotrichosis) in Section 3, infants and children with immunosuppression or other underlying conditions can become infected by uncommonly encountered fungi. Children can acquire infection with these fungi through inhalation via the respiratory tract or direct inoculation after traumatic disruption of cutaneous barriers. A list of these fungi and the pertinent underlying host conditions, reservoir or route of entry, Clinical Manifestations, diagnostic laboratory tests, and Treatment for each can be found in Table 3.6 . Taken as a group, few fungal susceptibility data are available on which to base Treatment recommendations for these fungal infections, especially in children. Consultation with a pediatric infectious disease specialist experienced in the diagnosis and Treatment of invasive fungal infections should be considered when caring for a child infected with one of these mycoses.

Table 3-6

Footnotes

a . Consider use of a lipid-associated formulation of amphotericin B.

b . Infection may be refractory to amphotericin B; use of investigational antifungal compounds may be required.

c . Voriconazole is an alternative agent for adults intolerant of, or with infection refractory to, amphotericin B.

d . Itraconazole has been shown to be effective for cutaneous disease in adults, but safety and efficacy have not been established in children younger than 12 years of age.

e . Itraconazole may be the Treatment of choice, but data on safety and effectiveness in children are limited.

f . Voriconazole demonstrates activity in vitro, but no clinical data are available.

g . Posaconazole demonstrates activity in vitro, but few clinical data are available for children.