Temporal Trends and Clinical Outcomes of Pediatric Invasive Fungal Diseases: A Ten-Year Retrospective Study from a Tertiary-Care Center in Thailand

Abstract Background: Invasive fungal diseases (IFDs) remain an important cause of morbidity and mortality among immunocompromised children. Changes in diagnostic criteria and increasing use of antifungal prophylaxis may influence the epidemiology and clinical presentation of pediatric IFDs. Longitudinal data from Southeast Asia remain limited. This study aimed to characterize temporal trends, clinical features, and outcomes of pediatric IFDs using the 2020 EORTC/MSGERC criteria. Methods: We retrospectively reviewed children aged 0–15 years diagnosed with IFDs at a tertiary-care hospital in Bangkok, Thailand, from 2014 to 2023. IFD episodes were classified as proven, probable, or possible according to the 2020 EORTC/MSGERC criteria and categorized by causative organism. Temporal trends, clinical characteristics, antifungal prophylaxis exposure, and outcomes were analyzed. Results: Among 156 patients, 171 IFD episodes were identified: invasive aspergillosis (60 episodes), invasive candidiasis (61), Pneumocystis pneumonia (33), cryptococcosis (5), other invasive mold infections (8), and endemic mycoses (4). Invasive aspergillosis and Pneumocystis pneumonia demonstrated greater year-to-year variability with higher case numbers in later years, whereas invasive candidiasis occurred consistently throughout the study. A proportion of IFD episodes occurred despite antifungal prophylaxis, including 23.3% of invasive aspergillosis, 8.2% of invasive candidiasis, and 12.1% of Pneumocystis pneumonia. Hematologic malignancies were the most common underlying conditions among children with invasive aspergillosis(68.3%) and Pneumocystis pneumonia (27.3%). Invasive candidiasis primarily affected infants and young children with chronic conditions, including chronic liver or gastrointestinal disease (25.4%) and congenital heart disease (25.4%), and was strongly associated with central venous catheter use (88.9%). Candida albicans remained the most common pathogen, with overall low antifungal resistance. The clinical manifestations were non-specific and overlapped across pathogens, most commonly presenting with fever and organ-specific symptoms. Ninety-day all-cause mortality was 20.3% for aspergillosis, 24.8% for candidiasis, and 12.9% for Pneumocystis pneumonia. Conclusions: Pediatric IFDs remained associated with substantial mortality despite evolving diagnostic criteria and increasing use of antifungal prophylaxis, underscoring the need for improved diagnostic and preventive strategies.