Invasive fungal infections: case-based presentation in pediatric patients.

This supplement is in part based on a closed roundtable meeting that was held April 30, 2009 in New York City and was jointly sponsored by Postgraduate Institute for Medicine and Global Education Exchange, LLC. through an educational grant from Merck & Co., Inc. The roundtable is available as a free CME webinar on www.doctorfungus.org. The articles comprising this in-journal supplement were reviewed by two referees utilizing CMRO’s customary rigorous peer-review process.


Preface
Invasive fungal infections are a major source of morbidity and mortality in immunocompromised children and neonates, particularly in preterm infants. This in-journal supplement intends to review the current clinical data relating to the presentation and clinical management of pediatric invasive fungal infections, as well as to evaluate current clinical practices in light of recent data to optimize clinical outcomes. The three review articles incorporate case studies to illustrate the salient features of invasive mycoses in infants and children. These cases underscore the inherent complexities of invasive mycoses in children, while providing a better understanding of the risk factors, pathophysiology, and age-appropriate pharmacotherapy for invasive aspergillosis and invasive candidiasis. The supplement begins with an article by Dr. Theoklis Zaoutis, who provides an overview of candidemia in children and discusses choices of antifungal therapy and treatment recommendations of the Infectious Diseases Society of America. This is followed by a review of neonatal candidiasis by Dr. David Kaufman, with an emphasis on antifungal prophylaxis. Finally, Dr. William Steinbach focuses on the unique clinical features of pediatric aspergillosis and reviews key treatment recommendations. Each of the three articles also brings forth the views of infectious disease thought leaders and clinicians dedicated to the study of pediatric fungal infections.
We are grateful to the authors, who formed the faculty for this CME-accredited educational activity designed to meet the educational needs of pediatricians, infectious disease specialists, general practitioners, and other healthcare providers involved in the care and management of pediatric patients with invasive fungal diseases. The articles are based in part on a closed roundtable meeting that was held on April 30, 2009, in New York, NY, USA, which is available as a webinar on www. doctorfungus.org.
We would like to acknowledge Merck & Co., Inc. for providing the educational grant in support of this publication. However, the views expressed are entirely those of the authors. The articles each underwent CMRO's standard, rigorous peer-review process. In addition, the reader is directed to the Program Information, including the CME accreditation statement, and financial disclosures available on page 1755-1760.
Finally, the joint sponsors of this activity, Postgraduate Institute for Medicine and Global Education Exchange, LLC., value your feedback. At the conclusion of this activity, please take the time to complete and return the evaluation form and the CME assessment. Your opinions are important in assessing the effectiveness of this educational activity and in guiding the development of future programs.

Program information
Invasive fungal infections: case-based presentation in pediatric patients

Program description
Invasive fungal infections are a major source of morbidity and mortality in immunocompromised children and neonates, particularly in preterm infants. Neonates and pediatric patients have traditionally been underrepresented in clinical trials. Consequently, there is a paucity of pediatric clinical data; many therapeutic decisions in children are often extrapolated from clinical data obtained from adult patients. While many aspects of invasive mycoses are similar between adults and children, there are important differences between the two with respect to the epidemiology of different fungi, their clinical presentations, and the pharmacokinetic parameters of various antifungal agents, such that extrapolations may not always be justified or safe. Furthermore, neonates are so vastly different from older children and adults that they need to be considered separately. Recently, a large pediatric phase 3 clinical trial was concluded and others like it are on the way, which will provide evidence-based, more effective therapeutic strategies for pediatric patients.
This case-based publication will focus on the pathogenesis, diagnosis, and state-of-the-art treatment of invasive candidiasis and aspergillosis in pediatric patients. This evidence-based update will provide the clinician with a rational approach to the management of systemic fungal infections.

Learning objectives
Describe the diagnostic workup in neonates and children with invasive fungal infections Outline preventive measures and the role of prophylaxis and empiric therapy in neonatal candidiasis Specify management strategies for invasive fungal infections in pediatric patients Discuss the clinical application of the new developments in antifungal therapy

Target audience
This activity has been designed to meet the educational needs of pediatricians, infectious disease specialists, general practitioners, and other healthcare providers involved in the care of pediatric patients with invasive fungal diseases.

Accreditation statement
This activity has been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of Postgraduate Institute for Medicine (PIM) and Global Education Exchange, LLC. (GLOBEX). PIM is accredited by the ACCME to provide continuing medical education for physicians.

Credit designation
Postgraduate Institute for Medicine designates this educational activity for a maximum of 1.75 AMA PRA Category 1 Credit(s) TM . Physicians should only claim credit commensurate with the extent of their participation in the activity.