Abstract
Fungal infections of the lungs are relatively common and potentially life-threatening conditions in immunocompromised children. The role of imaging in children with lung mycosis is to delineate the extension of pulmonary involvement, to assess response to therapy, and to monitor for adverse sequelae such as bronchiectasis and cavitation. The aim of this paper is to show imaging findings in a series of patients with fungal pneumonia from two tertiary children’s hospitals, to discuss differential diagnoses and to show how imaging findings can vary depending on the host immune response.
![](http://media.springernature.com/m312/springer-static/image/art%3A10.1007%2Fs00247-016-3696-6/MediaObjects/247_2016_3696_Fig1_HTML.gif)
![](http://media.springernature.com/m312/springer-static/image/art%3A10.1007%2Fs00247-016-3696-6/MediaObjects/247_2016_3696_Fig2_HTML.gif)
![](http://media.springernature.com/m312/springer-static/image/art%3A10.1007%2Fs00247-016-3696-6/MediaObjects/247_2016_3696_Fig3_HTML.gif)
![](http://media.springernature.com/m312/springer-static/image/art%3A10.1007%2Fs00247-016-3696-6/MediaObjects/247_2016_3696_Fig4_HTML.gif)
![](http://media.springernature.com/m312/springer-static/image/art%3A10.1007%2Fs00247-016-3696-6/MediaObjects/247_2016_3696_Fig5_HTML.gif)
![](http://media.springernature.com/m312/springer-static/image/art%3A10.1007%2Fs00247-016-3696-6/MediaObjects/247_2016_3696_Fig6_HTML.gif)
![](http://media.springernature.com/m312/springer-static/image/art%3A10.1007%2Fs00247-016-3696-6/MediaObjects/247_2016_3696_Fig7_HTML.gif)
![](http://media.springernature.com/m312/springer-static/image/art%3A10.1007%2Fs00247-016-3696-6/MediaObjects/247_2016_3696_Fig8_HTML.gif)
![](http://media.springernature.com/m312/springer-static/image/art%3A10.1007%2Fs00247-016-3696-6/MediaObjects/247_2016_3696_Fig9_HTML.gif)
![](http://media.springernature.com/m312/springer-static/image/art%3A10.1007%2Fs00247-016-3696-6/MediaObjects/247_2016_3696_Fig10_HTML.gif)
![](http://media.springernature.com/m312/springer-static/image/art%3A10.1007%2Fs00247-016-3696-6/MediaObjects/247_2016_3696_Fig11_HTML.gif)
![](http://media.springernature.com/m312/springer-static/image/art%3A10.1007%2Fs00247-016-3696-6/MediaObjects/247_2016_3696_Fig12_HTML.gif)
![](http://media.springernature.com/m312/springer-static/image/art%3A10.1007%2Fs00247-016-3696-6/MediaObjects/247_2016_3696_Fig13_HTML.gif)
![](http://media.springernature.com/m312/springer-static/image/art%3A10.1007%2Fs00247-016-3696-6/MediaObjects/247_2016_3696_Fig14_HTML.gif)
![](http://media.springernature.com/m312/springer-static/image/art%3A10.1007%2Fs00247-016-3696-6/MediaObjects/247_2016_3696_Fig15_HTML.gif)
![](http://media.springernature.com/m312/springer-static/image/art%3A10.1007%2Fs00247-016-3696-6/MediaObjects/247_2016_3696_Fig16_HTML.gif)
Similar content being viewed by others
References
Catherinot E, Lanternier F, Bougnoux ME et al (2010) Pneumocystis jirovecii pneumonia. Infect Dis Clin North Am 24:107–138
Beauté J, Obenga G, Le Mignot L et al (2011) Epidemiology and outcome of invasive fungal diseases in patients with chronic granulomatous disease: a multicenter study in France. Pediatr Infect Dis J 30:57–62
Castagnola E, Mikulska M, Viscoli C et al (2015) Prophylaxis and empirical therapy of infection in cancer patients. In: Mandell, Douglas, Bennet (eds) Principles and practice of infectious diseases, 8th edn. Churchill-Livingstone-Elsevier, Philadelphia, pp 3395–3413
Biral E, Faraci M, Lanino E et al (2012) Mycobacterium tuberculosis pneumonia and bacteremia after hallogenic hematopoietic stem cell transplant: report of an instructive pediatric case. New Microbiol 35:353–357
Nucci M, Nouer SA, Anaissie E (2015) Distinguishing the causes of pulmonary infiltrates in patients with acute leukaemia. Clin Lymphoma Myeloma Leuk 15:S98–S103
Bergeron A, Porcher R, Sulahian A et al (2012) The strategy for the diagnosis of invasive pulmonary aspergillosis should depend on both the underlying condition and the leukocyte count of patients with hematologic malignancies. Blood 119:1831–1837
Wattier RL, Dvorak CC, Hoffman JA et al (2015) A prospective, international cohort study of invasive mold infections in children. J Pediatr Dis Soc 4:313–322
Steinbach WJ, Roilides E, Berman D et al (2012) Results from a prospective, international, epidemiologic study of invasive candidiasis in children and neonates. Pediatr Infect Dis J 31:1252–1257
Pappas PG, Alexander BD, Andes DR et al (2010) Invasive fungal infections among organ transplantation recipients: results of the Transplant-Associated Infection Surveillance Network (TRANSNET). Acta Pediatr 99:673–678
Winthrop KL, Novosad SA, Baddley JW et al (2015) Opportunistic infections and biologic therapies in immune-mediated inflammatory diseases: consensus recommendations for infection reporting during clinical trials and postmarketing surveillance. Ann Rheum Dis 74:2107–2116
Tragiannidis A, Roilides E, Walsh TJ et al (2012) Invasive aspergillosis in children with acquired immunodeficiencies. Clin Infect Dis 54:258–267
Sodhi KS, Khandelwal N, Saxena AK et al (2016) Rapid lung MRI in children with pulmonary infections: time to change our diagnostic algorithms. J Magn Reson Imaging 43:1196–1206
Donowitz GR, Harman C, Pope T et al (1991) The role of chest roentgenogram in febrile neutropenic patients. Arch Intern Med 151:701–704
Schueller G, Matzek W, Kalhs P et al (2005) Pulmonary infections in the late period after allogenic bone marrow transplantation: chest radiography versus computed tomography. Eur J Radiol 53:489–494
Lehrnbecher T, Koehl U, Wittekindt B et al (2008) Changes in host defence induced by malignancies and antineoplastic treatment: implication for immunotherapeutic strategies. Lancet Oncol 9:269–278
Kuhlman JE, Fishman EK, Siegelmann SS (1985) Invasive pulmonary aspergillosis in acute leukemia: characteristic findings on CT, the halo sign, and the role of CT in early diagnosis. Radiology 157:611–614
Greene RE, Schlamm HT, Oestmann JW (2003) Imaging findings in acute invasive pulmonary aspergillosis: clinical significance of the halo sign. Clin Infect Dis 44:373–379
Georgiadou SP, Sipsas NV, Marom EM et al (2011) The diagnostic value of halo and reverse halo signs for invasive mold infections in compromised hosts. Clin Infect Dis 52:1144–1155
Caillot D, Couaillier JF, Bernard A et al (2001) Increasing volume and changing characteristics of invasive pulmonary aspergillosis on sequential thoracic computed tomography scans in patients with neutropenia. J Clin Oncol 19:253–259
Kim MJ, Lee KS, Kim J et al (2001) Crescent sign in invasive pulmonary aspergillosis: frequency and related CT and clinical factors. J Comput Assist Tomogr 25:305–310
Horger M, Hebart H, Einsele H et al (2005) Initial CT manifestations of invasive pulmonary aspergillosis in 45 non-HIV immunocompromised patients: association with patient outcome? Eur J Radiol 55:437–444
Holland DV, Guillerman RP, Brody AS (2014) Thoracic manifestations of systemic diseases. In: Garcia-Pena P, Guillerman RP (eds) Pediatric chest imaging, 3rd edn. Springer, Heidelberg, pp 395–429
Burgos A, Zaoutis TE, Dvorak CC et al (2008) Pediatric invasive aspergillosis: a multicentre retrospective analysis of 139 contemporary cases. Pediatrics 121:e1286–e1294
Buckingham SJ, Hansell DM (2003) Aspergillus in the lung: diverse and coincident forms. Eur Radiol 13:1786–1800
Vail CM, Chiles C (1987) Invasive pulmonary aspergillosis: radiologic evidence of tracheal involvement. Radiology 165:745–746
Stevens DA, Moss RB, Kurup VP et al (2003) Allergic bronchopulmonary aspergillosis in cystic fibrosis – state of the art: Cystic Fibrosis Foundation Consensus Conference. Clin Infect Dis 37:S225–S264
Panchal N, Bhagat R, Pant C et al (1997) Allergic bronchopulmonary aspergillosis: the spectrum of computed tomography appearances. Respir Med 91:213–219
Gefter WB (1992) The spectrum of pulmonary aspergillosis. J Thorac Imaging 7:56–74
Hafeez I, Muers MF, Murphy SA et al (2000) Non-tuberculous mycobacterial lung infection complicated by chronic necrotising pulmonary aspergillosis. Thorax 55:717–719
George R, Andronikou S, Theron S et al (2009) Pulmonary infections in HIV-positive children. Pediatr Radiol 39:545–554
Schmiedel Y, Zimmerli S (2016) Common invasive fungal diseases: an overview of invasive candidiasis, aspergillosis, cryptococcosis, and Pneumocystis pneumonia. Swiss Med Wkly 146:w14281
Meersseman W, Lagrou K, Spriet I et al (2009) Significance of the isolation of Candida species from airway samples in critically ill patients: a prospective, autopsy study. Intensive Care Med 35:1526–1531
Pasqualotto AC (2009) Candida and the paediatric lung. Paediatr Respir Rev 10:186–191
Daltro P, Santos NE, Gasparetto TD et al (2011) Pulmonary infections. Pediatr Radiol 41:S69–S82
Pappas PG, Alexander BD, Andes DR et al (2010) Invasive fungal infections among organ transplant recipients: results of the Transplant-Associated Infection Surveillance Network (TRANSNET). Clin Infect Dis 50:1101–1111
Upton A, Marr KA (2006) Emergence of opportunistic mould infections in the hematopoietic stem cell transplant patient. Curr Infect Dis Rep 8:434–441
Cortez KJ, Roilides E, Quiroz-Telles F et al (2008) Infection caused by Scedosporium spp. Clin Microbiol Rev 21:157–197
Girmenia C, Pagano L, Martino B et al (2005) Invasive infections caused by Trichosporon species and Geotrichum capitatum in patients with hematological malignancies: a retrospective multicenter study from Italy and review of the literature. J Clin Microbiol 43:1818–1828
Phulpin-Weibel A, Gaspar N, Emirian A et al (2013) Focus on invasive mucormycosis in paediatric haematology oncology patients: a series of 11 cases. Mycoses 56:236–240
Kawel N, Schorer GM, Desbiolles L et al (2011) Discrimination between invasive pulmonary aspergillosis and pulmonary lymphoma using CT. Eur J Radiol 77:417–425
Westra SJ, Brody AS, Mahani MG et al (2015) The incidental pulmonary nodule in a child. Part 1. Pediatr Radiol 45:628–633
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflicts of interest
None
Rights and permissions
About this article
Cite this article
Toma, P., Bertaina, A., Castagnola, E. et al. Fungal infections of the lung in children. Pediatr Radiol 46, 1856–1865 (2016). https://doi.org/10.1007/s00247-016-3696-6
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00247-016-3696-6