Management is controversial and may range from watchful waiting for asymptomatic and otherwise healthy children to surgical resection in patients with symptoms. 233.3 Invasive Disease Invasive Aspergillus infection is characterized by hyphal infiltration of vascular structures, thrombosis, and focal necrosis. Primary invasive disease may occur at any site in which airborne conidia may colonize and germinate, such as the respiratory tract or skin. In the severely neutropenic child, dissemination follows direct extension from the primary site and hematogenous seeding of distant sites. Sinonasal disease, pulmonary disease, and cutaneous disease are the most common primary infections in children.
Otitis media is rare.
Itraconazole, a triazole antifungal agent, has appreciable in vitro activity against Aspergillus species, but experience with this agent for the treatment of aspergillosis in children is limited. Aerosolized amphotericin B is currently under investigation for prophylaxis in cancer patients during periods of profound neutropenia. Otitis externa associated with Aspergillus infection is rare, occurs in immunosuppressed individuals, and is associated with hearing loss and spread to the petrous portion of the temporal bone and the pinna. Nasosinusitis occurs almost exclusively in patients with profound neutropenia associated with chemotherapy for cancer and is rare in children. Fever, cough, epistaxis, headache, and sinus pain are the most common clinical signs.