Chronic pulmonary aspergillosis in children – a scoping global review

Abstract Background Chronic pulmonary aspergillosis (CPA) affects those with underlying lung conditions or mild immunocompromise. CPA carries a poor prognosis in adults. Its pathogenesis remains obscure. We summarise all cases of CPA in children globally. Methods From 6,503 screened reports, we reviewed the full text of 604, of which 44 fit the inclusion criteria and an additional 11 other cases with little detail which were included under supplementary data. Chronic granulomatous disease and cystic fibrosis cases were excluded. Results We found 47 well-documented individual cases of CPA in children published from 1963 to 2022. Twenty-two cases were simple aspergillomas, and 11 were chronic cavitary pulmonary aspergillosis. Ages ranged from under 1 year to 17 years old, and 28 (59.8%) were male. Eighteen (38.3%) cases had no reported underlying disease. Underlying diseases included pulmonary tuberculosis (14.9%), Job’s Syndrome (10.6%), congenital pulmonary airway malformation (8.5%), allergic bronchopulmonary aspergillosis or asthma (6.4%), pulmonary hydatid cyst (4.3%), bacterial pneumonia with cavitation (4.3%), diabetes mellitus (4.3%) and single cases of pulmonary sequestration or bronchogenic cyst. All cases had either microbiological or immunological evidence of Aspergillus spp. apart from two confirmed by histopathology only. Surgical resection only was done in 18 (39.1%) patients, 15 (32.6%) were treated with surgery and antifungal therapy and 13 (28.3%) were only treated with antifungals; one patient died before intervention. Forty-three cases (91.5%) were alive on hospital discharge, but follow-up was limited, while two died. Conclusions CPA is apparently rare in children but does occur, often with no antecedent condition. Prognosis is good with early diagnosis.