Pediatric vs. Adult Invasive Aspergillosis in Cancer and Hematopoietic Transplant Patients: Insights from a Matched Cohort at a Tertiary Cancer Center

<b>Background:</b> Invasive aspergillosis (IA) is a life-threatening infection in immunocompromised patients, including those with hematologic malignancies and hematopoietic stem cell transplants. While adult IA has been well characterized, data on pediatric populations remain limited, and potential age-related differences are often overlooked in current management guidelines. <b>Methods:</b> We conducted a retrospective matched cohort study at a tertiary cancer center, evaluating IA cases diagnosed over a 31-year period. Pediatric patients (≤18 years) with proven or probable IA were matched 1:3 with adult IA cases based on year of diagnosis, underlying disease, and history of hematopoietic cell transplantation. We compared demographics, clinical presentation, diagnostic modalities, microbiology, antifungal prophylaxis, and treatment approaches between the two groups. <b>Results:</b> The study included 34 pediatric and 102 matched adult IA cases. Pediatric patients were significantly more likely to present with neutropenia (<i>p</i> = 0.04) and sinus involvement (<i>p</i> = 0.048). Serum galactomannan testing was more often positive in pediatric patients (<i>p</i> = 0.027), whereas bronchoalveolar lavage galactomannan was more frequently positive in adults (<i>p</i> = 0.003). Differences in antifungal prophylactic regimens were also observed. <b>Conclusions:</b> Our findings underscore significant age-related variations in IA epidemiology, diagnostics, and management. These results support the development of age-specific diagnostic algorithms and antifungal strategies.