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6% of the cases developing within the first week of life. In another study, weekly surveillance fungal cultures were taken from neonates and 12.1% were colonized with Candida, including C.?albicans in 42% [33]. Most were colonized later (>5?days), and neonates born vaginally were at higher risk for early colonization. Importantly, invasive candidiasis occurred in 6.9% of colonized neonates, but in only 0.76% of non-colonized infants, suggesting that monitoring for colonization in the highest-risk infants may be beneficial. A larger Italian study [34] found that 32.1% of very low birthweight infants (Selleck LY2109761 colonization of central venous catheters and MAPK colonization at other sites remained significant for invasive fungal infection. In the largest analysis of paediatric patients with IA [20], A.?fumigatus was the species most frequently recovered by culture (52.8%), followed by Aspergillus flavus (15.7%), Aspergillus terreus (4.7%), and Aspergillus niger (4.7%). Nodules constituted the most frequent finding on chest computed tomography (CT) or plain radiography (59%), and nodules were seen less frequently in the youngest children than in the older age groups: nodules were seen in 38.7% (12/31) of the 0�C5-year-olds, as compared with 71.8% (28/39) and 62.5% (25/40) of the 6�C12-year group and ��13-years group, respectively. Only 3/110 patients (2.2%) showed the air-crescent sign, none of whom were in the 0�C5-year age group. There are conflicting reports on a potential Aspergillus species difference seen in infected children vs. adult patients. The National Institute of Allergy and Infectious Diseases Bacteriology and Mycoses Study Group reviewed 256 isolates of Aspergillus species from adult patients who had IA from 24 medical centres [35], and A.?fumigatus accounted for EPZ5676 mw 67% of the isolates, A.?flavus being the second most common isolate, at 16%. In contrast, the previously described St Jude [36] and Toronto [37] paediatric reviews revealed that A.?flavus was the most common species isolated. However, in more recent studies, the paediatric IA epidemiology has paralleled that in adults, with a 2001 French paediatric study demonstrating that the most common isolates were A.?fumigatus (11/23) and A.?flavus (6/23) [38]. The larger study of contemporary cases [20] mirrored the newer French paediatric study and adult findings [9,35], suggesting that the earlier claims of A.?flavus predominance in children possibly resulted from older cases of IA. In adult studies [39], pulmonary IA is the clinical site most commonly identified, which is to be expected, given the airborne route of infection. In the large multicentre paediatric series [20], 79.9% of cases were pulmonary IA, and 13.7% were cutaneous IA. Of the patients with cutaneous disease, 52.6% (10/19) had disease strictly localized to the skin. A.