In children with persistent symptomatic CDC, despite adequate antifungal therapy, administration of corticosteroids may yield rapid resolution of symptoms and decreased inflammatory markers. In patients who do not respond to steroids, the addition of a nonsteroidal anti-inflammatory drug should be considered.

Mucormycosis has emerged as an increasingly important cause of morbidity and mortality in immunocompromised patients, but contemporary data in children are lacking. We conducted a nationwide multicentre study to investigate the characteristics of mucormycosis in children with haematological malignancies. The cohort included 39 children with mucormycosis: 25 of 1136 children (incidence 2Á2%) with acute leukaemias prospectively enrolled in a centralized clinical registry in 2004-2017, and an additional 14 children with haematological malignancies identified by retrospective search of the databases of seven paediatric haematology centres. Ninety-two percent of mucormycosis cases occurred in patients with acute leukaemias. Mucormycosis was significantly associated with high-risk acute lymphoblastic leukaemia (OR 3Á75; 95% CI 1Á51-9Á37; P = 0Á004) and with increasing age (OR 3Á58; 95% CI 1Á24-9Á77; P = 0Á01). Fifteen patients (38%) died of mucormycosis. Rhinocerebral pattern was independently associated with improved 12-week survival (OR 9Á43; 95% CI 1Á47-60Á66; P = 0Á02) and relapsed underlying malignancy was associated with increased 12-week mortality (OR 6Á42; 95% CI, 1Á01-40Á94; P = 0Á05). In patients receiving frontline therapy for their malignancy (n = 24), one-year cumulative mucormycosis-related mortality was 21 AE 8% and five-year overall survival was 70 AE 8%. This largest paediatric population-based study of mucormycosis demonstrates that children receiving frontline therapy for their haematological malignancy are often salvageable. ALL, acute lymphoblastic leukaemia; AML, acute myeloid leukaemia; SCT, stem cell transplantation. *Variables are presented as n (%), unless otherwise stated. † The dash indicates that the variable was entered into the initial multivariate logistic regression model based on its P value in the univariate analysis (≤0Á10), but it was removed from the final model through the backward elimination procedure. ‡ Lymphocytopenia and monocytopenia were not included in the multivariate analysis as only a subcategory of patients had evaluable data. Surgical interventions were not included in order to avoid possible selection bias. SCT was not included due to its high correlation with relapsed and refractory disease (phi coefficient = 0Á78 and 0Á65, respectively).

Background: Mucormycosis is a rare but emerging life-threatening fungal disease with limited treatment options. Isavuconazole is a new triazole that has shown efficacy in adults for primary and salvage treatment of mucormycosis. However, data in children are scarce. Methods: The demographic and clinical data of pediatric patients with proven mucormycosis who were treated with isavuconazole in 2015 to 2019 at 2 centers were collected. Results: Four children of median age 10.5 years (range 7–14) met the study criteria. Three had underlying hematologic malignancies, and 1 had sustained major trauma. Isavuconazole was used as salvage therapy in all: in 3 patients for refractory disease, and in 1 after intolerance to another antifungal drug. Isavuconazole was administered alone or combined with other antifungal agents. Following treatment and surgical intervention, complete clinical, radiologic and mycologic responses were documented in all patients. A literature review identified 8 children with mucormycosis who were successfully treated with isavuconazole, as salvage therapy in the majority. Conclusion: Our limited experience supports the use of isavuconazole as salvage therapy in pediatric mucormycosis.