Intra-abdominal Rhizopus microsporus Infection Successfully Treated by Combined Aggressive Surgical, Antifungal, and Iron Chelating Therapy

Abstract

Zygomycetes are widely distributed in the environment as inhabitants of soil and decaying matter. On rare occasions, these organisms can cause invasive infections in immunocompromised hosts. As zygomycetes are resistant to most conventional antifungal agents, its infection is often fatal. We report 2 cases of unusual intra-abdominal Rhizopus microsporus infection in children with acute leukemia as a result of an unprecedented outbreak due to oral intake of contaminated allopurinol tablets and ready-to-eat food items. Among the 2 patients, one of them survived after aggressive combined surgical, antifungal (AmBisome, Caspofungin, and Posaconazole) and iron chelation therapy.

A Cecal Mucormycosis Mass Mimicking Colon Cancer in a Patient with Renal Transplant: A Case Report and Literature Review

“…Mucormycosis appears to grow abundantly in iron-rich media, which predispose patients to iron overload [ 1 ]. It was recognized that the older iron chelators such as deferoxamine, when used in dialysis patients, have a higher risk for the development of zygomycosis [ 9 , 10 ]. Deferoxamine act as a siderophore to supply iron to the fungus, while the newer ones such as Deferasirox and Deferiprone do not facilitate iron uptake by the fungi, apparently because they share higher-affinity constants for iron, so they deprive the fungi of iron, hence its growth [ 9 , 10 ].…”

Mucormycosis - Dual Therapy with Prolonged Survival

“…This is a disease condition without many therapeutic options due to the severity of disease. The standard treatment recommended in rhinocerebral mucormycosis is amphotericin B with debridement, but the combined treatment of amphotericin B plus either an echinocandin or an azole with debridement was shown to improve survival in three cases [10,11]. Drugs that have an FDA approved indication for mucormycosis are amphotericin B with its lipid derivatives, and isavuconazonium sulfate, the pro-drug of isavuconazole, which was not available until 2015 (a year after this patient's death).…”

Transfusion related iron overload in pediatric oncology patients treated at a tertiary care centre and treatment with chelation therapy

“…In addition, ICT may reduce cardiotoxicity in iron overloaded patients receiving anthracycline therapy ; although, ICT by itself is not protective against anthracycline cardiotoxicity in vivo . Finally, ICT, by depriving microorganisms of iron, may be a useful adjunctive therapy in cancer patients with opportunistic infections , including Pneumocytis jeroveci pneumonia and fungal infection.…”