Mucormycosis Rhinosinusitis at Diagnosis of Acute Lymphoblastic Leukemia

Abstract

We present the case of an adolescent with mucor rhinosinusitis diagnosed concomitantly with acute lymphoblastic leukemia at a hospital in Tegucigalpa, Honduras. We also discuss the challenges faced in the dual management of hematologic malignancies and invasive fungal disease in a low-middle-income country, such as access to diagnostics, immunosuppressants, imaging, and antifungals. Despite these shortcomings, the patient was successfully treated for both the diseases. Low-middle-income country hospitals can effectively treat invasive fungal diseases by providing adequate diagnostic and support services, which can improve the outcomes of pediatric cancer patients.

Use of Fungal Diagnostics and Therapy in Pediatric Cancer Patients in Resource-Limited Settings

“…Expedited diagnosis and treatment of fungal infections can improve outcomes in children with cancer [65]. Definitive diagnosis of mold infections is difficult, because signs and symptoms are nonspecific; in the early stages, persistent or recurrent fever may be the only sign of infection.…”

“…Except for Fusarium , [66] blood culture results are rarely used to diagnose molds. Mold infections are usually confirmed by the study of infected tissue [65]. In LMICs, collecting surgical specimens and radiographs is often too expensive or inaccessible.…”

“…The use of automated systems and even rapid identification systems (e.g., peptide nucleic acid fluorescence in situ hybridization/matrix-assisted laser desorption/ionization time-of-flight mass spectrometry [PNA-FISH/MALDI-TOF]) to identify bloodstream yeasts is becoming more widespread [71]; however, traditional characterization by morphologic and biochemical characteristics is still commonly used in LMICs [65, 72–74]. The clinical validity of susceptibility testing is better established for yeast than for mold; accordingly, the literature from resource-limited countries reflects greater use of such testing for yeast [33].…”