Paediatric mucormycosis: tailoring surgical strategies to compliment antifungal chemotherapy. Different strokes for different folks

Abstract

Children manifesting soft-tissue fungal infections are uncommonly seen, more so the subgroup of invasive soft-tissue mucormycosis. Invasive fungal infections in various organs respond differently and are often complicated by an immune-compromised host. Repeated and aggressive clearance of disease till an infection-clear margin is obtained is the mainstay of surgical therapy. This is coupled with appropriate antifungal therapy and the management of any underlying medical conditions. From our experience, we propose a surgical algorithm for therapy of soft-tissue mucormycosis in children.

Successful Management of Rhino-Orbital-Cerebral Mucormycosis in a Child with Acute-on-Chronic Kidney Disease and Malnutrition

“…Multiple surgeries may be required in the case of extensive disease. 11 Pana et al has demonstrated less mortality in patient given combined antifungals and surgery compared to those given antifungals alone (18.5% versus 60%). 17 Our patient required three sessions of complex operations, without which, it was clear that pharmaceutical interventions were not sufficient to control the infection.…”

“… 3 , 4 Histopathology and fungal culture are considered the gold standard for the diagnosis. 4 , 7 , 11 Mucorales are readily recognised morphologically on the basis of non-septate or occasionally pauci-septate, broad, thin walled hyphae with wide angled branching and evidence of angioinvasion. 3 , 9 , 11 We believe that the early diagnosis achieved within 24 hours of patient’s admission played a very important role in her satisfactory outcome.…”

“…Multiple surgeries may be required in the case of extensive disease. 11 Pana et al . has demonstrated less mortality in patient given combined antifungals and surgery compared to those given antifungals alone (18.5% versus 60%).…”

“…5 While liposomal amphotericin B is the recommended first-line therapy, posaconazole is mainly used as a stepdown or salvage therapy. 3,4,11,12 Chamilos et al showed that delayed amphotericin B therapy (≥6 days after diagnosis) was associated with a two-fold increase in mortality in patients with haematological malignancy and mucormycosis compared with early treatment (83% versus 49%). 5 Ray et al reported a case of rhino-orbital mucormycosis in a child with acute kidney injury.…”