Pediatric Mucormycosis: A 10-Year Systematic Review of Reported Cases and Review of the Literature

Abstract

Mucormycosis is a severe infection that affects a variety of patients, including immunocompromised children and neonates. Given improved survival rates from advances in the treatment of malignancies, the population at risk for mucormycosis is increasing. We conducted a systematic review of cases of mucormycosis in children in the English-language literature reported between August 2008 and June 2017 and analyzed the clinical characteristics, diagnosis, management, and outcome of those infections. The most common underlying diagnoses included neutropenia (41%), hematologic malignancy (39%), prematurity (13%), and hematopoietic stem cell transplant (11%). Sinus disease (28%) and disseminated disease (24%) were the most common presentations. Rhizopus spp were the most common organisms isolated (22%). Amphotericin B remains the backbone of treatment and was prescribed in 86% of these cases. The resulting mortality rate remains high (32%). We provide here the results of a literature review of mucormycosis in children, including its epidemiology and clinical manifestations, and describe current advances in its diagnosis and treatment.

Fungal infections in children with haematologic malignancies and stem cell transplant recipients

“…(Wattier et al ., ). The Mucorales moulds are the next most commonly reported cause of IFD (Zaoutis et al ., ; Pana et al ., ; Otto et al ., ). The epidemiology of IFD with other yeasts and moulds is not well defined, though Bartlett and colleagues recently identified non‐ Candida yeasts in nearly 5% of cases and non‐ Aspergillus, non‐Mucorales moulds in >20% of cases (Bartlett et al ., ).…”

“…A recent retrospective analysis comparing combination therapy with monotherapy for the initial treatment of mucormycosis in adults with haematologic malignancies found no significant differences in six‐week mortality (Kyvernitakis et al ., ). Regardless, reviews of published cases of paediatric mucormycosis show that combination therapy is frequently used (Zaoutis et al ., ; Otto et al ., ). As with invasive aspergillosis, the duration of therapy is guided by resolution of infection and correction of immune dysfunction.…”

The diagnostic pitfalls of mucormycosis

“…All clinical manifestations progress rapidly because of tissue angioinvasion leading to thrombosis and tissue necrosis. 6,7 Mortality ranges between 22% and 59% in different reports. 1,2 We describe a case of Lichtheimia corymbifera infection in an adolescent with B-cell-Non-Hodgkin lymphoma (B-NHL) involving lung, kidney and thyroid that initially was diagnosed as probable aspergillosis, delaying the effective therapy for mucormycosis.…”

“…Biopsy should be pursued as soon as possible, because the identification by histopathology, culture, and molecular tests lead to earlier initiation of antifungal therapy. 6,13 The first-line medical treatment of mucormycosis is liposomal Amphotericin B (L-AmB) at the daily dose of 5-7.5 mg/kg or the combination of L-AmB with triazoles. 6,7,17 Surgery is essential in the treatment of mucormycosis, and the highest levels of therapeutic success have been achieved when surgery was combined with medical management especially in pulmonary lesions.…”

“…6,13 The first-line medical treatment of mucormycosis is liposomal Amphotericin B (L-AmB) at the daily dose of 5-7.5 mg/kg or the combination of L-AmB with triazoles. 6,7,17 Surgery is essential in the treatment of mucormycosis, and the highest levels of therapeutic success have been achieved when surgery was combined with medical management especially in pulmonary lesions. 13 Conclusions.…”