Unsuspected invasive neonatal gastrointestinal mucormycosis: A clinicopathological study of six cases from a tertiary care hospital

Patra, Somdatta; Vij, Mukul; Chirla, Dinesh; Kumar, Narendar; Samal, Subash Chandra

doi:10.4103/0971-9261.102329

Cited by 27 publications

(28 citation statements)

References 15 publications

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“…However, on the basis of data available from certain groups of patients, the disease prevalence appears to be nearly 0.16% amongst diabetics and 1.2% amongst renal transplant recipients, with most of these cases manifesting as the ROC form . Also, gastrointestinal mucormycosis reportedly occurs in nearly 20% of all operated cases of neonatal enterocolitis in one center . In fact, the frequency of gastrointestinal mucormycosis was found to be so high in that centre that clinicians suspect the disease in any neonate having intestinal perforation.…”

Section: High Incidencementioning

confidence: 99%

Mucormycosis in India: unique features

Chakrabarti

Singh

2014

Mycoses

193

158

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SummaryMucormycosis remains a devastating invasive fungal infection, with high mortality rates even after active management. The disease is being reported at an alarming frequency over the past decades from India. Indian mucormycosis has certain unique features. Rhino-orbito-cerebral presentation associated with uncontrolled diabetes is the predominant characteristic. Isolated renal mucormycosis has emerged as a new clinical entity. Apophysomyces elegans and Rhizopus homothallicus are emerging species in this region and uncommon agents such as Mucor irregularis and Thamnostylum lucknowense are also being reported. This review focuses on these distinct features of mucormycosis observed in India.

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Section: High Incidencementioning

confidence: 99%

Mucormycosis in India: unique features

Chakrabarti

Singh

2014

Mycoses

193

158

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“…The other predisposing factors are preterm baby, steroid therapy, malnutrition, immunosuppression, low birth weight, immature immune system of the neonate with fragile skin barrier, orogastric intubation. (1,5,6,7,8) Members of mucoraceae show affinity for arterial invasion leading to thrombosis and ischaemic infarction of the tissue supplied by the artery. In gastrointestinal mucormycosis, this leads to gangrene of the involved bowel segment mimicking NEC (Necrotising Enterocolitis).…”

Section: Discussionmentioning

confidence: 99%

Gastrointestinal Mucormycosis of Neonate Masquerading as Necrotising Enterocolitis

Muthukanagarajan¹,

Karnan²,

Sadagopan³

et al. 2016

jemds

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Mucormycosis is a rare opportunistic invasive fungal infection that seldom infects healthy persons. Mucormycosis can affect any organ in the body among which gastrointestinal mucormycosis is very rare. Antemortem or preoperative diagnosis of gastrointestinal mucormycosis is not possible until histopathological demonstration of the fungal elements is done. Treatment consists of surgical debridement with systemic antifungal therapy with amphotericin B. The high mortality rate associated with GIMN (Gastrointestinal Mucormycosis of Neonate) is not only due to delay in diagnosis, but also because of inadequate and inappropriate treatment. All the infants with bowel surgery done for perforating or inflammatory lesions should be subjected to careful histopathological examination, else atypical causes for bowel perforations like GIM might be missed. Herewith presenting a rare case of gastrointestinal mucormycosis that occurred in a full-term, 5-day-old immunocompetent neonate.

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“…Since its first review in 1994, about 30 cases of neonatal GIM have been reported in English literature till date [1,3]. Of these, 22 are from India [1,[3][4][5].…”

Section: Discussionmentioning

confidence: 99%

A Survivor of Neonatal Intestinal Mucormycosis

Sathe¹

2015

JCDR

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A full term male neonate, with birth weight 1.750 kilograms, was diagnosed to have an anorectal malformation at birth. A cut back anoplasty was performed on the third day of life. The baby was referred to our hospital one day later, for bilious vomiting and abdominal distension. On admission, the general condition was poor. The child was dehydrated and icteric. The tongue was coated with slough. On examination, there was mild epigastric distension. All haematological investigations except platelet count (40,000 per cu.mm) were within normal range. Total and direct bilirubin levels were 12.2 mg% and 6.8 mg% respectively. Mother tested negative for HIV antibody test. With the clinical and radiologic diagnosis of intestinal perforation, exploratory laparotomy was performed on the fourth day of life. A gangrenous jejuno-ileal segment was resected and an anastomosis was done. On excision, a ten centimeter long dull and dusky intestinal segment was received. Mesenteric vessel thrombosis was seen. On opening, the mucosa was blackish and edematous. The resection margins were viable. Histopathology showed transmural necrosis with neutrophilic inflammatory infiltrate and plenty of nuclear debris [Table/ Fig-1a-d Gastrointestinal mucormycosis (GIM) is a rare opportunistic fungal infection. One third of all patients are children and of these, 50% are infants. The most common clinical mimic is necrotizing enterocolitis (NEC). It has to be differentiated from this entity as the treatment is entirely different. High index of suspicion by the clinicians and the pathologists aids in early diagnosis and immediate treatment. If untreated, it has a frequent fatal outcome. Very few survivors of GIM are found in literature. We report a rare case of a surviving neonate of GIM. morphology was different from Aspergillus where the hyphae are slender, septate and show acute angle branching. Mesenteric vessels showed fresh thrombi with fungal hyphae within. Gomori's methenamine silver stain highlighted the fungi black [Table/ Fig-1a-d]. Material from tongue slough was sent for mycology culture after the diagnosis of mucormycosis was given on histopathology. However, culture results were noncontributory. The patient was treated with intravenous liposomal Amphotericin B. The patient responded well, had a functioning anastomosis at the time of discharge and is well after a follow up of six months.

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Unsuspected invasive neonatal gastrointestinal mucormycosis: A clinicopathological study of six cases from a tertiary care hospital

Cited by 27 publications

References 15 publications

Mucormycosis in India: unique features

Mucormycosis in India: unique features

Gastrointestinal Mucormycosis of Neonate Masquerading as Necrotising Enterocolitis

A Survivor of Neonatal Intestinal Mucormycosis

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