Clinical spectrum and outcome of invasive filamentous fungal infections in children with Type 1 diabetes: North Indian experience

Abstract

There is scarcity of data on spectrum and outcome of invasive filamentous fungal infections (IFIs) in children with Type 1 diabetes (T1D) from developing countries. A retrospective review of medical records of children with T1D hospitalized with IFI over the past decade at the Pediatric Endocrinology and Diabetes Unit of a large tertiary care hospital of North India was performed with an aim to study their clinical spectrum, hospital course and final outcome. Of the 10 patients studied, nasal/paranasal involvement was seen in 6 and pulmonary involvement in 5 patients. One patient developed disseminated disease. Majority of the identified mycoses belonged to Class Zygomycetes Order Mucorales. Early surgery along with antifungal therapy helped limit the extension of infection and achieve a good outcome in majority of patients. Two patients died; one with a late diagnosis of pulmonary mucormycosis and the other with disseminated disease. The longterm morbidity in the survivors was minimal. In conclusion, rapid diagnosis followed by a multimodal approach involving aggressive surgical debridement, appropriate antifungal therapy and control of hyperglycemic state is the key to good outcome in this otherwise lethal infection.

Early Diagnosis and Surgery is Crucial to Survival Outcome in Rhinocerebral Mucormycosis

“…Our experience with invasive filamentous fungal infections in patients with T1D, predominantly caused by zygomycetes, is similar with the mean time from presentation to diagnosis of 5.8 ± 4.7 days (range 1-14 days) and debridement surgeries performed immediately after confirmation of diagnosis [5]. The relatively better outcome in our patients was probably a result of earlier diagnosis and treatment effected by a very dedicated team of pediatric endocrinologists, otolaryngologists, mycologists, histopathologists, intensivists, and pediatric surgeons at our center [4,5]. The overall survival rate of 55 % in the study by Kolekar, although at par with most centers in the world, could be related to the differences in the timings of diagnosis and surgery in their patients.…”

“…In our recent study on 4 children with Type 1 diabetes (T1D) and rhinosinus mucormycosis, the mean time to confirm the diagnosis was 3.5 days (range 1-7 days) and endoscopic or open surgery was performed within a week of hospitalization in all patients [4]. Our experience with invasive filamentous fungal infections in patients with T1D, predominantly caused by zygomycetes, is similar with the mean time from presentation to diagnosis of 5.8 ± 4.7 days (range 1-14 days) and debridement surgeries performed immediately after confirmation of diagnosis [5]. The relatively better outcome in our patients was probably a result of earlier diagnosis and treatment effected by a very dedicated team of pediatric endocrinologists, otolaryngologists, mycologists, histopathologists, intensivists, and pediatric surgeons at our center [4,5].…”

“…This information can be easily retrieved from the hospital records of these patients and presented in a subsequent issue of IJOHNS. Also the addition of information regarding the predisposing factors for mucormycosis such as poor glycemic control and ketoacidotic state in the studied patients will be very useful to the readers [5]. …”

Isavuconazole in a Successful Combination Treatment of Disseminated Mucormycosis in a Child with Acute Lymphoblastic Leukaemia and Generalized Haemochromatosis: A Case Report and Review of the Literature

“…The most significant risk factors are: prolonged neutropenia, former broad-spectrum antibiotic therapy and diabetes including steroid-induced [4]. Review of the paediatric pulmonary mucormycosis reports published since 2010 based on PubMed and Cochrane databases showed that mucormycosis risk factors were: neutropenia (61.5% patients), broad-spectrum antibiotic therapy (35%), previous treatment with voriconazole (31%) and diabetes (27%) (Table 1) [10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25]. A total of 26 patients were identified: 19 children suffered from haematological disease, 5 had diabetes, one had osteosarcoma and one was diagnosed after a neardrowning incident.…”

<strong>COVID-19: Considerations for Children and Adolescents with Diabetes</strong>

“…Children with poorly controlled diabetes have increase susceptibility to bacterial and fungal infection due to various alterations in their immune response such as decreased T-lymphocyte and neutrophil function, decreased inflammatory cytokine secretion, decreased complement system and anti-oxidant system responses, and probably decreased antibody response (6,7). There is no substantial reason to believe that the clinical course of children with poorly controlled diabetes and COVID-19 could be different from what has been observed in adult patients.…”