Disseminated <i><scp>R</scp>hizopus microsporus</i> infection following allogeneic hematopoietic stem cell transplantation in a child with severe aplastic anemia

Ye, B.; Yu, Daojun; Zhang, X.; Shao, Keding; Chen, D.; Wu, Denghao; Zhang, Y.; Zhou, Yuhong; Shen, Yueqian; Q, Yu

doi:10.1111/tid.12144

Cited by 4 publications

(9 citation statements)

References 18 publications

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“…Especially HSCT recipients run high risk of developing invasive fungal infections during the immediate post-transplant and the pre- and post-engraftment period and the engraftment period up to 3 months after transplantation [2]. Our patient showed suspected infection about 3 months after transplantation.…”

Section: Discussionmentioning

confidence: 79%

“…Compared to focal RM fungal infections disseminated infections are even more seldom [2, 13, 14]. Especially HSCT recipients run high risk of developing invasive fungal infections during the immediate post-transplant and the pre- and post-engraftment period and the engraftment period up to 3 months after transplantation [2].…”

Section: Discussionmentioning

confidence: 99%

“…The most common sites of origin are sinuses (39%), lungs (24%), and skin (19%) [2, 15]. Dissemination commonly affects lung and brain, whereas liver, heart, and kidneys are rarely colonized [5].…”

Section: Discussionmentioning

confidence: 99%

“…Zygomycetes are environmental nonseptate molds widely distributed in soil, plants, and decaying material [1, 2]. The class zygomycetes contain the order mucorales, the latter including the genus Rhizopus.…”

Section: Introductionmentioning

confidence: 99%

“…Fungi like Rhizopus, Mucor and Rhizomucor account for over 75% of all mucormycosis cases [3–5]. Being ubiquitous in the environment, acquirement is usually generated through inhalation of spores often leading to rhinocerebral (39%) or pulmonary (24%), seldom to cutaneous (19%) or disseminated disease (23%) in predisposed individuals [2, 6, 7]. …”

Section: Introductionmentioning

confidence: 99%

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Clinical challenge: fatal mucormycotic osteomyelitis caused by Rhizopus microsporus despite aggressive multimodal treatment

et al. 2014

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BackgroundMucormycosis is an invasive mycotic disease caused by fungi in the zygomycetes class. Although ubiquitous in the environment, zygomycetes are rarely known to cause invasive disease in immunocompromised hosts with a high mortality even under aggressive antifungal and surgical therapy. Clinically, mucormycosis frequently affects the sinus occasionally showing pulmonary or cerebral involvement. However skeletal manifestation with Rhizopus microsporus (RM) osteomyelitis leading to emergency surgical proximal femoral resection with fatal outcome has not been described yet.Case presentationWe report the case of a 73-year-old male suffering from myelodysplastic syndrome with precedent bone marrow transplantation. Six months after transplantation he consulted our internal medicine department in a septic condition with a four week history of painful swelling of the right hip. Radiography, computed tomography and magnetic resonance imaging revealed multiple bone infarcts in both femurs. In the right femoral head, neck and trochanteric region a recent infarct showed massive secondary osteomyelitis, breaking through the medial cortex. Emergency surgical proximal femoral resection was performed due to extensive bone and soft tissue destruction. Microbiological and basic local alignment search tool (BLAST) analysis revealed RM. Amphotericin B and posaconazole treatment with septic revision surgery was performed. However the disease ran a rapid course and was fatal two months after hospital admission.ConclusionThis alarming result with extensive RM osteomyelitis in the proximal femur of an immunocompromised patient may hopefully warn medical staff to perform early imaging and aggressive surgical supported multimodal treatment in similar cases.Electronic supplementary materialThe online version of this article (doi:10.1186/1471-2334-14-488) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 79%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Clinical challenge: fatal mucormycotic osteomyelitis caused by Rhizopus microsporus despite aggressive multimodal treatment

et al. 2014

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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

et al. 2018

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Invasive mucormycosis in immunocompromised children is a life-threatening fungal infection. We report a case of a 7-year-old girl treated for acute lymphoblastic leukaemia complicated by disseminated mucormycosis during induction therapy. Microscopic examination of surgically removed lung tissue revealed wide, pauci-septate hyphae suggesting a Mucorales infection. This diagnosis was confirmed immunohistochemically and by PCR analysis followed by a final identification of Cunninghamella sp. The patient was treated successfully with surgical debridement and antifungal combination therapy with amphotericin B, caspofungin and isavuconazole. The use of isavuconazole in a child was not previously reported. Additionally, case reports concerning pulmonary mucormycoses in paediatric population published after 2010 were reviewed. Nineteen out of 26 identified patients suffered from haematological diseases. Reported mortality reached 38.5%. By the fact of rising morbidity, unsatisfactory results of treatment and remaining high mortality of mucormycoses in immunocompromised patients, new therapeutic options are warrant. Isavuconazole, with its broad-spectrum activity, good safety profile and favourable pharmacokinetics, is a promising drug. However, further studies are necessary to confirm positive impact of isavuconazole on mucormycosis treatment in children.

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A comprehensive review of pathogenesis of mucormycosis with implications of COVID-19: Indian perspective

Sachdev

Chettiankandy

Sardar

et al. 2021

JGOH

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Mucormycosis is a deadly fungal infection that targets immunocompromised individuals. India being the “diabetes” capital of the world contributes to about 40% of global burden of the infectious disease. With the addition of COVID-19 pandemic to the equation, there has been an alarming increase in the number of reported cases of mucormycosis. The disease itself along with corticosteroid and certain other strategies used in its treatment predispose the patients to develop secondary bacterial and fungal infections. Therefore, it is imperative for clinicians to understand the pathogenesis of mucormycosis at present so that they can develop combative counter strategies. We provide a comprehensive review of the pathogenetic process of mucormycosis while also elucidating implications of COVID-19 pandemic in the epidemiology and pathogenesis of the infectious malice in an Indian background.

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Disseminated Rhizopus microsporus infection following allogeneic hematopoietic stem cell transplantation in a child with severe aplastic anemia

Cited by 4 publications

References 18 publications

Clinical challenge: fatal mucormycotic osteomyelitis caused by Rhizopus microsporus despite aggressive multimodal treatment

Clinical challenge: fatal mucormycotic osteomyelitis caused by Rhizopus microsporus despite aggressive multimodal treatment

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

A comprehensive review of pathogenesis of mucormycosis with implications of COVID-19: Indian perspective

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