Mucormycosis diagnosed during induction chemotherapy in five pediatric patients with acute lymphoblastic leukemia

Abstract

Mucormycosis in pediatric oncology patients is a rare invasive fungal infection associated with significant morbidity and mortality. We describe five patients diagnosed with mucormycosis during induction chemotherapy for acute lymphoblastic leukemia at our institution. All of the patients in our series survived, some in spite of having disseminated disease. Most of the patients’ chemotherapy was modified with the aim of controlling their leukemia while minimizing immunosuppression until their fungal infection was under control. Although mucormycosis is frequently fatal, rapid diagnosis and a multidisciplinary approach can lead to excellent outcomes, even in patients undergoing intensive chemotherapy.

Mucormycosis in Children With Hematologic Malignancies: A Case Series and Review of the Literature

“…In the literature review, a mucormycosis-related mortality of 36.5% was observed. 5,[7][8][9]14,[17][18][19][20] These mortality rates are in accordance with the previous mucormycosis review of this subgroup in which a mortality of 36.1% was reported from 1990 to 2007 (without significant trend in survival over time) (n = 61). 17 As described, our review strengthens the concept that survival has significantly improved over time.…”

“…17 In the literature review, all series but one reported the highest incidence of mucormycosis during induction therapy, which is in line with our case series. 5,8,9,14,17–20…”

“…10,23,27 This phenomenon might be explained by selective pressure. 19 As for diagnosing mucormycosis, culture remains the standard. However, in the literature review, culturing of this mold was unsuccessful or not attempted in the majority of cases (68%).…”

“…In total, 9 case series with a total of 159 patients were identified using the described strategy. 5,[7][8][9]14,[16][17][18][19][20] One-hundred forty-eight patients were found who met inclusion criteria (11 children did not have an underlying hematologic malignancy). The majority was male (59%).…”

Disseminated mucormycosis in a child with acute lymphoblastic leukemia: a case report and autopsy findings

“…Children with hematological malignancies undergoing chemotherapy treatments involving immunity are among the highest-risk groups. When the index of suspicion is low, this diagnosis can go unnoticed, which has severe consequences since the mortality rate in patients who develop the disseminated disease can be as high as 100% [1][2][3] .…”