Neonatal Colonic Mucormycosis--A Tropical Perspective

Abstract

Neonatal gastrointestinal (GI) mucormycosis is a rare, usually fatal, opportunistic fungal infection, which is difficult to diagnose early or preoperatively. We report three babies, only one of whom survived, with a review of the literature. All three had similar findings of necrosis of colon with multiple perforations. While the first baby was diagnosed as long segment Hirschsprung's, the second was treated as small left colon but went on to show signs of peritonitis. The third presented with pneumonia, which progressed to sepsis and peritonitis. All three were diagnosed by histology postoperatively and two of them succumbed, one in spite of amphotericin and the other as he was too sick to start antifungals and had a rapid downhill course. The one who survived did so even though she did not receive amphotericin, but had clear margins of resection. The only chance of survival in this fatal disease is early diagnosis and rapid institution of aggressive therapy inclusive of adequate surgical debridement and appropriate antifungal medications.

A Rare Case of Neonatal Colonic Mucormycosis

“…Alexander P et al have reported 3 babies with colonic necrosis with multiple perforations [2]. The clinical manifestation of majority of these patients mimicked those of NEC.…”

“…Uniformly, the prognosis has been grave with only 4 cases being diagnosed antemortem leading to surgical intervention, antifungal therapy and out of this only three survived [2]. Two of the babies who survived, needed a second laparotomy and surgical debridement few months beyond the neonatal period.…”

“…Since, the diagnosis is based on histopathological examination of the resected segment (specimen) of stomach and/or bowel, it cannot be diagnosed preoperatively [1,2]. These cases are initially diagnosed as Necrotising enterocolitis (NEC), but later on are confirmed as gastrointestinal (colonic) mucormycosis.…”

Rare case of disseminated neonatal zygomycosis mimicking necrotizing enterocolitis with necrotizing fasciitis

“…Neonatal gastrointestinal zygomycosis usually mimics NEC clinically [5][6][7][8][9][10][11]. In zygomycosis, cultures of affected lesions are often negative, which can delay accurate diagnosis and administration of specific treatment.…”

“…Consequently, the diagnosis usually depends on histopathologic examination of the surgically resected organs or the infected tissues at autopsy [2,[5][6][7]9,10]. Typical and characteristic histopathologic findings are as follows: (1) broad, aseptate filaments with right angle branching hyphae in tissue specimens and (2) typical hyphae showing features of perivascular and blood vessel invasion, particularly, arterial invasion, which can cause arterial thrombosis and subsequent ischemic necrotic changes in the tissue [2,[5][6][7][9][10][11].…”