Zygomycetes Infections in Pediatric HematologyOncology Patients

Abstract

Fungi from the Zygomycetes class are increasingly recognized causes of infection in immunosuppressed children, but no comprehensive literature review and few case series have been published on the topic. A case series of 6 pediatric oncology patients with Zygomycetes infections cared for at our institution was constructed, and a concurrent search of the English language literature for Zygomycetes infections in children with oncologic disorders was undertaken. Our case series described 6 patients (5 male) between the ages of 2.5 and 19.5 years. One patient was diagnosed with rhinocerebral disease, 2 with rhinosinusitis, 2 with pulmonary involvement, and 1 with a gastrointestinal presentation. Five patients survived. Our literature review identified 82 cases from 61 studies. The mean subject age was 10.8 years (1.4 to 21.0 y). About 92.7% of all patients suffered from some form of leukemia, with 70.7% suffering from acute lymphoblastic leukemia. Overall, 58.5% of reported patients survived, with individuals with disseminated disease showing the worst prognosis (68.2% mortality) and those with cutaneous disease the best (14.3% mortality). Survival is increasingly reported in the literature, perhaps as a result of improved diagnostic capabilities, increased physician awareness and increased reliance on adjunctive surgical therapy.

A case of rhino-orbital-cerebral mucormycosis

“…The fungus is angioinvasive, causing severe thrombosis and tissue necrosis [1]. Underlying predisposing conditions are major risk factors for the disease [1][2][3][4]. In our case, chemotherapy-induced neutropenia (ANC of the patient remained <1.0x10 9 /l throughout) was one of the risk factors.…”

“…In our case, chemotherapy-induced neutropenia (ANC of the patient remained <1.0x10 9 /l throughout) was one of the risk factors. Steroids, used in treatment of ALL, may also increase the risk of fungal infection [2,3]. The initial symptoms of rhino-orbitalcerebral mucormycosis is similar to either sinusitis or periorbital cellulitis.…”

“…Mucormycosis is a rare, rapidly destructive fungal infection most commonly affecting immunocompromised and diabetic patients [1][2][3][4]. Depending on the anatomical site involved, it can be broadly classified as rhino-orbitalcerebral, pulmonary, gastrointestinal, cutaneous or disseminated disease [1,2].…”

“…It is important to treat or reverse the underlying cause and immunosuppressive medications should be dose reduced or stopped if possible [1][2][3]. Angioinvasion, thrombosis, and tissue necrosis result in poor penetration of antifungal agents to the site of infection.…”

“…Depending on the anatomical site involved, it can be broadly classified as rhino-orbitalcerebral, pulmonary, gastrointestinal, cutaneous or disseminated disease [1,2]. The fungus is angioinvasive, causing severe thrombosis and tissue necrosis [1].…”