Mucormycosis in a pediatric population: a review of 20 cases from southern Turkey
Background. Mucormycosis is a fatal invasive fungal infection seen most often in patients with compromised defense mechanisms. The aim of this article was to review the data of pediatric mucor in the South of Turkey. Methods. Twenty pediatric cases with biopsy proven mucormycosis were reported, between January 2007 through January 2017. Data were extracted from the medical charts of patients retrospectively. Results. Underlying conditions were hematological malignancy (75%), in whom 93% had acute leukemia, aplastic anemia (15%), diabetes mellitus (5%) and other malignancies (5%). The main sites of infection were sinus (85%); alone (29.4%) or with cerebral (17.6%), and orbital involvement (17.6%). Pulmonary involvement was reported in 11 patients (55%), two of them had the alone form and nine cases were associated with nasal sinus involvement. Disseminated mucormycosis was documented in 45%. Fever and pain/swelling of organs were the most commonly encountered signs and symptoms. Treatment compromised of am-photericin B monotherapy in five patients. All patients except one received liposomal formu-lations (LAmB). A combination of surgery and antifungal therapy was performed in 75%. Crude survival was 55%; among 15 cases treated with a combination of surgery and antifun-gal therapy, survival rate was 8/15 (53%). The overall mortality rate was high in patients diagnosed with disseminated infection (100%). Conclusions. Mucormycosis in pediatric cases requires a high index of suspicion and urgent evaluation of clinical samples. Surgical debridement should be considered when feasible. Initial medical therapy should include an amphotericin preparation with or step-down to posaconazole
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1. Pana ZD, Roilides E, Warris A, Groll AH, Zaoutis T. Epidemiology of invasive fungal disease in children. J Pediatr Infect Dis Soc 2017; 6(Suppl 1): S3-S11.2. Petrikkos G, Skiada A, Lortholary O, Roilides E, Walsh TJ, Kontoyiannis DP. Epidemiology and clinical manifestations of mucormycosis. Clin Infect Dis 2012; 54(Suppl 1): S23-S34.
3. Chakrabarti A, Singh R. The emerging epidemiology of mould infections in developing countries. Curr Opin Infect Dis 2011; 24: 521-526.
4. Roden MM, Zaoutis TE, Buchanan WL, et al. Epidemiology and outcome of zygomycosis: a review of 929 reported cases. Clin Infect Dis 2005; 41: 634-653.
5. Skiada A, Lanternier F, Groll AH, et al; European Conference on Infections in Leukemia Diagnosis and treatment of mucormycosis in patients with hematological malignancies: Guidelines from the 3rd European Conference on Infections in Leukemia (ECIL 3). Haematologica 2013; 98: 492-504.
6. Petrikkos G, Drogari-Apiranthitou M. Zygomycosis in immunocompromised non-haematological patients. Mediterr J Hematol Infect Dis 2011; 3: e2011012.
7. Cornely OA, Arıkan-Akdaglı S, Dannaoui E, et al; European Society of Clinical Microbiology and Infectious Diseases Fungal Infection Study Group; European Confederation of Medical Mycology ESCMID and ECMM joint clinical guidelines for the diagnosis and managment of mucormycosis 2013. Clin Microbiol Infect 2014; 20(Suppl 3): 5-26.
8. Bitar D, Van Cauteren D, Lanternier F, et al. Increasing incidence of zygomycosis (mucormycosis), France, 1997-2006. Emerg Infect Dis 2009; 15: 1395-1401.
9. Zeka AN, Taşbakan M, Pullukçu H, Sipahi OR, Yamazhan T, Arda B. Evaluation of zygomycosis cases by pooled analysis method reported from Turkey. Mikrobiyol Bul 2013; 47: 708-816.
10. Francis JR, Villanueva P, Bryant P, Blyth CC. Mucormycosis in children; review and recommendations for management. J Pediatric Infect Dis Soc 2018; 7: 159-164.
11. Kömür S, Inal AS, Kurtaran B, et al. Mucormycosis: a 10-year experience at a tertiary care center in Turkey. Turk J Med Sci 2016; 46: 58-62.
12. Guymer C, Khurana S, Suppiah R, Hennessey I, Cooper C. Successful treatment of disseminated mucormycosis in a neutropenic patient with T-cell acute lymphoblastic leukaemia. BMJ Case Rep 2013; 2013: bcr2013009577.
13. Muggeo P, Calore E, Decembrino N, et al. Invasive mucormycosis in children with cancer: a retrospective study from the Infection Working Group of Italian Pediatric Hematology Oncology Association. Mycoses 2019; 62: 165-170.
14. Al-Ajam MR, Bizri AR, Mokhbat J, Weedon J, Lutwick L. Mucormycosis in the Eastern Mediterranean: a seasonal disease. Epidemiol Infect 2006; 134: 341- 346.
15. Kontoyiannis DP, Lewis RE. Invasive zygomycosis: update on pathogenesis, clinical manifestations, and management. Infect Dis Clin North Am 2006; 20: 581-607.
16. Shpitzer T, Keller N, Wolf M, et al. Seasonal variations in rhino-cerebral Mucor infection. Ann Otol Rhinol Laryngol 2005; 114: 695-698.
17. Kontoyiannis DP, Lionakis MS, Lewis RE, et al. Zygomycosis in a tertiary-care cancer center in the era of Aspergillus-active antifungal therapy: a casecontrol observational study of 27 recent cases. J Infect Dis 2005; 191: 1350-1360.
18. Siwek GT, Pfaller MA, Polgreen PM, et al. Incidence of invasive aspergillosis among allogeneic hematopoietic stem cell transplant patients receiving voriconazole prophylaxis. Diagn Microbiol Infect Dis 2006; 55: 209-212.
19. Trifilio S, Singhal S, Williams S, et al. Breakthrough fungal infections after allogeneic hematopoietic stem cell transplantation in patients on prophylactic voriconazole. Bone Marrow Transplant 2007; 40: 451-456.
20. Pagella F, De Bernardi F, Dalla Gasperina D, et al. Invasive fungal rhinosinusitis in adult patients: our experience in diagnosis and management. J Craniomaxillofac Surg 2016; 44: 512-520.
21. Palejwala SK, Zangeneh TT, Goldstein SA, Lemole GM. An aggressive multidisciplinary approach reduces mortality in rhinocerebral mucormycosis. Surg Neurol Int 2016; 7: 61.
22. Bakhshaee M, Bojdi A, Allahyari A, et al. Acute invasive fungal rhinosinusitis: our experience with 18 cases. Eur Arch Otorhinolaryngol 2016; 273: 4281- 4287.
23. Green KK, Barham HP, Allen GC, Chan KH. Prognostic factors in the outcome of invasive fungal sinusitis in a pediatric population. Pediatr Infect Dis J 2016; 35: 384-386.
24. Jiang N, Zhao G, Yang S, et al. A retrospective analysis of eleven cases of invasive rhino-orbitocerebral mucormycosis presented with orbital apex syndrome initially. BMC Ophthalmol 2016; 16: 10.
25. Teixeira CA, Medeiros PB, Leushner P, Almeida F. Rhinocerebral mucormycosis: literature review apropos of a rare entity. BMJ Case Rep 2013; 2013: bcr 20122008552.
26. Yan X, Zong F, Kong H, et al. Pulmonary fungal diseases in immunocompetent hosts: a single-center retrospective analysis of 35 subjects. Mycopathologia 2016; 181: 513-521.
27. Feng J, Sun X. Characteristics of pulmonary mucormycosis and predictive risk factors for the outcome. Infection 2018; 46: 503-512.
28. Lin E, Moua T, Limper AH. Pulmonary mucormycosis: clinical features and outcomes. Infection 2017; 45: 443-448.
29. He R, Hu C, Tang Y, Yang H, Cao L, Niu R. Report of 12 cases with tracheobronchial mucormycosis and a review. Clin Respir J 2018; 12: 1651-1660.
30. Pana ZD, Seidel D, Skiada A, et al; Collaborators of Zygomyco.net and/or FungiScope™ Registries*. Invasive mucormycosis in children: an epidemiologic study in European and non-European countries based on two registries. BMC Infect Dis 2016; 16: 667.
31. Rüping MJ, Heinz WJ, Kindo AJ, et al. Forty-one recent cases of invasive zygomycosis from a global clinical registry. J Antimicrob Chemother 2010; 65: 296-302.
32. Skiada A, Pagano L, Groll A, et al; European Confederation of Medical Mycology Working Group on Zygomycosis. Zygomycosis in Europe: analysis of 230 cases accrued by the registry of the European Confederation of MedicalMycology (ECMM) Working Group on Zygomycosis between 2005 and 2007. Clin Microbiol Infect 2011; 17: 1859- 1867.
33. Chakrabarti A, Chatterjee SS, Das A, et al. Invazive zygomycosis in India: experience in a tertiary care hospital. Postgrad Med J 2009; 85: 573-581.
34. Rinaldi MG. Zygomycosis. Infect Dis Clin North Am 1989; 3: 19-41. 35. Ribes JA, Vanover-Sams CL, Baker DJ. Zygomycetes in human disease. Clin Microbiol Rev 2000; 13: 236- 301.
36. Walsh TJ, Gamaletsou MN, McGinnis MR, Hayden RT, Kontoyiannis DP. Early clinical and laboratory diagnosis of invasive pulmonary, extrapulmonary and disseminated mucormycosis (zygomycosis). Clin Infect Dis 2012; 54(Suppl 1): S55-S60.
37. Lackner M, Caramalho R, Lass-Flörl C. Laboratory diagnosis of mucormycosis: current status and future perspectives. Future Microbiol 2014; 9: 683- 695.
38. De Pauw B, Walsh TJ, Donnelly JP, et al; European Organization for Research and Treatment of Cancer/Invasive Fungal Infections Cooperative Group; National Institute of Allergy and Infectious Diseases Mycoses Study Group (EORTC/MSG) Consensus Group. Revised definitions of invasine fungal disease from the European Organization for Research and Treatment of Cancer/Invasive Fungal Infections Cooperative Group and the National Institute of Allergy and Infectious Diseases Mycoses Study Group (EORTC/MSG) Consensus Group. Clin Infect Dis 2008; 46: 1813-1821.
39. Iosifidis E, Papachristou S, Roilides E. Advances in the treatment of mycoses in pediatric patients. J Fungi (Basel) 2018; 4: 115.
40. Vehreschild JJ, Birtel A, Vehreschild MJ, et al. Mucormycosis treated with posaconazole: review of 96 case reports. Crit Rev Microbiol 2013; 39: 310-324.
41. Pagano L, Cornely OA, Busca A, et al. Combined antifungal approach for the treatment of invasive mucormycosis in patients with hematologic diseases: a report from the SEIFEM and FUNGISCOPE registries. Haematologica 2013; 98: e127-e130.
42. Kyvernitakis A, Torres HA, Jiang Y, Chamilos G, Lewis RE, Kontoyiannis DP. Initial use of combination treatment does not impact survival of 106 patients with haematologic malignancies and mucormycosis: a propensity score analysis. Clin Microbiol Infect 2016; 22: 811.e1-811.e8.
43. Rai S, Yadav S, Kumar D, Kumar V, Rattan V.. Management of rhinomaxillary mucormycosis with posaconazole in immunocompetent patients. J Oral Biol Craniofac Res 2016; 6(Supp 1): S5-S8.
44. Spellberg B, Kontoyiannis DP, Fredricks D, et al. Risk factors for mortality in patients with mucormycosis. Med Mycol 2012; 50: 611-618.
45. Madney Y, Khedr R, Ahmed N, et al. Overview and outcome of mucormycosis among children with cancer: report from the Children’s Cancer Hospital Egypt. Mycoses 2019; 62: 984-989.
46. Sipsas NV, Gamaletsou MN, Anastasopoulou A, Kontoyiannis DP.Therapy of mucormycosis. J Fungi (Basel) 2018; 4: 90
- ISSN: 0041-4301
- Yayın Aralığı: Yılda 6 Sayı
- Başlangıç: 1958
- Yayıncı: Hacettepe Üniversitesi Çocuk Sağlığı Enstitüsü Müdürlüğü
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