1
|
Federica F, Elisa Z, Maria Grazia P, Calogero V, Patrizia DI, Maria Caterina P, Marica DP, Piergiorgio G, DeCorti F. Surgical treatment of invasive fungal infection in pediatric oncology. Eur J Haematol 2024; 113:90-98. [PMID: 38558136 DOI: 10.1111/ejh.14205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 03/04/2024] [Accepted: 03/12/2024] [Indexed: 04/04/2024]
Abstract
BACKGROUND Invasive fungal disease (IFD) is typically aggressive and related with high mortality in children with a hematological malignancy. The association of medical and surgical treatment may ameliorate the outcome. The aim of this study was to analyze the surgical treatment of fungal infections in pediatric oncological populations. METHODS Retrospective study (2000-2022) of a single-center experience. We reviewed the medical record of all patients with hematologic malignancies and IFD, analyzing the outcome. RESULTS From the 70 pediatric cases of hematologic malignancies with the diagnosis IFD over 22 years, we included in the present study 44 cases who required surgical approaches for either diagnosis or treatment. Twenty-one patients were males and the mean age was 11 (range 1-23) years. The main indications for surgery were lack of improvement following medical treatment and/or progression of fungal infection (80%) and diagnosis confirmation (20%). Only five patients needed an emergency operation for rapid worsening of symptoms. The most common site of infection was the lung (80%) and the most frequently identified pathogen was Aspergillus (75%). The most common surgical procedures were lobectomy (performed in 17 patients) and atypical lung resection (10). Complications of surgery were mostly treated by medical approach. The mean time of resumption of oncological treatment was 40 (range 0-150) days. CONCLUSIONS Surgery is an important step in the multimodal treatment of invasive fungal infection with excellent resolution rate. Overall mortality depends on the underlying malignancy.
Collapse
Affiliation(s)
- Fati Federica
- Pediatric Surgery, Department of Woman and Child's Health, University Hospital of Padua, Padua, Italy
| | - Zambaiti Elisa
- Pediatric Surgery, Department of Woman and Child's Health, University Hospital of Padua, Padua, Italy
- Department of Pediatric Surgery, Pediatric Hospital Regina Margherita, Turin, Italy
| | - Petris Maria Grazia
- Pediatric Hematology, Oncology and Stem Cell Transplant Center, Department of Women's and Child's Health, University of Padua, Padua, Italy
| | - Virgone Calogero
- Pediatric Surgery, Department of Woman and Child's Health, University Hospital of Padua, Padua, Italy
| | - Dall' Igna Patrizia
- Division of Pediatric Surgery, Department of Emergencies and Organ Transplantation, Bari University, Bari, Italy
| | - Putti Maria Caterina
- Pediatric Hematology, Oncology and Stem Cell Transplant Center, Department of Women's and Child's Health, University of Padua, Padua, Italy
| | - De Pieri Marica
- Division of Pediatric Infectious Diseases, Department of Women's and Children's Health, University of Padua, Padua, Italy
| | - Gamba Piergiorgio
- Pediatric Surgery, Department of Woman and Child's Health, University Hospital of Padua, Padua, Italy
| | - Federica DeCorti
- Pediatric Surgery, Department of Woman and Child's Health, University Hospital of Padua, Padua, Italy
| |
Collapse
|
2
|
Yusuf AA, Ibrahim IG, Hirsi IM, Adali A, Hassan YY, Yasar MZ, Abdullahi IM, Hassan MS. Rhino-Orbital Cerebral Mucormycosis in a Healthy Female Child: Case Report. Int Med Case Rep J 2024; 17:241-246. [PMID: 38559497 PMCID: PMC10981427 DOI: 10.2147/imcrj.s454697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 03/18/2024] [Indexed: 04/04/2024] Open
Abstract
Mucormycosis is a potentially fatal condition with a high mortality rate, particularly when there is extra nasal involvement, and it is rare for patients with fungal brain disease to survive. It mostly affects patients who are metabolically or immunologically compromised, which constitutes one of the three classical stages of the progression of Rhino-Orbito-Cerebral Mucormycosis (ROCM). Stage I: infection of the nasal mucosa and paranasal sinuses; Stage II: orbital involvement; Stage III: cerebral involvement.Here, we report a case of rhino-orbital cerebral mucormycosis in a 14-year-old girl with no known risk factor who presented with periorbital edema, right eye proptosis, fever, and extreme facial pain, which progressively worsened to confusion and left leg weakness in 3 days after admission. The final diagnosis was rhino-orbital-cerebral mucormycosis. The infection was successfully treated using liposomal amphotericin and surgical debridement to remove infected orbital tissue. Mucormycosis is a potentially fatal disease that necessitates prompt diagnosis and treatment. Children are rarely infected with mucormycosis. The majority of studies show that people are typically between 40 and 50 years old. ROCM is typically diagnosed using clinical symptoms and histopathologic evaluation; however, imaging is critical in determining the presence of intracranial lesions. The standard treatment for ROCM is amphotericin B at a recommended dose of 1.0-1.5 mg/kg/day for weeks or months, depending on the clinical response and severity of adverse drug reactions, particularly nephrotoxicity.Rhino-orbital cerebral mucormycosis in a healthy female child is uncommon; early diagnosis and prompt treatment with Amphotericin B should be necessary. Devastating consequences will result from a delayed diagnosis.
Collapse
Affiliation(s)
- Abdisalam Abdullahi Yusuf
- Department of Pediatric, Mogadishu Somalia Turkish Training and Research Hospital, Mogadishu, Somalia
| | - Ismail Gedi Ibrahim
- Department of Radiology, Mogadishu Somalia Turkish Training and Research Hospital, Mogadishu, Somalia
- Faculty of Medicine and Surgery, Mogadishu University, Mogadishu, Somalia
| | - Ibrahim Mohamed Hirsi
- Department of Pediatric, Mogadishu Somalia Turkish Training and Research Hospital, Mogadishu, Somalia
| | - Ali Adali
- Department of Pediatric, Mogadishu Somalia Turkish Training and Research Hospital, Mogadishu, Somalia
| | - Yonis Yusuf Hassan
- Department of Pediatric, Mogadishu Somalia Turkish Training and Research Hospital, Mogadishu, Somalia
| | - Mehmet Zeki Yasar
- Department of Pediatric, Mogadishu Somalia Turkish Training and Research Hospital, Mogadishu, Somalia
| | - Ismail Mohamoud Abdullahi
- Department of Pathology, Mogadishu Somalia Turkish Training and Research Hospital, Mogadishu, Somalia
| | - Mohamed Sheikh Hassan
- Faculty of Medicine and Surgery, Mogadishu University, Mogadishu, Somalia
- Department of Neurology, Mogadishu Somalia Turkish Training and Research Hospital, Mogadishu, Somalia
| |
Collapse
|
3
|
Marón GA, Inagaki K, Rodriguez A, Knapp KM, Hayden RT, Adderson EE. Mucormycosis in children with cancer and hematopoietic cell transplant-A single center cohort study. PLoS One 2024; 19:e0297590. [PMID: 38335202 PMCID: PMC10857578 DOI: 10.1371/journal.pone.0297590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 01/09/2024] [Indexed: 02/12/2024] Open
Abstract
Although mucormycosis is an important cause of morbidity and mortality in children with cancer, our understanding of the typical characteristics of these infections is incomplete. We reviewed all cases of mucormycosis diagnosed at a single pediatric cancer center over 5 decades to identify the clinical features of mucormycosis in pediatric oncology patients and to identify risk factors for mortality. There were 44 cases of mucormycosis diagnosed between 1970-2019. Most patients (89%) had hematological malignancies and a history of prolonged and severe neutropenia (91%). In this series, hyperglycemia and exposure to corticosteroids were common. Pulmonary (36%) and disseminated infections (32%) were most common; rhino-orbital-cerebral infections were relatively infrequent (11%). Rhizopus spp. was the most common etiological agent (40%) followed by Mucor spp. (31%), and Cunninghamella spp. (19%). Overall mortality was 44% and 51% and attributable mortality was 39% and 41% at the end of antifungal therapy and end of follow up, respectively. Attributable mortality fell to 18% in 2010-2019, from 58-60% in previous decades; adjunctive surgery was associated with decreased mortality. Mortality remains unacceptably high despite aggressive antifungal therapy and adjunctive surgery, suggesting novel therapeutic strategies are needed.
Collapse
Affiliation(s)
- Gabriela A. Marón
- Department of Infectious Diseases, St. Jude Children’s Research Hospital, Memphis, Tennessee, United States of America
- Department of Pediatrics, University of Tennessee Health Sciences Center, Memphis, Tennessee, United States of America
| | - Kengo Inagaki
- Department of Infectious Diseases, St. Jude Children’s Research Hospital, Memphis, Tennessee, United States of America
| | - Alicia Rodriguez
- Department of Pathology, St. Jude Children’s Research Hospital, Memphis, Tennessee, United States of America
| | - Katherine M. Knapp
- Department of Infectious Diseases, St. Jude Children’s Research Hospital, Memphis, Tennessee, United States of America
- Department of Pediatrics, University of Tennessee Health Sciences Center, Memphis, Tennessee, United States of America
| | - Randall T. Hayden
- Department of Pathology, St. Jude Children’s Research Hospital, Memphis, Tennessee, United States of America
| | - Elisabeth E. Adderson
- Department of Infectious Diseases, St. Jude Children’s Research Hospital, Memphis, Tennessee, United States of America
- Department of Pediatrics, University of Tennessee Health Sciences Center, Memphis, Tennessee, United States of America
| |
Collapse
|
4
|
Zhang L, Zhong DX, Yue M, Xuan LT, Zhang ZX, Li JJ, Li JH, Zou JZ, Yan YC, Liu R. [Clinical analysis of six cases of mucormycosis in children with acute leukemia]. ZHONGHUA XUE YE XUE ZA ZHI = ZHONGHUA XUEYEXUE ZAZHI 2023; 44:594-597. [PMID: 37749043 PMCID: PMC10509617 DOI: 10.3760/cma.j.issn.0253-2727.2023.07.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Indexed: 09/27/2023]
Affiliation(s)
- L Zhang
- Department of Hematology, Capital Institute of Pediatrics, Beijing 100020, China
| | - D X Zhong
- Department of Hematology, Capital Institute of Pediatrics, Beijing 100020, China
| | - M Yue
- Department of Hematology, Capital Institute of Pediatrics, Beijing 100020, China
| | - L T Xuan
- Department of Hematology, Capital Institute of Pediatrics, Beijing 100020, China
| | - Z X Zhang
- Department of Hematology, Capital Institute of Pediatrics, Beijing 100020, China
| | - J J Li
- Department of Hematology, Capital Institute of Pediatrics, Beijing 100020, China
| | - J H Li
- Department of Hematology, Capital Institute of Pediatrics, Beijing 100020, China
| | - J Z Zou
- Department of Pathology, Capital Institute of Pediatrics, Beijing 100020, China
| | - Y C Yan
- Department of Imaging, Capital Institute of Pediatrics, Beijing 100020, China
| | - R Liu
- Department of Hematology, Capital Institute of Pediatrics, Beijing 100020, China
| |
Collapse
|
5
|
Lynch JP, Fishbein MC, Abtin F, Zhanel GG. Part 1: Mucormycosis: Prevalence, Risk Factors, Clinical Features and Diagnosis. Expert Rev Anti Infect Ther 2023. [PMID: 37262298 DOI: 10.1080/14787210.2023.2220964] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 05/30/2023] [Indexed: 06/03/2023]
Abstract
INTRODUCTION Mucormycosis (MCR) is caused by filamentous molds within the Class Zygomycetes and Order Mucorales. Infections can result from inhalation of spores into the nares, oropharynx or lungs, ingestion of contaminated food or water, or inoculation into disrupted skin or wounds. In developed countries, MCR occurs primarily in severely immunocompromised hosts. In contrast, in developing/low income countries, most cases of MCR occur in persons with poorly controlled diabetes mellitus and some cases in immunocompetent subjects following trauma. Mucormycosis exhibits a propensity to invade blood vessels, leading to thrombosis and infarction of tissue. Mortality rates associated with invasive MCR are high and can exceed 90% with disseminated disease. Mucormycosis can be classified as one of six forms: (1) rhino-orbital-cerebral mucormycosis (ROCM); (2) pulmonary; (3) cutaneous; (4) gastrointestinal or renal (5); disseminated; (6) uncommon (focal) sites. AREAS COVERED The authors discuss the prevalence, risk factors and clinical features of mucormycosis.A literature search of mucormycosis was performed via PubMed (up to November 2022), using the key words: invasive fungal infections; mold; mucormycosis; Mucorales; Zyzomyces; Zygomycosis; Rhizopus, diagnosis. EXPERT OPINION Mucormycosis occurs primarily in severely immunocompromised hosts. Mucormycosis can progress rapidly, and delay in initiating treatment by even a few days worsens outcomes.
Collapse
Affiliation(s)
- Joseph P Lynch
- Division of Pulmonary, Critical Care Medicine, Allergy, and Clinical Immunology, Department of Internal Medicine, the David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Michael C Fishbein
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Fereidoun Abtin
- Section of Radiology Cardiothoracic and Interventional, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - George G Zhanel
- Department of Medical Microbiology/Infectious Diseases, Max Rady College of Medicine, University of Manitoba
| |
Collapse
|
6
|
Yang N, Zhang L, Feng S. Clinical Features and Treatment Progress of Invasive Mucormycosis in Patients with Hematological Malignancies. J Fungi (Basel) 2023; 9:jof9050592. [PMID: 37233303 DOI: 10.3390/jof9050592] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Revised: 05/11/2023] [Accepted: 05/16/2023] [Indexed: 05/27/2023] Open
Abstract
The incidence rate of invasive mucormycosis (IM) in patients with hematological malignancies (HMs) is increasing year by year, ranging from 0.07% to 4.29%, and the mortality rate is mostly higher than 50%. With the ongoing pandemic of COVID-19, COVID-19-associated mucormycosis (CAM) also became a global health threat. Patients with high risk factors such as active HMs, relapsed/refractory leukemia, prolonged neutropenia may still develop breakthrough mucormycosis (BT-MCR) even under the prophylaxis of Mucorales-active antifungals, and such patients often have higher mortality. Rhizopus spp. is the most common genus associated with IM, followed by Mucor spp. and Lichtheimia spp. Pulmonary mucormycosis (PM) is the most common form of IM in patients with HMs, followed by rhino-orbital-cerebral mucormycosis (ROCM) and disseminated mucormycosis. The prognosis of IM patients with neutrophil recovery, localized IM and receiving early combined medical-surgical therapy is usually better. As for management of the disease, risk factors should be eliminated firstly. Liposome amphotericin B (L-AmB) combined with surgery is the initial treatment scheme of IM. Those who are intolerant to L-AmB can choose intravenous formulations or tablets of isavuconazole or posaconazole. Patients who are refractory to monotherapy can turn to combined antifungals therapy.
Collapse
Affiliation(s)
- Nuobing Yang
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin 300020, China
- Tianjin Institutes of Health Science, Tianjin 301600, China
| | - Lining Zhang
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin 300020, China
- Tianjin Institutes of Health Science, Tianjin 301600, China
| | - Sizhou Feng
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin 300020, China
- Tianjin Institutes of Health Science, Tianjin 301600, China
| |
Collapse
|
7
|
Tanimura K, Nakajima M, Shirakawa N, Tao K, Sugiyama M, Watanabe Y, Arakawa A, Kikuchi M, Takahashi M, Narita Y, Shiotsuka M, Kobayashi O, Iwata S, Yoshida A, Abe M, Yamagoe S, Miyazaki Y, Ogawa C. Surgical site infection caused by Rhizopus caespitosus after metastasectomy for osteosarcoma: First report of infection in humans. Pediatr Blood Cancer 2023; 70:e30049. [PMID: 36317667 DOI: 10.1002/pbc.30049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 09/19/2022] [Indexed: 11/05/2022]
Affiliation(s)
- Kazuki Tanimura
- Department of Pediatric Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Miho Nakajima
- Department of Pediatric Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Nami Shirakawa
- Department of Pediatric Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Kayoko Tao
- Department of Pediatric Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Masanaka Sugiyama
- Department of Pediatric Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Yuko Watanabe
- Department of Pediatric Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Ayumu Arakawa
- Department of Pediatric Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Miyu Kikuchi
- Department of Neurosurgery and Neuro-Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Masamichi Takahashi
- Department of Neurosurgery and Neuro-Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Yoshitaka Narita
- Department of Neurosurgery and Neuro-Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Mika Shiotsuka
- Department of Infectious Diseases, National Cancer Center Hospital, Tokyo, Japan
| | - Osamu Kobayashi
- Department of Infectious Diseases, National Cancer Center Hospital, Tokyo, Japan
| | - Satoshi Iwata
- Department of Infectious Diseases, National Cancer Center Hospital, Tokyo, Japan
| | - Akihiko Yoshida
- Department of Diagnostic Pathology, National Cancer Center Hospital, Tokyo, Japan
| | - Masahiro Abe
- Department of Fungal Infection, National Institute of Infectious Diseases, Tokyo, Japan
| | - Satoshi Yamagoe
- Department of Fungal Infection, National Institute of Infectious Diseases, Tokyo, Japan
| | - Yoshitsugu Miyazaki
- Department of Fungal Infection, National Institute of Infectious Diseases, Tokyo, Japan
| | - Chitose Ogawa
- Department of Pediatric Oncology, National Cancer Center Hospital, Tokyo, Japan
| |
Collapse
|
8
|
Zhang T, Shen Y, Feng S. Clinical research advances of isavuconazole in the treatment of invasive fungal diseases. Front Cell Infect Microbiol 2022; 12:1049959. [PMID: 36530445 PMCID: PMC9751058 DOI: 10.3389/fcimb.2022.1049959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 11/16/2022] [Indexed: 12/02/2022] Open
Abstract
Purpose Invasive fungal diseases (IFD) are a major global public health concern. The incidence of IFD has increased the demand for antifungal agents. Isavuconazole (ISA) is a new triazole antifungal agent that has shown promising efficacy in the prophylaxis and treatment of invasive fungal diseases. The aim of this review is to summarize the recent real-world experiences of using ISA for the treatment and prevention of IFD. Methods We performed a comprehensive literature search of the MEDLINE, PubMed, Embase, and Cochrane databases for clinical applications of ISA in the real world. Tables and reference lists are presented for this systematic review. Results IFD poses a major threat to public health and causes high mortality rates. ISA may provide a good treatment. For example, the efficacy of ISA in the treatment of invasive aspergillosis (IA) is comparable to that of voriconazole, and its efficacy in the treatment of invasive mucormycosis (IM) is similar to that of liposomal amphotericin B (L-AmB); therefore, ISA is recommended as the first-line treatment for IA and IM. ISA can also achieve good efficacy in the treatment of invasive candidiasis (IC) and can be used as an alternative to de-escalation therapy after first-line drug therapy. In addition, most studies have shown the efficacy and safety of ISA for the prophylaxis of IFD. Conclusion Taken together, ISA are expected to become a new choice for the treatment and prevention of IFD because of their good tolerability, high bioavailability, and few drug interactions.
Collapse
Affiliation(s)
- Tingting Zhang
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin, China,Hematopoietic Stem Cell Transplantation Center, Tianjin Institutes of Health Science, Tianjin, China
| | - Yuyan Shen
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin, China,Hematopoietic Stem Cell Transplantation Center, Tianjin Institutes of Health Science, Tianjin, China
| | - Sizhou Feng
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin, China,Hematopoietic Stem Cell Transplantation Center, Tianjin Institutes of Health Science, Tianjin, China,*Correspondence: Sizhou Feng,
| |
Collapse
|
9
|
Maertens J, Pagano L, Azoulay E, Warris A. Liposomal amphotericin B-the present. J Antimicrob Chemother 2022; 77:ii11-ii20. [PMID: 36426672 PMCID: PMC9693760 DOI: 10.1093/jac/dkac352] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Most invasive fungal infections are opportunistic in nature but the epidemiology is constantly changing, with new risk groups being identified. Neutropenia is a classical risk factor for fungal infections, while critically ill patients in the ICU are now increasingly at risk of yeast and mould infections. Factors to be considered when choosing antifungal treatment include the emergence of rarer fungal pathogens, the risk of resistance to azoles and echinocandins and the possibility of drug-drug interactions. Liposomal amphotericin B has retained its place in the therapeutic armamentarium based on its clinical profile: a broad spectrum of antifungal activity with a low risk of resistance, predictable pharmacokinetics with a rapid accumulation at the infection site (including biofilms), a low potential for drug-drug interactions and a low risk of acute and chronic treatment-limiting toxicities versus other formulations of amphotericin B. It is a suitable choice for the first-line empirical or pre-emptive treatment of suspected fungal infections in neutropenic haematology patients and is an excellent alternative for patients with documented fungal disease who can no longer tolerate or continue their first-line azole or echinocandin therapy, both in the haematology setting and in the ICU. Moreover, it is the first-line drug of choice for the treatment of invasive mucormycosis. Finally, liposomal amphotericin B is one of the few antifungal agents approved for use in children of all ages over 1 month and is included in paediatric-specific guidelines for the management of fungal disease.
Collapse
Affiliation(s)
- J Maertens
- Department of Hematology, University Hospital Gasthuisberg, KU Leuven, Leuven, Belgium.,Department of Microbiology, Immunology, and Transplantation, KU Leuven, Leuven, Belgium
| | - L Pagano
- Sezione di Ematologia, Fondazione Policlinico Universitario Agostino Gemelli-IRCCS-Università Cattolica del Sacro Cuore, Rome, Italy
| | - E Azoulay
- Médecine Intensive et Réanimation, Hôpital Saint-Louis, APHP, University of Paris, Paris, France
| | - A Warris
- MRC Centre for Medical Mycology, University of Exeter, Exeter, UK.,Great Ormond Street Hospital, Paediatric Infectious Diseases Unit, London, UK
| |
Collapse
|
10
|
Gatti M, Campoli C, Belotti T, Cojutti PG, Masetti R, Pession A, Viale P, Pea F. Real-World Comparison of Isavuconazole and Voriconazole in Terms of the Need for Dosage Adjustments Guided by Clinical Pharmacological Advice During Primary Prophylaxis of Invasive Fungal Infections in Pediatric Patients with Hemato-Oncological Malignancies. Ther Drug Monit 2022; 44:641-650. [PMID: 35344524 DOI: 10.1097/ftd.0000000000000980] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Accepted: 02/25/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND Limited evidence concerning optimal azole dosing regimens currently exists for antifungal prophylaxis in hemato-oncological pediatric patients. METHODS Hemato-oncological children receiving intravenous or oral isavuconazole or voriconazole for primary antifungal prophylaxis at IRCCS Azienda Ospedaliero-Universitaria of Bologna during November 2020 to October 2021 and undergoing CPA programs based on real-time therapeutic drug monitoring (TDM) were retrospectively analyzed. CPAs for isavuconazole and voriconazole and the number of dosage adjustments were collected. Normalized trough concentrations [(C min )/dose/kg] were calculated for both drugs at each TDM assessment, and the coefficient of variation was determined. The efficacy and safety of the drugs were evaluated. RESULTS Sixteen hemato-oncological pediatric patients received azole prophylaxis (mean age and weight: 9.1 ± 4.9 years and 32.6 ± 16.0 kg; 6 isavuconazole and 10 voriconazole). Sixty and 89 CPAs were delivered as isavuconazole and voriconazole, respectively. Dosage adjustments were needed in 3.3% of cases for isavuconazole and 53.9% of cases for voriconazole ( P < 0.001). At first TDM, achievement of the desired target during standard dosing regimens was higher for isavuconazole (83.3%) than for voriconazole (10.0%; P = 0.008). Dispersion of normalized concentrations was higher for voriconazole (CV = 139.1% vs. CV = 79.4%). Elevation of ALT and aspartate aminotransferase levels between baseline and the third month was higher in patients receiving voriconazole (median, 28 vs. 90 U/L; P = 0.038, and 19 vs. 65.5 U/L; P = 0.002). CONCLUSIONS Our findings suggest that there is limited variability in isavuconazole exposure in hemato-oncological pediatric patients receiving azole prophylaxis , resulting in a low need for CPA-guided dosage adjustments.
Collapse
Affiliation(s)
- Milo Gatti
- Department of Medical and Surgical Sciences, Alma Mater Studiorum, University of Bologna, Bologna, Italy
- Clinical Pharmacology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Caterina Campoli
- Infectious Diseases Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; and
| | - Tamara Belotti
- Pediatric Oncology and Hematology Unit "Lalla Seràgnoli," IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Pier Giorgio Cojutti
- Clinical Pharmacology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Riccardo Masetti
- Department of Medical and Surgical Sciences, Alma Mater Studiorum, University of Bologna, Bologna, Italy
- Pediatric Oncology and Hematology Unit "Lalla Seràgnoli," IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Andrea Pession
- Department of Medical and Surgical Sciences, Alma Mater Studiorum, University of Bologna, Bologna, Italy
- Pediatric Oncology and Hematology Unit "Lalla Seràgnoli," IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Pierluigi Viale
- Department of Medical and Surgical Sciences, Alma Mater Studiorum, University of Bologna, Bologna, Italy
- Infectious Diseases Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; and
| | - Federico Pea
- Department of Medical and Surgical Sciences, Alma Mater Studiorum, University of Bologna, Bologna, Italy
- Clinical Pharmacology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| |
Collapse
|
11
|
Loeffen YGT, Scharloo F, Goemans BF, Heitink-Polle KMJ, Lindemans CA, van der Bruggen T, Hagen F, Wolfs TFW. Mucormycosis in Children With Hematologic Malignancies: A Case Series and Review of the Literature. Pediatr Infect Dis J 2022; 41:e369-e376. [PMID: 35703287 DOI: 10.1097/inf.0000000000003608] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Mucormycosis is classified as the third leading cause of invasive fungal disease in immunocompromised patients and is characterized by high morbidity and mortality (33%-56%). The aim of this study is to describe presentation, treatment and outcome of Dutch pediatric hemato-oncology patients recently diagnosed with mucormycosis and to review the literature to gain more insight specifically into contemporary outcome data. METHODS Ten cases were diagnosed in the Princess Máxima Center for Pediatric Oncology from 2018 to 2021 and were retrospectively reviewed. In addition, 9 case series (n = 148) were included from literature. RESULTS In our case series, 5 patients of 10 children (age 2-17 years) had disseminated invasive fungal disease. Four patients had localized pulmonary disease and 1 had a localized renal infection. One diagnosis was made postmortem. The underlying diseases were acute lymphoblastic leukemia (n = 6), acute myeloid leukemia (n = 2) and lymphoma (n=2). Seven patients received combination therapy comprising of a lipid amphotericin B formulation and a triazole, surgery was performed in 67%. All neutropenic patients received granulocyte transfusions and/or granulocyte colony-stimulating factor. Mucormycosis-related mortality was 20%. In the literature review, mucormycosis-related mortality was 36% for all patients and 66% for patients with disseminated disease. Survival rates were similar over the past 2 decades. The most common underlying disorder was acute lymphoblastic leukemia. Liposomal amphotericin B was the mainstay of treatment. Seventy percent of patients underwent surgery. CONCLUSIONS Although survival of mucormycosis improved significantly overtime, it plateaued in the past decades. This series shows that with screening, early diagnostics and early antifungal and if possible surgical treatment, mortality is low and even disseminated disease is salvageable if approached aggressively with a combination of surgery and antifungal treatment. Further research focused on diagnostics, combination antifungal and adjunctive therapy is necessary to enhance the survival of mucormycosis in children.
Collapse
Affiliation(s)
- Yvette G T Loeffen
- From the Department of Pediatric Infectious Diseases and Immunology, Wilhelmina Children's Hospital, University Medical Center Utrecht
| | | | - Bianca F Goemans
- Department of Hemato-Oncology, Princess Máxima Center for Pediatric Oncology
| | | | - Caroline A Lindemans
- Department of Pediatrics, Wilhelmina Children's Hospital, University Medical Center Utrecht, Pediatric Blood and Bone Marrow Transplantation, Prinses Máxima Center for Pediatric Oncology
| | | | - Ferry Hagen
- Department of Medical Microbiology, University Medical Center Utrecht
| | - Tom F W Wolfs
- From the Department of Pediatric Infectious Diseases and Immunology, Wilhelmina Children's Hospital, University Medical Center Utrecht
| |
Collapse
|
12
|
COVID-19, Mucormycosis and Cancer: The Triple Threat-Hypothesis or Reality? J Pers Med 2022; 12:jpm12071119. [PMID: 35887616 PMCID: PMC9320339 DOI: 10.3390/jpm12071119] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 07/04/2022] [Accepted: 07/08/2022] [Indexed: 01/09/2023] Open
Abstract
COVID-19 has been responsible for widespread morbidity and mortality worldwide. Invasive mucormycosis has death rates scaling 80%. India, one of the countries hit worst by the pandemic, is also a hotbed with the highest death rates for mucormycosis. Cancer, a ubiquitously present menace, also contributes to higher case fatality rates. All three entities studied here are individual, massive healthcare threats. The danger of one disease predisposing to the other, the poor performance status of patients with all three diseases, the impact of therapeutics for one disease on the pathology and therapy of the others all warrant physicians having a better understanding of the interplay. This is imperative so as to effectively establish control over the individual patient and population health. It is important to understand the interactions to effectively manage all three entities together to reduce overall morbidity. In this review article, we search for an inter-relationship between the COVID-19 pandemic, emerging mucormycosis, and the global giant, cancer.
Collapse
|
13
|
Wang J, Wang Y, Han F, Chen J. Multiple diagnostic methods for mucormycosis: A retrospective case series. J Clin Lab Anal 2022; 36:e24588. [PMID: 35792018 PMCID: PMC9396201 DOI: 10.1002/jcla.24588] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 06/08/2022] [Accepted: 06/25/2022] [Indexed: 12/29/2022] Open
Affiliation(s)
- JiaXin Wang
- Kidney Disease Center, The First Affiliated Hospital, College of Medicine Zhejiang University Hangzhou China
| | - YaoMin Wang
- Kidney Disease Center, The First Affiliated Hospital, College of Medicine Zhejiang University Hangzhou China
| | - Fei Han
- Kidney Disease Center, The First Affiliated Hospital, College of Medicine Zhejiang University Hangzhou China
| | - JiangHua Chen
- Kidney Disease Center, The First Affiliated Hospital, College of Medicine Zhejiang University Hangzhou China
| |
Collapse
|
14
|
Central Nervous System Fungal Infections in Paediatric Patients. CURRENT FUNGAL INFECTION REPORTS 2022. [DOI: 10.1007/s12281-021-00427-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
|
15
|
Kluge S, Strauß R, Kochanek M, Weigand MA, Rohde H, Lahmer T. Aspergillosis: Emerging risk groups in critically ill patients. Med Mycol 2021; 60:6408468. [PMID: 34677613 DOI: 10.1093/mmy/myab064] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 09/23/2021] [Accepted: 10/19/2021] [Indexed: 02/06/2023] Open
Abstract
Information on invasive aspergillosis (IA) and other invasive filamentous fungal infections is limited in non-neutropenic patients admitted to the intensive care unit (ICU) and presenting with no classic IA risk factors. This review is based on the critical appraisal of relevant literature, on the authors' own experience and on discussions that took place at a consensus conference. It aims to review risk factors favoring aspergillosis in ICU patients, with a special emphasis on often overlooked or neglected conditions. In the ICU patients, corticosteroid use to treat underlying conditions such as chronic obstructive pulmonary disease (COPD), sepsis, or severe COVID-19, represents a cardinal risk factor for IA. Important additional host risk factors are COPD, decompensated cirrhosis, liver failure, and severe viral pneumonia (influenza, COVID-19). Clinical observations indicate that patients admitted to the ICU because of sepsis or acute respiratory distress syndrome are more likely to develop probable or proven IA, suggesting that sepsis could also be a possible direct risk factor for IA, as could small molecule inhibitors used in oncology. There are no recommendations for prophylaxis in ICU patients; posaconazole mold-active primary prophylaxis is used in some centers according to guidelines for other patient populations and IA treatment in critically ill patients is basically the same as in other patient populations. A combined evaluation of clinical signs and imaging, classical biomarkers such as the GM assay, and fungal cultures examination, remain the best option to assess response to treatment. LAY SUMMARY The use of corticosteroids and the presence of co-morbidities such as chronic obstructive pulmonary disease, acute or chronic advanced liver disease, or severe viral pneumonia caused by influenza or Covid-19, may increase the risk of invasive aspergillosis in intensive care unit patients.
Collapse
Affiliation(s)
- Stefan Kluge
- Department of Intensive Care Medicine, University Medical Center Hamburg - Eppendorf, Hamburg, D-20246, Germany
| | - Richard Strauß
- Department of Medicine 1, Medizinische Klinik 1, University Hospital Erlangen, Erlangen, D-91054, Germany
| | - Matthias Kochanek
- Department I of Internal Medicine, Faculty of Medicine and University Hospital Cologne, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, University of Cologne, D-50937, Germany
| | - Markus A Weigand
- Department of Anesthesiology, Heidelberg University Hospital, Heidelberg, D-69120, Germany
| | - Holger Rohde
- Institute of Medical Microbiology, Virology and Hygiene, University Medical Center Hamburg-Eppendorf, Hamburg, D-20246, Germany
| | - Tobias Lahmer
- Klinik und Poliklinik für Innere Medizin II, Klinikum rechts der Isar der Technischen Universität Munich, Munich, D-81675, Germany
| |
Collapse
|
16
|
Ferdjallah A, Nelson KM, Meyer K, Jennissen CA, Ebens CL. Isavuconazonium Sulfate Use in Multi-Modal Management of Invasive Mucormycosis in Four Pediatric Allogeneic Hematopoietic Cell Transplant Patients. J Pediatr Pharmacol Ther 2021; 26:863-867. [PMID: 34790078 DOI: 10.5863/1551-6776-26.8.863] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 02/04/2021] [Indexed: 11/11/2022]
Abstract
Prolonged neutropenia increases the risk for lethal invasive fungal infections (IFIs) such as those caused by Rhizopus species. Isavuconazonium sulfate is a new triazole that lacks pediatric dosing recommendations. Clinical courses of 4 pediatric patients with IFIs in the peri-allogeneic hematopoietic cell transplantation (alloHCT) period between 2015 and 2017 were reviewed. The reviews included previously unreported pharmacokinetic and safety data, and the IFIs included Rhizopus. Isavuconazonium sulfate was initiated with a loading dose followed by daily dosing, adjusted to a goal trough concentration of >3 mg/L based on adult literature. This target was achieved at a median of 7 days, demonstrating varying rates of metabolism. Renal insufficiency, electrolyte disturbances, and transaminitis were noted, although attribution was confounded by other alloHCT complications. One patient survived infection-free to hospital discharge and 1 of 3 deceased patients had evidence of an unresolved IFI (case 2). Case 2 was subtherapeutic for 39% of the duration of treatment, compared with others at an average of 29%, suggesting this target trough to be clinically relevant because case 2 demonstrated positive sinus and nasal cultures for Rhizopus on autopsy. We recommend initiation of isavuconazonium 10 mg/kg with a maximum dose of 372 mg. A loading dose of 10 mg/kg is used every 8 hours for 6 doses followed by 10 mg/kg dosing every 24 hours. Monitoring must continue beyond steady state. If early monitoring is not possible, we recommend a first drug level at week 3. If dose increases are required, a partial reload has been more successful instead of increasing daily doses. Further larger studies are needed to demonstrate optimum dosing in pediatric patients.
Collapse
|
17
|
Sun Y, Li H, Chen J, Ma Z, Han P, Liu Y, Wen J, Ren F, Ma X. Case Report: Metagenomics Next-Generation Sequencing Can Be Performed for the Diagnosis of Disseminated Mucormycosis. Front Med (Lausanne) 2021; 8:675030. [PMID: 34746163 PMCID: PMC8568769 DOI: 10.3389/fmed.2021.675030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 09/20/2021] [Indexed: 01/15/2023] Open
Abstract
Mucormycosis is an infection caused by a group of filamentous molds with in the order Mucorales. In developing countries, most cases of mucormycosis occur in persons with poorly controlled diabetes mellitus or subjects with normal post-traumatic immune function. Mucormycosis exhibits a marked propensity for invading blood vessels. The mortality rate of invasive mucormycosis is very high (>30-50%), and 90% of mortality is related to disseminated diseases. We report a 62-year-old man with underlying diseases, such as diabetes and psoriatic arthritis, with a history of trauma before admission. Chest CT showed multiple cavities. Based on the suspected clinical manifestation of mucormycosis infection, the patient received a microbiological culture of bronchoalveolar lavage fluid, and metagenomics next generation sequencing (mNGS) was performed. The results suggested Klebsiella pneumoniae infection. However, Rhizopus microsporus strains were shown by the mNGS of transpulmonary puncture tissue. Therefore, we report a case in which rare pathogens are identified by mNGS.
Collapse
Affiliation(s)
- Yi Sun
- Department of Gynecology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.,Gene Hospital of Henan Province, Precision Medicine Center, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - HuiLing Li
- Department of Respiratory, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - JiaJun Chen
- School of Public Health, Zhengzhou University, Zhengzhou, China
| | - ZhongHui Ma
- Gene Hospital of Henan Province, Precision Medicine Center, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.,Department of Stomatology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Pin Han
- Department of Gynecology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.,Gene Hospital of Henan Province, Precision Medicine Center, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - YuChen Liu
- Department of Gynecology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.,Gene Hospital of Henan Province, Precision Medicine Center, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Jing Wen
- Department of Gynecology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.,Gene Hospital of Henan Province, Precision Medicine Center, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Fang Ren
- Department of Gynecology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - XiaoXu Ma
- Department of Respiratory, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| |
Collapse
|
18
|
Avatef Fazeli M, Rezaei L, Javadirad E, Iranfar K, Khosravi A, Amini Saman J, Poursabbagh P, Ghadami MR, Parandin MM, Dehghani A, Ahmadi Jouybari T, Mahdavian B, Eivazi N, Rezaei S, Rezaei A, Emami B, Haqgou M, Bozorgomid A, Sayad B. Increased incidence of rhino-orbital mucormycosis in an educational therapeutic hospital during the COVID-19 pandemic in western Iran: An observational study. Mycoses 2021; 64:1366-1377. [PMID: 34252988 PMCID: PMC8447086 DOI: 10.1111/myc.13351] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 07/02/2021] [Accepted: 07/07/2021] [Indexed: 12/23/2022]
Abstract
Background COVID‐19 patients, especially the patients requiring hospitalisation, have a high risk of several complications such as opportunistic bacterial and fungal infections. Mucormycosis is a rare and opportunistic fungal infection that mainly affects diabetic and immunocompromised patients. An increase has been observed in the number of rhino‐orbital mucormycosis in patients with COVID‐19 admitted to Imam Khomeini Hospital, Kermanshah, Iran, since October 2020. This is a report of the frequency, risk factors, clinical manifestations, treatment and prognosis of COVID‐19 associated with mucormycosis infection. Methods The medical records of COVID‐19 patients with rhino‐orbital mucormycosis who were diagnosed in an educational therapeutic hospital in Kermanshah, west of Iran were surveyed. Several parameters were analysed including demographic, clinical, therapeutic and laboratory characteristics. Results Twelve patients with COVID‐19–associated rhino‐orbital mucormycosis were identified from 12 October to 18 November 2020. All cases reported as proven mucormycosis had a history of hospitalisation due to COVID‐19. Comorbidities mainly included diabetes mellitus (83.33%) and hypertension (58.33%). Seventy‐five per cent of patients received corticosteroids for COVID‐ 19 treatment. The sites of involvement were rhino‐sino‐orbital (83%) and rhino‐sino (17%). Amphotericin B/liposomal amphotericin B alone or in combination with surgical debridement or orbital exenteration was used as the first‐line therapy. The overall mortality rate was 66.7% (8/12). Conclusions We found a high incidence of mucormycosis among COVID‐19 patients. Diabetes mellitus and corticosteroid use were the dominant predisposing factor of mucormycosis. Mucormycosis is a life‐threatening and opportunistic infection; therefore, physicians should know the signs and symptoms of the disease so that a timely diagnosis and therapy can be performed.
Collapse
Affiliation(s)
- Manouchehr Avatef Fazeli
- Department of Otorhinolaryngology, School of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Leila Rezaei
- Department of Ophthalmology, School of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Etrat Javadirad
- Department of Pathology, School of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Khosro Iranfar
- Department of Otorhinolaryngology, School of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Abbas Khosravi
- Department of Ophthalmology, School of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Javad Amini Saman
- Department of Anesthesiology, School of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Pardis Poursabbagh
- Department of Otorhinolaryngology, School of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Mohammad Rasoul Ghadami
- Department of Otorhinolaryngology, School of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran.,Sleep Disorders Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Mohammad Mehdi Parandin
- Department of Ophthalmology, School of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Amrollah Dehghani
- Department of Otorhinolaryngology, School of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Touraj Ahmadi Jouybari
- Department of Interna, Medicine, School of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Behzad Mahdavian
- Department of Infectious Disease, School of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Nastaran Eivazi
- Department of Otorhinolaryngology, School of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Sohbat Rezaei
- Department of Otorhinolaryngology, School of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Alireza Rezaei
- Department of Otorhinolaryngology, School of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Bashir Emami
- Imam Khomeini and Mohamad Kermanshahi Clinical Research Development Unit, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Mohadeseh Haqgou
- Department of Otorhinolaryngology, School of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Arezoo Bozorgomid
- Infectious Diseases Research Center, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Babak Sayad
- Department of Infectious Disease, School of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran.,Infectious Diseases Research Center, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| |
Collapse
|
19
|
Invasive Mucormycosis in Children With Malignancies: Report From the Infection Working Group of the Hellenic Society of Pediatric Hematology-Oncology. J Pediatr Hematol Oncol 2021; 43:176-179. [PMID: 32890077 DOI: 10.1097/mph.0000000000001931] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Accepted: 08/10/2020] [Indexed: 12/18/2022]
Abstract
Mucormycosis is an invasive, life-threatening fungal infection that mainly affects immunocompromised hosts. We collected data of pediatric mucormycosis cases from all 7 Greek Hematology-Oncology Departments for the years 2008-2017. Six cases of invasive mucormycosis diagnosed during treatment for malignancies were included in the study. In 4 children (66%) mucormycosis occurred within the first 20 days after diagnosis of the underlying disease. Two cases were classified as proven mucormycosis and 4 as probable. The most frequently recorded species was Rhizopus arrhizus (2 patients), followed by Mucor spp (1), and Lichtheimia spp (1). All patients received liposomal amphotericin B. Combined antifungal treatment was used in 5 cases. Surgical excision was performed in 4 cases (66%). Two patients died at 6 and 12 months after the diagnosis, respectively, 1 (17%) because of mucormycosis. Our data suggest that mucormycosis may occur early after the initiation of intensive chemotherapy in children with malignancies.
Collapse
|
20
|
Mauro M, Lo Cascio G, Balter R, Zaccaron A, Bonetti E, Vitale V, Chinello M, De Bortoli M, Brazzarola P, Bruno C, Cesaro S. The Diagnostic Pitfalls of Mucormycosis. Mediterr J Hematol Infect Dis 2020; 12:e2020079. [PMID: 33194153 PMCID: PMC7643780 DOI: 10.4084/mjhid.2020.079] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 10/17/2020] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Invasive mucormycosis is a very aggressive fungal disease among immunocompromised pediatric patients caused by saprophytic fungi that belong to the order of the Mucorales. CASE REPORT We describe a case of of Lichtheimia corymbifera infection in a 15-year-old child with B-cell-Non-Hodgkin Lymphoma (B-NHL) involving lung, kidney and thyroid that initially was diagnosed as probable aspergillosis delaying the effective therapy for mucormycosis. CONCLUSIONS This case showed that also the intensive chemotherapy for B-NHL may represent a risk factor for mucormycosis infection. Liposomal amphotericin B and surgery remain the key tools for the successful treatment of this aggressive disease.
Collapse
Affiliation(s)
- Margherita Mauro
- Pediatric Hematology Oncology, Department of Mother and Child, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Giuliana Lo Cascio
- Unità Operativa Complessa di Microbiologia e Virologia, Dipartimento di Patologia e diagnostica, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Rita Balter
- Pediatric Hematology Oncology, Department of Mother and Child, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Ada Zaccaron
- Pediatric Hematology Oncology, Department of Mother and Child, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Elisa Bonetti
- Pediatric Hematology Oncology, Department of Mother and Child, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Virginia Vitale
- Pediatric Hematology Oncology, Department of Mother and Child, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Matteo Chinello
- Pediatric Hematology Oncology, Department of Mother and Child, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Massimiliano De Bortoli
- Pediatric Hematology Oncology, Department of Mother and Child, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Paolo Brazzarola
- Endocrine Surgery Unit, Department of Surgery and Oncology, University and Hospital Trust of Verona, Verona, Italy
| | - Costanza Bruno
- Department of Radiology, Radiology Institute, Verona, Italy
| | - Simone Cesaro
- Pediatric Hematology Oncology, Department of Mother and Child, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| |
Collapse
|
21
|
Feng YH, Guo WW, Wang YR, Shi WX, Liu C, Li DM, Qiu Y, Shi DM. Rhinocerebral mucormycosis caused by Rhizopus oryzae in a patient with acute myeloid leukemia: A case report. World J Dermatol 2020; 8:1-9. [DOI: 10.5314/wjd.v8.i1.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 05/29/2020] [Accepted: 06/20/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Rhinocerebral mucormycosis (RCM) is a rare fatal fungal infection which is on the increase among immunocompromised hosts such as patients who have had hematological cancers, or have received immunosuppressive drugs, corticosteroids, or other T cell suppressing agents.
CASE SUMMARY We report a case of RCM caused by Rhizopus oryzae, one of the most common opportunistic pathogens, in a patient suffering from a fourth relapse of acute myeloid leukemia. The patient developed RCM after he had received long-term antibiotic agents and corticosteroids. The pathogen was isolated three times from nasal secretions collected from the deep parts of the nasal cavity and was identified by morphology and internal transcribed spacer sequencing. Blood infection was excluded by droplet digital polymerase chain reaction and blood culture. The patient was empirically treated with caspofungin and voriconazole for several days while the lesions continued to progress. The patient was given amphotericin B in combination with caspofungin after RCM was suspected, and the lesions improved over the course of treatment, which lasted several days. However, the patient eventually died of the primary disease.
CONCLUSION This case indicates that immunosuppressive drugs, including corticosteroids and antimetabolites in hematological tumor, do increase the risk of infections of this type. Early diagnosis, prompt and frequent surgical debridement, and treatment with amphotericin B without delay are all essential in combatting RCM.
Collapse
Affiliation(s)
- Ya-Hui Feng
- Department of Clinical Medicine, Jining Medical University, Jining 272067, Shandong Province, China
| | - Wen-Wen Guo
- Department of Hematology, Jining No. 1 People’s Hospital, Jining 272067, Shandong Province, China
| | - Ya-Ru Wang
- Department of Dermatology, Jining No. 1 People’s Hospital, Jining 272067, Shandong Province, China
| | - Wen-Xia Shi
- Department of Clinical Medicine, Jining Medical University, Jining 272067, Shandong Province, China
| | - Chen Liu
- Laboratory of Clinical Mycology, Jining No. 1 People’s Hospital, Jining 272067, Shandong Province, China
| | - Dong-Mei Li
- Medical Center, Georgetown University, Washington, DC 20057, United States
| | - Ying Qiu
- Department of Dermatology, Jining No. 1 People’s Hospital, Jining 272067, Shandong Province, China
| | - Dong-Mei Shi
- Laboratory of Medical Mycology, Department of Dermatology, Jining No. 1 People’s Hospital, Jining 272067, Shandong Province, China
| |
Collapse
|
22
|
Abstract
BACKGROUND Mucormycosis is a rare but emerging life-threatening fungal disease with limited treatment options. Isavuconazole is a new triazole that has shown efficacy in adults for primary and salvage treatment of mucormycosis. However, data in children are scarce. METHODS The demographic and clinical data of pediatric patients with proven mucormycosis who were treated with isavuconazole in 2015 to 2019 at 2 centers were collected. RESULTS Four children of median age 10.5 years (range 7-14) met the study criteria. Three had underlying hematologic malignancies, and 1 had sustained major trauma. Isavuconazole was used as salvage therapy in all: in 3 patients for refractory disease, and in 1 after intolerance to another antifungal drug. Isavuconazole was administered alone or combined with other antifungal agents. Following treatment and surgical intervention, complete clinical, radiologic and mycologic responses were documented in all patients. A literature review identified 8 children with mucormycosis who were successfully treated with isavuconazole, as salvage therapy in the majority. CONCLUSION Our limited experience supports the use of isavuconazole as salvage therapy in pediatric mucormycosis.
Collapse
|
23
|
Khafagy R, Gupta S, Campisi P, Waters V. Treatment of localized mucormycosis using nasal amphotericin B irrigation in pediatric oncology. Pediatr Blood Cancer 2020; 67:e28175. [PMID: 31925929 DOI: 10.1002/pbc.28175] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Accepted: 12/21/2019] [Indexed: 01/26/2023]
Affiliation(s)
- Rana Khafagy
- Department of Pharmacy, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Sumit Gupta
- Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Paolo Campisi
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Otolaryngology-Head & Neck Surgery, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Valerie Waters
- Division of Infectious Diseases, The Hospital for Sick Children, Toronto, Ontario, Canada
| |
Collapse
|
24
|
Biddeci G, Antonello M, Pizzi M, Petris MG, Pillon M, Donà D, Biffi A, Putti MC. Mucormycosis with peculiar aortic involvement in a child with acute lymphoblastic leukemia. Pediatr Hematol Oncol 2020; 37:164-169. [PMID: 31847684 DOI: 10.1080/08880018.2019.1691294] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Among fungal infection, mucormycosis is a rare but severe etiology in immunocompromised patients. Lung and sinus are the usual sites; the involvement of blood vessels is also described. The diagnosis is a real challenge, because blood tests (galactomannan, beta-D-glucan) are negative and the only diagnostic tool is usually the biopsy of the affected zone. Aortitis is rare and usually caused by bacterial infection, fungal etiology is unusual and only episodic cases are reported in literature. Medical therapy alone is usually not sufficient and debilitating surgical intervention is required. We report the case of a child affected by B precursor acute lymphoblastic leukemia, presenting a systemic fungal infection complicated by aortitis, probably due to Mucor. The patient developed fever and pneumonia during the Induction phase of chemotherapy. At the beginning, the infection was treated as bacterial and the diagnosis of Mucor infection was possible only after surgical intervention with histological analysis. Medical therapy (antifungal) was not sufficient alone to cure the infection and an urgent surgical intervention was required. This case underlines the challenge in the diagnosis of mucomycosis, that should be suspected in case of prolonged fever during aplasia, not responding to standard antibiotic and antifungal therapies. Mucor infection often require a combined intervention, both medical and surgical to cure the infection.
Collapse
Affiliation(s)
- Giada Biddeci
- Pediatric Onco-Hematology Unit, Department of Women's and Children's Health, University of Padova, Padova, Italy
| | - Michele Antonello
- Clinic of Vascular and Endovascular Surgery, University of Padova, Padova, Italy
| | - Marco Pizzi
- Surgical Pathology and Cythopathology Unit, Department of Medicine, University of Padova, Padova, Italy
| | - Maria Grazia Petris
- Pediatric Onco-Hematology Unit, Department of Women's and Children's Health, University of Padova, Padova, Italy
| | - Marta Pillon
- Pediatric Onco-Hematology Unit, Department of Women's and Children's Health, University of Padova, Padova, Italy
| | - Daniele Donà
- Division of Pediatric Infectious Diseases, Department for Woman and Child Health, University of Padua, Padua, Italy
| | - Alessandra Biffi
- Pediatric Onco-Hematology Unit, Department of Women's and Children's Health, University of Padova, Padova, Italy
| | - Maria Caterina Putti
- Pediatric Onco-Hematology Unit, Department of Women's and Children's Health, University of Padova, Padova, Italy
| |
Collapse
|
25
|
Decembrino N, Perruccio K, Zecca M, Colombini A, Calore E, Muggeo P, Soncini E, Comelli A, Molinaro M, Goffredo BM, De Gregori S, Giardini I, Scudeller L, Cesaro S. A Case Series and Literature Review of Isavuconazole Use in Pediatric Patients with Hemato-oncologic Diseases and Hematopoietic Stem Cell Transplantation. Antimicrob Agents Chemother 2020; 64:e01783-19. [PMID: 31871077 PMCID: PMC7038308 DOI: 10.1128/aac.01783-19] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2019] [Accepted: 12/10/2019] [Indexed: 01/12/2023] Open
Abstract
We analyzed the use of isavuconazole (ISA) as treatment or prophylaxis for invasive fungal disease (IFD) in children with hemato-oncologic diseases. A multicentric retrospective analysis was performed among centers belonging to the Italian Association for Pediatric Hematology and Oncology (AIEOP). Pharmacokinetic (PK) monitoring was applied by a high-performance liquid chromatography-tandem mass spectrometry (HLPC-MS/MS) assay. Twenty-nine patients were studied: 10 during chemotherapy and 19 after allogeneic hematopoietic stem cell transplantation (HSCT). The patients consisted of 20 males and 9 females with a median age of 14.5 years (age range, 3 to 18 years) and a median body weight of 47 kg (body weight range, 15 to 80 kg). ISA was used as prophylaxis in 5 patients and as treatment in 24 cases (20 after therapeutic failure, 4 as first-line therapy). According to European Organization for Research and Treatment of Cancer (EORTC) criteria, we registered 5 patients with proven IFD, 9 patients with probable IFD, and 10 patients with possible IFD. Patients with a body weight of <30 kg received half the ISA dose; the others received ISA on the adult schedule (a 200-mg loading dose every 8 h on days 1 and 2 and a 200-mg/day maintenance dose); for all but 10 patients, the route of administration switched from the intravenous route to the oral route during treatment. ISA was administered for a median of 75.5 days (range, 6 to 523 days). The overall response rate was 70.8%; 12 patients with IFD achieved complete remission, 5 achieved partial remission, 5 achieved progression, and 3 achieved stable IFD. No breakthrough infections were registered. PK monitoring of 17 patients revealed a median ISA steady-state trough concentration of 4.91 mg/liter (range, 2.15 to 8.54 mg/liter) and a concentration/dose (in kilograms) ratio of 1.13 (range, 0.47 to 3.42). Determination of the 12-h PK profile was performed in 6 cases. The median area under the concentration-time curve from 0 to 12 h was 153.16 mg·h/liter (range, 86.31 to 169.45 mg·h/liter). Common Terminology Criteria for Adverse Events grade 1 to 3 toxicity (increased transaminase and/or creatinine levels) was observed in 6 patients, with no drug-drug interactions being seen in patients receiving immunosuppressants. Isavuconazole may be useful and safe in children with hemato-oncologic diseases, even in the HSCT setting. Prospective studies are warranted.
Collapse
Affiliation(s)
- N Decembrino
- Pediatric Hematology/Oncology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - K Perruccio
- Division of Pediatric Hematology, University Hospital of Perugia, Perugia, Italy
| | - M Zecca
- Pediatric Hematology/Oncology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - A Colombini
- Pediatric Hematology/Oncology, Fondazione Monza e Brianza per il Bambino e la Mamma, Monza, Italy
| | - E Calore
- Clinic of Pediatric Hematology/Oncology, Department of Women's and Children's Health, University Hospital of Padova, Padua, Italy
| | - P Muggeo
- Department of Pediatric Oncology and Hematology, University Hospital of Policlinico, Bari, Italy
| | - E Soncini
- Pediatric Hematology/Oncology, Spedali Civili, Brescia, Italy
| | - A Comelli
- Department of Infectious and Tropical Diseases, Spedali Civili, Brescia, Italy
| | - M Molinaro
- Clinical and Experimental Pharmacokinetics Lab, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - B M Goffredo
- Metabolic Pathology Lab, Ospedale Pediatrico Bambino Gesù, Rome, Italy
| | - S De Gregori
- Clinical and Experimental Pharmacokinetics Lab, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - I Giardini
- Clinical and Experimental Pharmacokinetics Lab, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - L Scudeller
- Clinical Epidemiology and Biometric Unit, Scientific Direction, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - S Cesaro
- Pediatric Hematology/Oncology, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| |
Collapse
|
26
|
Elitzur S, Arad-Cohen N, Barg A, Litichever N, Bielorai B, Elhasid R, Fischer S, Fruchtman Y, Gilad G, Kapelushnik J, Kharit M, Konen O, Laor R, Levy I, Raviv D, Shachor-Meyouhas Y, Shvartser-Beryozkin Y, Toren A, Yaniv I, Nirel R, Izraeli S, Barzilai-Birenboim S. Mucormycosis in children with haematological malignancies is a salvageable disease: a report from the Israeli Study Group of Childhood Leukemia. Br J Haematol 2019; 189:339-350. [PMID: 31885080 DOI: 10.1111/bjh.16329] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Accepted: 09/04/2019] [Indexed: 12/12/2022]
Abstract
Mucormycosis has emerged as an increasingly important cause of morbidity and mortality in immunocompromised patients, but contemporary data in children are lacking. We conducted a nationwide multicentre study to investigate the characteristics of mucormycosis in children with haematological malignancies. The cohort included 39 children with mucormycosis: 25 of 1136 children (incidence 2·2%) with acute leukaemias prospectively enrolled in a centralized clinical registry in 2004-2017, and an additional 14 children with haematological malignancies identified by retrospective search of the databases of seven paediatric haematology centres. Ninety-two percent of mucormycosis cases occurred in patients with acute leukaemias. Mucormycosis was significantly associated with high-risk acute lymphoblastic leukaemia (OR 3·75; 95% CI 1·51-9·37; P = 0·004) and with increasing age (OR 3·58; 95% CI 1·24-9·77; P = 0·01). Fifteen patients (38%) died of mucormycosis. Rhinocerebral pattern was independently associated with improved 12-week survival (OR 9·43; 95% CI 1·47-60·66; P = 0·02) and relapsed underlying malignancy was associated with increased 12-week mortality (OR 6·42; 95% CI, 1·01-40·94; P = 0·05). In patients receiving frontline therapy for their malignancy (n = 24), one-year cumulative mucormycosis-related mortality was 21 ± 8% and five-year overall survival was 70 ± 8%. This largest paediatric population-based study of mucormycosis demonstrates that children receiving frontline therapy for their haematological malignancy are often salvageable.
Collapse
Affiliation(s)
- Sarah Elitzur
- The Rina Zaizov Division of Pediatric Hematology-Oncology, Schneider Children's Medical Center, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Nira Arad-Cohen
- Pediatric Hematology-Oncology Department, Ruth Rappaport Children's Hospital, Rambam Health Care Campus, Haifa, Israel.,Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Assaf Barg
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Division of Pediatric Hematology, Oncology and BMT, The Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Ramat Gan, Israel
| | - Naomi Litichever
- The Rina Zaizov Division of Pediatric Hematology-Oncology, Schneider Children's Medical Center, Petah Tikva, Israel
| | - Bella Bielorai
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Division of Pediatric Hematology, Oncology and BMT, The Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Ramat Gan, Israel
| | - Ronit Elhasid
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Pediatric Hemato-Oncology, Sourasky Medical Center, Tel Aviv, Israel
| | - Salvador Fischer
- The Rina Zaizov Division of Pediatric Hematology-Oncology, Schneider Children's Medical Center, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yariv Fruchtman
- Department of Pediatric Hematology-Oncology, Soroka Medical Center, Ben Gurion University, Beer Sheva, Israel
| | - Gil Gilad
- The Rina Zaizov Division of Pediatric Hematology-Oncology, Schneider Children's Medical Center, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Joseph Kapelushnik
- Department of Pediatric Hematology-Oncology, Soroka Medical Center, Ben Gurion University, Beer Sheva, Israel
| | - Mira Kharit
- Department of Hematology, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Osnat Konen
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Pediatric Radiology, Schneider Children's Medical Center, Petah Tikva, Israel
| | - Ruth Laor
- Pediatric Hematology-Oncology, Bnai Zion Medical Center, Haifa, Israel
| | - Itzhak Levy
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Pediatric Infectious Disease Unit, Schneider Children's Medical Center, Petah Tikva, Israel
| | - Dror Raviv
- Pediatric Hematology-Oncology, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Yael Shachor-Meyouhas
- Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.,Pediatric Infectious Disease Unit, Ruth Rappaport Children's Hospital, Rambam Health Care Campus, Haifa, Israel
| | - Yulia Shvartser-Beryozkin
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Institute of Pathology, Beilinson Hospital, Petah Tikva, Israel
| | - Amos Toren
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Division of Pediatric Hematology, Oncology and BMT, The Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Ramat Gan, Israel
| | - Isaac Yaniv
- The Rina Zaizov Division of Pediatric Hematology-Oncology, Schneider Children's Medical Center, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ronit Nirel
- Department of Statistics, Hebrew University, Jerusalem, Israel
| | - Shai Izraeli
- The Rina Zaizov Division of Pediatric Hematology-Oncology, Schneider Children's Medical Center, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shlomit Barzilai-Birenboim
- The Rina Zaizov Division of Pediatric Hematology-Oncology, Schneider Children's Medical Center, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| |
Collapse
|
27
|
Aftandilian C, Eguiguren L, Mathew R, Messner A. Mucormycosis diagnosed during induction chemotherapy in five pediatric patients with acute lymphoblastic leukemia. Pediatr Blood Cancer 2019; 66:e27834. [PMID: 31131954 DOI: 10.1002/pbc.27834] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Revised: 05/02/2019] [Accepted: 05/14/2019] [Indexed: 01/22/2023]
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.
Collapse
Affiliation(s)
- Catherine Aftandilian
- Pediatric Hematology/Oncology, Stanford University School of Medicine, Palo Alto, California
| | - Lourdes Eguiguren
- Pediatric Infectious Disease, Stanford University School of Medicine, Palo Alto, California
| | - Roshni Mathew
- Pediatric Infectious Disease, Stanford University School of Medicine, Palo Alto, California
| | - Anna Messner
- Pediatric Otolaryngology/Head and Neck Surgery, Stanford University School of Medicine, Palo Alto, California
| |
Collapse
|
28
|
Chikley A, Ben-Ami R, Kontoyiannis DP. Mucormycosis of the Central Nervous System. J Fungi (Basel) 2019; 5:jof5030059. [PMID: 31288475 PMCID: PMC6787740 DOI: 10.3390/jof5030059] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Revised: 07/05/2019] [Accepted: 07/07/2019] [Indexed: 12/17/2022] Open
Abstract
Mucormycosis involves the central nervous system by direct extension from infected paranasal sinuses or hematogenous dissemination from the lungs. Incidence rates of this rare disease seem to be rising, with a shift from the rhino-orbital-cerebral syndrome typical of patients with diabetes mellitus and ketoacidosis, to disseminated disease in patients with hematological malignancies. We present our current understanding of the pathobiology, clinical features, and diagnostic and treatment strategies of cerebral mucormycosis. Despite advances in imaging and the availability of novel drugs, cerebral mucormycosis continues to be associated with high rates of death and disability. Emerging molecular diagnostics, advances in experimental systems and the establishment of large patient registries are key components of ongoing efforts to provide a timely diagnosis and effective treatment to patients with cerebral mucormycosis.
Collapse
Affiliation(s)
- Amanda Chikley
- Infectious Diseases Unit, Tel Aviv Sourasky Medical Center, Tel Aviv 64239, Israel
| | - Ronen Ben-Ami
- Infectious Diseases Unit, Tel Aviv Sourasky Medical Center, Tel Aviv 64239, Israel.
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 64239, Israel.
| | - Dimitrios P Kontoyiannis
- Department of Infectious Diseases, The University of Texas, M.D. Anderson Cancer Center, Houston 77030, TexasTX 77030, USA.
| |
Collapse
|