Paola Muggeo1, Elisabetta Calore2, Nunzia Decembrino3, Stefano Frenos4, Francesco De Leonardis1, Antonella Colombini5, Fara Petruzziello6, Katia Perruccio7, Massimo Berger8, Roberta Burnelli9, Giulio A Zanazzo10, Nicola Santoro1, Simone Cesaro11. 1. Department of Pediatric Oncology and Hematology, University Hospital of Policlinico, Bari, Bari, Italy. 2. Clinic of Pediatric Hemato-Oncology, Department of Women's and Children's Health, University Hospital of Padova, Padova, Italy. 3. Pediatric Hematology Oncology, IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy. 4. Oncoematologia Pediatrica, Ospedale Meyer, Firenze, Italy. 5. Ematologia Pediatrica Fondazione MBBM Ospedale San Gerardo, Monza, Italy. 6. Emato-Oncologia pediatrica, AO Santobono-Pausillipon, Napoli, Itlay. 7. Pediatric Hematology Oncology, Azienda Ospedaliera Universitaria, Ospedale Santa Maria della Misericordia, Perugia, Italy. 8. Pediatric Onco-Hematology, Stem Cell Transplantation and Cellular Therapy Division, AOU Città della Salute e della Scienza, Regina Margherita Children Hospital, Turin, Italy. 9. Pediatric Onco-Hematology Unit, Sant'Anna University Hospital, Ferrara, Italy. 10. Institute for Maternal and Child Health IRCCS Burlo Garofolo Trieste, Trieste, Italy. 11. Pediatric Hematology Oncology, Azienda Ospedaliera Universitaria Integrata, Verona, Italy.
Abstract
BACKGROUND: Invasive mucormycosis is a rare but frequently fatal fungal disease. The acute and rapidly progressive evolution causes unfavourable outcome in 22%-59% of patients and its treatment represents a clinical challenge, especially in immunocompromised patients. Current data in paediatric oncological patients are limited. OBJECTIVES: The infection Working Group of the Italian Association of Pediatric Hematology and Oncology (AIEOP) analysed the episodes of invasive mucormycosis occurred between 2009 and 2016. PATIENTS: Fifteen cases of proven mucormycosis (male/female 8/7; median age 14.1 years, range 7.7-18.6) were reported after chemotherapy for acute leukaemia and lymphoma (12) and allogeneic stem cell transplantation (3). The aetiology was Rhizopus oryzae 4, Lichtheimia corymbifera 3 and Mucor spp. 8. RESULTS: Paranasal sinus was the primary site of infection in 14/15 patients combined with orbital involvement (9), central nervous system (8), lung (4), thyroid gland and kidney (1). All patients received liposomal Amphotericin B (L-AmB) (3-10 mg/kg), with surgical debridement in 14/15 cases. Eleven patients received maintenance treatment with posaconazole (9) or isavuconazole (2). Eight out of fifteen patients (53.3%) died, after 3-6 months. CONCLUSIONS: Mucormycosis involved mainly the sinu-orbital site and affected children >10 years. Despite aggressive treatment with high-dose L-AmB and timely surgical debridement, the mortality rate remains still high.
BACKGROUND:Invasive mucormycosis is a rare but frequently fatal fungal disease. The acute and rapidly progressive evolution causes unfavourable outcome in 22%-59% of patients and its treatment represents a clinical challenge, especially in immunocompromised patients. Current data in paediatric oncological patients are limited. OBJECTIVES: The infection Working Group of the Italian Association of Pediatric Hematology and Oncology (AIEOP) analysed the episodes of invasive mucormycosis occurred between 2009 and 2016. PATIENTS: Fifteen cases of proven mucormycosis (male/female 8/7; median age 14.1 years, range 7.7-18.6) were reported after chemotherapy for acute leukaemia and lymphoma (12) and allogeneic stem cell transplantation (3). The aetiology was Rhizopus oryzae 4, Lichtheimia corymbifera 3 and Mucor spp. 8. RESULTS: Paranasal sinus was the primary site of infection in 14/15 patients combined with orbital involvement (9), central nervous system (8), lung (4), thyroid gland and kidney (1). All patients received liposomal Amphotericin B (L-AmB) (3-10 mg/kg), with surgical debridement in 14/15 cases. Eleven patients received maintenance treatment with posaconazole (9) or isavuconazole (2). Eight out of fifteen patients (53.3%) died, after 3-6 months. CONCLUSIONS:Mucormycosis involved mainly the sinu-orbital site and affected children >10 years. Despite aggressive treatment with high-dose L-AmB and timely surgical debridement, the mortality rate remains still high.
Authors: N Decembrino; K Perruccio; M Zecca; A Colombini; E Calore; P Muggeo; E Soncini; A Comelli; M Molinaro; B M Goffredo; S De Gregori; I Giardini; L Scudeller; S Cesaro Journal: Antimicrob Agents Chemother Date: 2020-02-21 Impact factor: 5.191