Mucormycosis in a Pediatric Oncology Population - Review of Cases and
the Literature
Abstract
Background: Mucormycosis is the third most common invasive
fungal infection in children and primarily affects immunocompromised
patients with cancer. Incidence rates and contemporary survival
statistics are needed in view of current cancer management protocols,
availability of molecular tests and newer antifungals. Methods:
A retrospective chart review of cases of mucormycosis in patients with
oncologic diagnoses at the Children’s Hospital of Eastern Ontario, in
Ottawa, Canada, between 2000 and 2020 was completed. We describe the
clinical characteristics, diagnosis, treatment, and outcomes and inform
areas for future research. Results: Over 20 years, the
incidence rate among hematology-oncology patients was 0.66% with four
cases identified. The underlying diagnosis in these cases was ALL(n=3)
and AML(n=1). The average age at diagnosis of mucormycosis was 7 years.
The sites of infection were cutaneous (perianal), disseminated,
rhino-orbito-cerebral and pulmonary. All patients were receiving
induction chemotherapy at the time of infection. Most were on high-dose
steroids(n=3) and antibiotics(n=3), and half(n=2) were on antifungal
prophylaxis. Mucormycosis was diagnosed using histopathological, culture
and/or PCR results. Rhizopus species was most commonly isolated.
ABLC was the mainstay of treatment, but all patients received
combination antifungal therapy. Two patients underwent surgical
debridement/resection. All cases had delays in their cancer treatment
secondary to infection. Mucormycosis-related mortality was 25 percent.
Conclusions: Mucormycosis has a high morbidity and mortality
affecting immunosuppressed individuals. Given its rarity and
heterogeneity in clinical presentation, diagnosis is often delayed. This
case series shows that with early diagnosis, aggressive anti-fungal
therapy with possible adjunctive surgical intervention, positive patient
outcomes can be achieved.