From the Guidelines
The approach to mucormycosis in pediatric patients involves prompt initiation of treatment with amphotericin B and consideration of surgery, as these are critical for successful management 1.
Key Considerations
- Diagnosis and management of mucormycosis in pediatric patients are similar to those in adults, but with subtle differences due to pediatric development regulations and guidelines 1.
- First-line treatment options for neonates, children, and adolescents include amphotericin B lipid complex and liposomal amphotericin B, with liposomal amphotericin B being the preferred drug for infections involving the central nervous system 1.
- Salvage therapy options for children ≥2 years and adolescents include posaconazole, combination of lipid amphotericin B plus caspofungin, and combination of lipid amphotericin B plus posaconazole 1.
Treatment Details
- Amphotericin B lipid complex and liposomal amphotericin B are recommended as first-line treatments, with a dose of 5 mg/kg 1.
- Posaconazole is recommended as a salvage therapy option, with a dose of 400 mg/day 1.
- Granulocyte colony-stimulating factor is strongly recommended in patients with neutropenia, with the dose chosen as licensed 1.
Important Factors
- Surgery is a critical component of treatment, especially for rhino-orbito-cerebral and pulmonary mucormycosis 1.
- Control of the predisposing condition is essential for successful management, including management of diabetes, trauma, or burns 1.
- Age below one year and dissemination are independent risk factors for death in children with mucormycosis 1.
From the Research
Approach to Mucormycosis in Pediatric Patients
- The approach to mucormycosis in pediatric patients involves a combination of surgical debridement and antifungal therapies, with amphotericin B being the cornerstone of treatment 2, 3, 4, 5.
- Diagnosis requires a high index of suspicion and evaluation with histopathology, culture, and molecular identification 2, 6.
- Clinical presentation is influenced by underlying risk factors, including immunosuppression, neutropenia, diabetes, and prematurity 2, 3, 4.
- The most common underlying diagnoses in pediatric patients with mucormycosis include neutropenia, hematologic malignancy, prematurity, and hematopoietic stem cell transplant 3, 4.
- Treatment outcomes are generally poor, with mortality rates ranging from 20-66% depending on the severity of the disease and the presence of underlying conditions 3, 4, 5.
Management Strategies
- Surgical debridement is a crucial component of treatment, with 67-70% of patients undergoing surgical procedures 4, 5.
- Antifungal therapy typically involves the use of amphotericin B, often in combination with other agents such as triazoles or echinocandins 3, 4, 5.
- Granulocyte transfusions and/or granulocyte colony-stimulating factor may be used to support neutropenic patients 4.
- Early diagnosis and treatment are critical to improving outcomes, with aggressive approaches to surgery and antifungal therapy potentially leading to better survival rates 4, 5.
Challenges and Future Directions
- Diagnostic and treatment challenges are significant, particularly in resource-poor settings where access to antifungal agents and surgical care may be limited 6.
- Further research is needed to improve diagnostic and therapeutic strategies, including the development of new antifungal agents and adjunctive therapies 4, 5.