• Surgical Sciences Journal
Case Report

Continuous Amphotericin Irrigation for Cutaneous Mucormycosis in the Pediatric Patient

Surgical Sciences Journal [2020; 2(1): 1-4]
Received: 25 November 2019, Accepted: 10 February 2020, Published: 14 February 2020


 

ABSTRACT

Mucormycosis is a life-threatening fungal infection caused by a group of molds called mucormycetes. Mucormycosis occurs in patients with less competent immune systems, including diabetes. Infected tissue is sent to a lab where it is cultured and examined under a microscope where doctors can diagnose the disease. As well, doctors do CT scans to check for damages to the facial structure. Treatment should be immediate and begin with high doses of intravenous antifungal medications such as amphotericin B, Isavuconazole or posaconazole. Surgery is required to remove infected tissue. To date, there are scant reports of the use of topical antifungal agents as an adjunct to surgery in the pediatric patient with cutaneous mucormycosis.

 

Key Words: pediatric; cutaneous; mucormycosis.

 

INTRODUCTION

Invasive infections caused by fungal organisms are a major cause of morbidity and mortality in immunocompromised pediatric patients. Mucormycosis is caused by members of the Mucoales order, of which the Rhizopus species are the most common pathogenic agents. Rhizopus species possess ketone reductase that enables proliferation in an acidic environment that is seen in poorly-controlled diabetes (i.e. ketoacidosis). Disorders like leukemia that cause a decrease in the white blood cell count predisposes the development of mucormycosis.

The Mucor fungal species are found in soil. Spores of mucormycosis enter the body through open wounds and attack host tissues. Infection can involve the sinuses and/or central nervous system (rhinocerebral), lung, gastrointestinal tract, heart, as well as the skin and soft tissues (cutaneous). The fungus is angioinvasive and causes thrombosis of vessels leading to tissue necrosis. [1]

Symptoms include fevers, sinus pain, an inflamed eye socket, and proptosis causing difficulty with vision. As well, one sign of fungal invasion is blood clotting and dead tissue due to a loss of blood flow. The latter is often associated with deep extension in the subcutis or below. [1] Patients experiencing such symptoms should managed emergently for the best outcome.

The diagnosis of mucormycosis requires a high degree of suspicious in the immunocompromised patient. Wound biopsies can be sent for culture as well as immediate staining. Since the former can take a while to grow out, immediate staining will minimize the time to treatment.

Unlike other invasive fungal infections, the prognosis and outcome of invasive mucormycosis have not significantly improved over the past decade. Successful treatment relies on immediate eradication of the organism. A multidisciplinary approach is necessary to improve survival and should include extensive surgical debridement, antifungal therapy, and correction of the underlying metabolic or impaired immunological status. Newer modalities that improve survival would be a welcome addition to the treatment paradigm.

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