Mucormycosis in a Pediatric Oncology Population - Review of Cases and the Literature

Background: Mucormycosis is the third most common invasive fungal infection in children and primarily affects those with cancer.Incidence rates and contemporary survival statistics are needed in view of current oncology treatments, 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, between 2000 and 2020 was completed.We describe the clinical characteristics, diagnosis, treatment, and outcomes and inform areas for future research.Results: The 20 years incidence rate among hematologic oncology patients was 0.66% with four cases identified.The underlying diagnosis in these cases was acute lymphoblastic leukemia (ALL) (n=3) and acute myeloid leukemia (AML) (n=1).The sites of infection were cutaneous, nasal, rhino-orbito-cerebral and pulmonary.All patients were receiving induction chemotherapy at the time of infection.Mucormycosis was diagnosed using histopathological, culture and/or PCR results.Rhizopus species was most commonly isolated.Amphotericin B Lipid Complex (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.One patient had mucormycosis-related mortality.Conclusion: This case series of pediatric mucormycosis shows that with early diagnosis, aggressive anti-fungal therapy with possible adjunctive surgical intervention, positive patient outcomes can be achieved.