Clinical Characteristics and Prognoses of Mucormycosis in Four Children

Figures & data

Table 1 Patient Demographics and Microbiological Data in Four Pediatric Patients with Mucormycosis

No.	Sex	Age (Years)	Underlying Condition	Phase Of Therapy	Duration of Neutropenia (Days)	Clinical Presentation	Sites of Involvement	Diagnostic Method	Specimen	Pathogen	Imaging
1	F	5.6	Bilateral nephroblastoma	Consolidation	38	Prolonged fever, cough and dyspnea	Lung angiocardiopathy	mNGS	BALF	Cunninghamella bertholletiae	Lung CT: multiple nodules, halo sign, and air crescent sign. Contrast-enhanced CT: aortic arch dissection with ruptured pseudoaneurysm.
2	F	11.3	Relapsed AML with myeloid sarcoma	Consolidation	201	Prolonged fever, cough, and headache	Brain	mNGS	PB CSF	Rhizomucor pusillus	Craniocerebral MRI and enhancement: hemorrhagic infarction.
3	F	11.9	SLE	Consolidation	0	Prolonged fever, cough and dyspnea	Lung	mNGS, Pathology	Hydrothorax BALF	Rhizopus microsporus	Lung CT: consolidation and massive pleural effusion. Contrast-enhanced CT: pulmonary artery and pulmonary vein occlusions.
4	M	8.1	Thalassemia	Allogeneic HSCT	20	Prolonged fever, cough, dyspnea, and chest and back pain	Lung angiocardiopathy	mNGS	PB BALF	Cunninghamella bertholletiae	Lung CT: consolidation and massive pleural effusion. Contrast-enhanced CT: pseudoaneurysm of the descending aorta, pulmonary artery and pulmonary vein occlusions.

Abbreviations: AML, acute myeloid leukemia; SLE, systemic lupus erythematosus; HSCT, hematopoietic stem cell transplantation; mNGS, metagenomics next generation sequencing; CSF, cerebrospinal fluid; PB, peripheral blood; BALF, bronchoalveolar lavage fluid; CT, computerized tomography; MRI, magnetic resonance imaging.

Figure 1 (A–E) Magnetic resonance imaging of patient No. 2. (A) The left occipital lobe showed an irregular gyrus with an abnormal signal shadow and a low signal on T1WI (arrow). (B) Slightly high signal on T2WI (arrow). (C) Slightly high signal on FLAIR (arrow). (D) Limited DWI diffusion (arrow). (E) Limited DWI diffusion (arrow). (F) Computed tomography (CT) of patient No. 1 showing multiple pulmonary nodules and marginal halo sign (arrow). (G) Computed tomography (CT) of patient No. 1 showing air crescent sign (arrow). (H) Enhanced CT of patient No. 3 showing left pulmonary artery occlusion, left atelectasis and left pleural effusion (arrow). (I) Enhanced CT of patient No. 3 showing left pulmonary vein occlusion (arrow). (J) Enhanced CT of patient No. 1 showing aortic arch dissection with ruptured pseudoaneurysm (arrow). (K) Enhanced CT of patient No. 4 showing a pseudoaneurysm of the descending aorta (arrow). (L) Bronchoscope of patient No. 4 showing a grayish-brown necrotic mass occluding the middle lobe of the right lung (arrow). (M) Bronchoscope of patient No. 1 showing a gelatinous substance occluded the base lobe of the left lower lung (arrow). (N) Alveolar lavage fluid pathology of patient No. 3 showing typical hyphal morphology. Mucorales hyphae were at least 6–16 µm wide, ribbon-like, pauci-septate, with subrectangular branching (HE 20X). (O) Alveolar lavage fluid pathology of patient No. 3 showing typical hyphal morphology. Mucorales hyphae were at least 6–16 µm wide, ribbon-like, pauci-septate, with subrectangular branching (PASM 20X).

Table 2 Treatments and outcomes of Four Pediatric Patients with Mucormycosis

No,	Antifungal Prophylaxis	First-Line Antifungal Treatment	Second-Line Antifungal Treatment	Surgical Debridement Procedures	Outcome	Time to Death from Mucormycosis Diagnosis
1	Voriconazole caspofungin	L-AmB, 5 mg/kg/d	None	None	Death	12
2	Voriconazole caspofungin	AmB, 5 mg/kg/d	L-AmB, 5 mg/kg/d posaconazol susp	None	Death	98
3	Voriconazole	AmB, 6 mg/kg/d posaconazole susp	None	None	Death	15
4	Caspofungin	AmB, 5 mg/kg/d posaconazole susp	AmB, 5 mg/kg/d IV isavuconazole	None	Death	47

Abbreviations: AmB, amphotericin B; L-AmB, liposomal amphotericin; susp–oral suspension.

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The key information and data generated and analyzed during this are given in this article.