Department of Paediatrics, Royal Darwin Hospital, Darwin, Australia.
Menzies School of Health Research, Charles Darwin University, Darwin, Australia.
J Pediatric Infect Dis Soc. 2018 May 15;7(2):159-164. doi: 10.1093/jpids/pix107.
Mucormycosis represents the third most common invasive fungal infection in children, and recent studies have suggested a rising incidence. Its case fatality rate is high, especially for neonates. Clinical presentation is influenced by underlying risk factors; associations with immunosuppression, neutropenia, diabetes, and prematurity have been described. It has been implicated in several hospital outbreaks. Diagnosis requires a high index of suspicion and evaluation with histopathology, culture, and, increasingly, molecular identification. Surgical debridement and antifungal therapies are the cornerstone for combatting invasive mucormycosis. However, the severity and relative rarity of this disease make comparative clinical trials for evaluating antifungal therapies in children difficult to conduct. Hence, therapeutic decisions are derived mainly from retrospective case series, in vitro data, and animal models. In this review, we summarize the literature on the epidemiology and diagnosis of this invasive fungal infection and provide suggestions on the management of mucormycosis in children.
毛霉菌病是儿童中第三常见的侵袭性真菌感染，最近的研究表明其发病率呈上升趋势。其病死率很高，尤其是新生儿。临床表现受潜在危险因素的影响；已描述了与免疫抑制、中性粒细胞减少症、糖尿病和早产的关联。它与几起医院暴发有关。诊断需要高度怀疑，并通过组织病理学、培养以及越来越多地通过分子鉴定进行评估。手术清创和抗真菌治疗是治疗侵袭性毛霉菌病的基石。然而，这种疾病的严重性和相对罕见性使得难以对儿童进行抗真菌治疗的临床试验进行比较。因此，治疗决策主要来自回顾性病例系列、体外数据和动物模型。在这篇综述中，我们总结了关于这种侵袭性真菌感染的流行病学和诊断的文献，并就儿童毛霉菌病的治疗提供建议。
