Shen Huili, Cai Xiaodi, Liu Jing, Yan Gangfeng, Ye Ying, Dong Rui, Wu Jufang, Li Li, Shen Quanli, Ma Yutong, Ou Qiuxiang, Shen Meili, Chen Weiming, Lu Guoping
Pediatric Intensive Care Unit, Children's Hospital of Fudan University, National Center for Children's Health, Shanghai, China.
Dermatological Department, Children's Hospital of Fudan University, National Center for Children's Health, Shanghai, China.
Front Pediatr. 2023 Jun 19;11:1130775. doi: 10.3389/fped.2023.1130775. eCollection 2023.
() is an opportunistic fungal pathogen of the order that may result in a rare but serious mucormycosis infection. Mucormycosis could be angioinvasive, causing thrombosis and necrosis in the nose, brain, digestive tract, and respiratory tract. The infection is highly lethal, especially in immunocompromised hosts, and the incidence has been on the rise. However, due to its relatively low incidence in pediatric population and the challenges with diagnosis, the awareness and management experience for pediatric mucormycosis are extremely limited, which might lead to poor outcomes. In this study, we comprehensively reviewed the course of a fatal rhinocerebral mucormycosis case in a pediatric neuroblastoma patient receiving chemotherapy. Due to a lack of awareness of the infection, the standard care of amphotericin B treatment was delayed and not administered until the identification of by metagenomic next-generation sequencing (mNGS)-based pan-pathogen detection of the patient's peripheral blood sample. We also reviewed the literature on infection cases reported worldwide between 2010 and 2022, with an analysis of clinical manifestation, prognosis, and epidemiological data. Our study not only highlighted the clinical value of comprehensive mNGS in rapid pathogen detection but also raised awareness of recognizing lethal fungal infection early in immunocompromised hosts including pediatric cancer patients.
（）是一种属于该目（此处原文有误，应为属，order应改为genus）的机会性真菌病原体，可能导致一种罕见但严重的毛霉病感染。毛霉病可能具有血管侵袭性，在鼻子、大脑、消化道和呼吸道引起血栓形成和坏死。这种感染具有高度致死性，尤其是在免疫功能低下的宿主中，并且发病率一直在上升。然而，由于其在儿科人群中的发病率相对较低以及诊断方面的挑战，儿童毛霉病的认识和管理经验极其有限，这可能导致不良后果。在本研究中，我们全面回顾了一名接受化疗的儿科神经母细胞瘤患者发生致命性鼻脑毛霉病的病程。由于对该感染缺乏认识，两性霉素B治疗的标准护理被延迟，直到通过对患者外周血样本进行基于宏基因组下一代测序（mNGS）的全病原体检测鉴定出（此处原文有误，应为病原体，by后缺少pathogen）才开始使用。我们还回顾了2010年至2022年间全球报道的（此处原文有误，应为该病原体，应加上pathogen）感染病例的文献，分析了临床表现、预后和流行病学数据。我们的研究不仅突出了全面mNGS在快速病原体检测中的临床价值，还提高了对包括儿科癌症患者在内的免疫功能低下宿主早期识别致命真菌感染的认识。
