Invasive zygomycosis in neonates and children.
Invasive zygomycosis in neonates and children has both similarities to and differences from that in adults. We searched PubMed and individual references for English-language reports of single cases or case series of neonatal (<1 month) and paediatric (< or =18 years) zygomycosis and compared the results with published results in adults. Cases were included if they fulfilled pre-specified criteria. A total of 59 cases of neonatal zygomycosis were reported to July 2007; 157 paediatric cases were published up to 2004 and an additional 30 paediatric cases were reported more recently. Prematurity was a major underlying factor among neonatal cases. The most common manifestations of zygomycosis were gastrointestinal (54%) and cutaneous (36%). This pattern differs from the sinopulmonary and rhinocerebral patterns typical in older children and adults. Overall mortality was 64% in neonates, 56% in children and 53% in adults. A tendency for dissemination was higher in neonates than adults. Dissemination and young age (<1 year) were independent risk factors for death in children. Most patients who survived received antifungal therapy. Surgery combined with antifungal therapy was a protective factor against death. Most neonates and children who survived had received an amphotericin B formulation. Zygomycosis is a life-threatening infection in children and neonates with differing patterns of involvement in individuals of different ages. The most common management strategy in survivors involved a combination of amphotericin B and surgery.
Roilides
E
E
3rd Department of Paediatrics, Aristotle University, Thessaloniki, Greece. roilides@med.auth.gr
Zaoutis
T E
TE
Walsh
T J
TJ
D000293:Adolescent; D000367:Age Factors; D000935:Antifungal Agents / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D003646:Debridement; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D012307:Risk Factors; D020096:Zygomycosis / Q000453:epidemiology* / Q000401:mortality / Q000473:pathology* / Q000628:therapy
D000935:Antifungal Agents