title: [Invasive mucormycosis in pediatric hematology patients--single-center experience from 2005-2010].
abstract: BACKGROUND
  Mucormycosis is an invasive fungal disease severely complicating treatment of patients with hematologic diseases. Effective therapy is represented by the combination of surgery and amphotericin B administration and early initiation of the therapy is necessary for favorable outcome. The first clinical symptoms are usually non-specific and this can lead to late therapy onset. The objective of this retrospective work was to determine the frequency, risk factors and outcome of invasive mucormycosis in pediatric hematology patients.
  
  
  METHODS
  The study cohort comprised 399 patients diagnosed with hematologic diseases in the Department of Pediatric Hematology and Oncology (DPHO), University Hospital Motol, Prague between 2005 and 2010. Risk factors for the development of mucormycosis, clinical symptoms and radiology and laboratory results were retrospectively evaluated. So were the therapy used and outcomes. The findings were analyzed using Fisher's exact test.
  
  
  RESULTS
  During the selected period, mucormycosis was detected in 8 patients diagnosed with hematologic disease. The incidence of mucormycosis was 1.75 %. These conditions accounted for 20.6 % of all mycoses. In five patients, it was found as isolated infection; three cases were associated with other mycoses (one with candidiasis, two with aspergillosis). The most frequent underlying disease was acute leukemia; the most common risk factor was severe prolonged neutropenia (median duration 21.5 days). Three of eight patients survived mucormycosis, a mortality rate of 62.5 %. The effective therapy was amphotericin B administration in three patients (p = 0.02); in two of them, it was combined with radical surgery.
  
  
  CONCLUSIONS
  In the cohort, the proportion of mucormycosis cases was surprisingly high when compared with other fungal diseases. Continuous surveillance of mucormycosis in the DPHO is needed. There was no significant influence of the combination of radical surgery and amphotericin B administration as compared to administration of amphotericin B alone. Nevertheless, according to the published data, we consider this approach as an optimal strategy for the management of mucormycosis at the present time.
authors.affiliation: Institute of Medical Microbiology, Charles University, 2nd Medical Faculty Prague. vanda.chrenkova@fnmotol.cz
authors.forename: Vanda
authors.initials: V
authors.lastname: Chrenková
authors.forename: Petr
authors.initials: P
authors.lastname: Hubáček
authors.forename: Barbora
authors.initials: B
authors.lastname: Weinbergerová
authors.forename: Petr
authors.initials: P
authors.lastname: Sedláček
authors.forename: Petra
authors.initials: P
authors.lastname: Keslová
authors.forename: Edita
authors.initials: E
authors.lastname: Kabíčková
authors.forename: Klára
authors.initials: K
authors.lastname: Pavlíčková
authors.forename: Lucie
authors.initials: L
authors.lastname: Srámková
authors.forename: Jiří
authors.initials: J
authors.lastname: Snajdauf
authors.forename: Eliška
authors.initials: E
authors.lastname: Bébrová
authors.forename: Otakar
authors.initials: O
authors.lastname: Nyč
authors.forename: Jan
authors.initials: J
authors.lastname: Starý
authors.forename: Petr
authors.initials: P
authors.lastname: Hamal
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D019337:Hematologic Neoplasms / Q000276:immunology*; D006801:Humans; D016867:Immunocompromised Host; D007223:Infant; D008297:Male; D009091:Mucormycosis / Q000175:diagnosis* / Q000382:microbiology