Zygomycosis in Neonates: An Uncommon but Life-threatening Infection

Emmanuel Roilides; Theoklis E Zaoutis; Aspasia Katragkou; Daniel K Benjamin; Thomas J Walsh

doi:10.1055/s-0029-1220775

American Journal of Perinatology, Table of Contents

Am J Perinatol 2009; 26(8): 565-573
DOI: 10.1055/s-0029-1220775

Zygomycosis in Neonates: An Uncommon but Life-threatening Infection

Emmanuel Roilides¹ ^, ⁴ , Theoklis E. Zaoutis² , Aspasia Katragkou¹ , Daniel K. Benjamin³ , Thomas J. Walsh⁴

¹3rd Department of Pediatrics, Aristotle University, Thessaloniki, Greece
²Department of Pediatrics and the Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, and Division of Infectious Diseases, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
³Department of Pediatrics, Duke Clinical Research Institute, Duke University, Durham, North Carolina
⁴Pediatric Oncology Branch, National Cancer Institute, Bethesda, Maryland

Abstract

ABSTRACT

We systematically reviewed all published cases of zygomycosis, an increasingly important infection with high mortality, in neonates. We searched PubMed and individual references for English publications of single cases or case series of neonatal (0 to 1 month) zygomycosis. Cases were included if they fulfilled prespecified criteria. Fifty-nine cases were published through July 2007. Most of the infants (77%) were premature. The most common sites of zygomycosis were gastrointestinal (54%) and cutaneous (36%) diseases. This pattern differs from sinopulmonary and rhinocerebral patterns of older children. Fifty-six percent of cases were diagnosed by histology only and 44% by histology and culture. Rhizopus spp. were isolated from 18/25 (72%) cases. Thirty-seven percent of patients received no antifungal therapy. Thirty-two (54%) neonates underwent surgery with (39%) or without (15%) antifungal agents. Overall mortality was 64%. A higher fraction of neonates treated with amphotericin B and surgery survived than those who received no therapy (70% versus 5%). Zygomycosis is a life-threatening infection in neonates with a distinct pattern of gastrointestinal and cutaneous involvement and high mortality. Combination of amphotericin B and surgery was common management strategy in survivors.

KEYWORDS

Epidemiology - mucormycosis - outcome - Rhizopus spp. - gastrointestinal infection

Full Text

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Emmanuel RoilidesM.D. Ph.D.

3rd Department of Pediatrics, Aristotle University School of Medicine, Hippokration Hospital

Konstantinoupoleos 49, GR-546 42 Thessaloniki, Greece

Email: roilides@med.auth.gr