Medical Oncology

, 30:433

Liposomal amphotericin B and surgery as successful therapy for pulmonary Lichtheimia corymbifera zygomycosis in a pediatric patient with acute promyelocytic leukemia on antifungal prophylaxis with posaconazole

  • Grazina Kleinotiene
  • Gintas Posiunas
  • Juozas Raistenskis
  • Edvardas Zurauskas
  • Sigita Stankeviciene
  • Valentina Daugelaviciene
  • Maciej Machaczka
Short Communication
  • 403 Downloads

Abstract

Pulmonary zygomycosis, also referred to as mucormycosis, is a fungal infection of lungs caused by fungi of the order Mucorales in the class of Zygomycetes. It is usually associated with high morbidity and mortality. Here, we report the case of a 14-year-old girl with pediatric acute promyelocytic leukemia (APL) on antifungal prophylaxis with posaconazole, who developed pulmonary Lichtheimia corymbifera (formerly Absidia corymbifera) zygomycosis. She was successfully treated by means of liposomal amphotericin B (L-AmB) and surgery. To our knowledge, this is the first published report on pediatric APL and pulmonary zygomycosis in the English language literature. At present, the patient is in complete remission of her APL and without any signs of recurrence of zygomycosis. This report suggests that efficient diagnostics, increased physician awareness, and reliance on adjunctive surgical therapy can result in a favorable outcome of pulmonary zygomycosis in immunocompromised children with hematological malignancies.

Keywords

Acute promyelocytic leukemia Children Lichtheimia corymbifera Invasive fungal infection Pediatric Treatment Zygomycosis 

References

  1. 1.
    Pfaller MA, Diekema DJ. Epidemiology of invasive mycoses in North America. Crit Rev Microbiol. 2010;36:1–53.PubMedCrossRefGoogle Scholar
  2. 2.
    Björkholm M, Runarsson G, Celsing F, Kalin M, Petrini B, Engervall P. Liposomal amphotericin B and surgery in the successful treatment of invasive pulmonary mucormycosis in a patient with acute T-lymphoblastic leukemia. Scand J Infect Dis. 2001;33:316–9.PubMedCrossRefGoogle Scholar
  3. 3.
    Antoniadou A. Outbreaks of zygomycosis in hospitals. Clin Microbiol Infect. 2009;15(Suppl 5):55–9.PubMedCrossRefGoogle Scholar
  4. 4.
    Roden MM, Zaoutis TE, Buchanan WL, et al. Epidemiology and outcome of zygomycosis: a review of 929 reported cases. Clin Infect Dis. 2005;41:634–53.PubMedCrossRefGoogle Scholar
  5. 5.
    Anderson ML. Infectious causes of bovine abortion during mid- to late-gestation. Theriogenology. 2007;68:474–86.PubMedCrossRefGoogle Scholar
  6. 6.
    Piancastelli C, Ghidini F, Donofrio G, et al. Isolation and characterization of a strain of Lichtheimia corymbifera (ex Absidia corymbifera) from a case of bovine abortion. Reprod Biol Endocrinol. 2009;7:138.PubMedCrossRefGoogle Scholar
  7. 7.
    Gleissner B, Schilling A, Anagnostopolous I, Siehl I, Thiel E. Improved outcome of zygomycosis in patients with hematological diseases? Leuk Lymphoma. 2004;45:1351–60.PubMedCrossRefGoogle Scholar
  8. 8.
    Liu ZH, Lv GX, Chen J, et al. Primary cutaneous zygomycosis due to Absidia corymbifera in a patient with cutaneous T cell lymphoma. Med Mycol. 2009;47:663–8.PubMedCrossRefGoogle Scholar
  9. 9.
    Horré R, Jovanic B, Herff S, et al. Wound infection due to Absidia corymbifera and Candida albicans with fatal outcome. Med Mycol. 2004;42:373–8.PubMedCrossRefGoogle Scholar
  10. 10.
    Mohammed S, Sahoo TP, Jayshree RS, et al. Sino-oral zygomycosis due to Absidia corymbifera in a patient with acute leukemia. Med Mycol. 2004;42:475–8.PubMedCrossRefGoogle Scholar
  11. 11.
    Hopwood V, Hicks DA, Thomas S, Evans EGV. Primary cutaneous zygomycosis due to Absidia corymbifera in a patient with AIDS. J Med Vet Mycol. 1992;30:399–402.PubMedCrossRefGoogle Scholar
  12. 12.
    Perlroth J, Choi B, Spellberg B. Nosocomial fungal infections: epidemiology, diagnosis, and treatment. Med Mycol. 2007;45:321–46.PubMedCrossRefGoogle Scholar
  13. 13.
    Torres-Narbona M, Guinea J, Martinez-Alarcon J, et al. Impact of zygomycosis on microbiology workload: a survey study in Spain. J Clin Microbiol. 2007;45:2051–3.PubMedCrossRefGoogle Scholar
  14. 14.
    Rees JR, Pinner RW, Hajjeh RA, Brandt ME, Reingold AL. The epidemiological features of invasive mycotic infections in the San Francisco Bay area, 1992–1993: results of population-based laboratory active surveillance. Clin Infect Dis. 1998;27:1138–47.PubMedCrossRefGoogle Scholar
  15. 15.
    Skiada A, Pagano L, Groll A, et al. Zygomycosis in Europe: analysis of 230 cases accrued by the registry of the European confederation of medical mycology (ECMM) Working Group on Zygomycosis between 2005 and 2007. Clin Microbiol Infect. 2011;17:1859–67.PubMedCrossRefGoogle Scholar
  16. 16.
    Lanternier F, Dannaoui E, Morizot G, et al. A global analysis of mucormycosis in France: the retrozygo study (2005–2007). Clin Infect Dis. 2012;54(Suppl 1):S35–43.PubMedCrossRefGoogle Scholar
  17. 17.
    Zaoutis TE, Roilides E, Chiou CC, et al. Zygomycosis in children: a systematic review and analysis of reported cases. Pediatr Infect Dis. 2007;26:723–7.CrossRefGoogle Scholar
  18. 18.
    Dehority W, Willert J, Pong A. Zygomycetes infections in pediatric hematology oncology patients: a case series and review of the literature. J Pediatr Hematol Oncol. 2009;31:911–9.PubMedCrossRefGoogle Scholar
  19. 19.
    Giacchino M, Milano GM, Carraro F, et al. Current evidence of antifungal prophylaxis and therapy in pediatric patients. Pediatr Rep. 2011;3:e6.PubMedCrossRefGoogle Scholar
  20. 20.
    O’Brien D, Lim CH, Farrell M, et al. Invasive intracerebral fungal infection in a leukaemic patient. Br J Neurosurg. 2012;26:423–5.PubMedCrossRefGoogle Scholar
  21. 21.
    Mantadakis E, Samonis G, Kalmanti M. A comprehensive review of acute promyelocytic leukemia in children. Acta Haematol. 2008;119:73–82.PubMedCrossRefGoogle Scholar
  22. 22.
    Bally C, Fadlallah J, Leverger G, et al. Outcome of acute promyelocytic leukemia (APL) in children and adolescents: an analysis in two consecutive trials of the European APL group. J Clin Oncol. 2012;30:1641–6.PubMedCrossRefGoogle Scholar
  23. 23.
    Marty FM, Cosimi LA, Baden LR. Breakthrough zygomycosis after voriconazole treatment in recipients of hematopoietic stem-cell transplants. N Engl J Med. 2004;350:950–2.PubMedCrossRefGoogle Scholar
  24. 24.
    Trifilio SM, Bennett CL, Yarnold PR, et al. Breakthrough zygomycosis after voriconazole administration among patients with hematologic malignancies who receive hematopoietic stem-cell transplants or intensive chemotherapy. Bone Marrow Transplant. 2007;39:425–9.PubMedCrossRefGoogle Scholar
  25. 25.
    Schalk E, Mohren M, Jentsch-Ullrich K, et al. Zygomycoses in patients with acute leukaemia. Ann Hematol. 2006;85:327–32.PubMedCrossRefGoogle Scholar
  26. 26.
    Herbrecht R. Posaconazole: a potent, extended-spectrum triazole anti-fungal for the treatment of serious fungal infections. Int J Clin Pract. 2004;58:612–24.PubMedCrossRefGoogle Scholar
  27. 27.
    Sun QN, Najvar LK, Bocanegra R, Loebenberg D, Graybill JR. In vivo activity of posaconazole against Mucor spp. in an immunosuppressed-mouse model. Antimicrob Agents Chemother. 2002;46:2310–2.PubMedCrossRefGoogle Scholar
  28. 28.
    Greenberg RN, Mullane K, van Burik JA, et al. Posaconazole as salvage therapy for zygomycosis. Antimicrob Agents Chemother. 2006;50:126–33.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • Grazina Kleinotiene
    • 1
  • Gintas Posiunas
    • 2
  • Juozas Raistenskis
    • 3
    • 4
  • Edvardas Zurauskas
    • 5
    • 6
  • Sigita Stankeviciene
    • 1
  • Valentina Daugelaviciene
    • 1
  • Maciej Machaczka
    • 7
  1. 1.Centre of Hematology and Oncology, Children’s HospitalVilnius University Hospital Santariskiu ClinicsVilniusLithuania
  2. 2.Clinic of Pediatric Surgery, Children’s HospitalVilnius University Hospital Santariskiu ClinicsVilniusLithuania
  3. 3.Department of Rehabilitation, Physical and Sports Medicine, Faculty of MedicineVilnius UniversityVilniusLithuania
  4. 4.Children’s HospitalVilnius University Hospital Santariskiu ClinicsVilniusLithuania
  5. 5.Lithuanian National Centre of PathologyVilnius University Hospital Santariskiu ClinicsVilniusLithuania
  6. 6.Department of Pathology, Forensic Medicine and Pharmacology, Faculty of MedicineVilnius UniversityVilniusLithuania
  7. 7.Division of Hematology, Department of Medicine at Huddinge, Karolinska Institutet, and Hematology Center KarolinskaKarolinska University Hospital HuddingeStockholmSweden

Personalised recommendations