Treatment of disseminated zygomycosis in an infant with acute lymphoblastic leukemia with amphotericin B lipid complex
Abstract
The incidence of zygomycosis is increasing. Invasive zygomycosis is a major cause of morbidity and mortality in patients with hematological diseases.1 In many patients, it is also necessary to continue chemotherapy as soon as possible.
Disseminated disease, especially in infants, is fatal. Increasingly, combinations of antifungals are being used to treat invasive zygomycosis.
A frequently isolated and well-described species of zygomycete that is the cause of invasive infection in immunocompromised patients is Rhizopus microsporus. We report a case of an infant treated for acute lymphoblastic leukemia (ALL) in whom we diagnosed an invasive disseminated infection with the pathogen Rhizopus microsporus one month after the start of intensive chemotherapy.
Surgery and transient treatment with combinations of amphotericin B lipid complex (ABLC) with caspofungin allowed intensive chemotherapy to be continued. Posaconazole was not used in the first line.
Echinocandins in combination with polyenes or posaconazole have been investigated for potential synergistic activity against zygomycetes. The three combinations of antifungals we tested (amphotericin B and caspofungin, amphotericin B and posaconazole, caspofungin and posaconazole) did not show any in vitro synergy in the clinical isolate.
Long-term effective and well-tolerated treatment of ABLC in our patient led to the complete disappearance of the infection.