Mucormycosis in Paediatric Patients After Haematopoietic Stem Cell Transplantation: A Systematic Review and Meta-Analysis.

Abstract

<h4>Background</h4>Data on the epidemiology, diagnostic methods and evidence-based recommended treatment methods for children with mucormycosis who have undergone Haematopoietic stem cell transplantation (HSCT) are limited.<h4>Objective</h4>Summarise past recommendations and the latest literature on the treatment of HSCT in children with mucorin infection and clarify the epidemiology, diagnosis, treatment and outcomes of this invasive fungal disease.<h4>Methods</h4>A comprehensive search for full-text studies involving humans that were published in English between January 2000 and December 2022 was conducted in Ovid MEDLINE and Ovid Embase using various key words and MeSH terms.<h4>Results</h4>A total of 951 articles were identified in the initial database search, of which 28 (32 individual patients) were included in the final analysis. The majority of HSCT recipients (14/26, 54%) had a diagnosis of mucormycosis within 30 days posttransplant, with a median time from transplant to diagnosis of 19 (27 patients; IQR, 13-213) days. Pulmonary mucormycosis (9/32, 28%) and disseminated mucormycosis (9/32, 28%) were the most commonly observed manifestations in paediatric patients after HSCT. Targeted antifungal therapy was used in 27 patients. Iv AmB formulations were the most commonly administered first-line treatment (26/27, 96%). Compared with iv AmB monotherapy, initial treatment with combination antifungal therapy appeared to improve all-cause mortality [3/10 (30%) vs. 6/17 (35%)].<h4>Conclusions</h4>The results of the present review will help to determine the pathology, diagnosis, treatment and outcomes of this invasive fungal disease.