Coronavirus disease 2019-associated mucormycosis in children: a systematic review of reported cases in the literature

Abstract

Background Coronavirus disease 2019 (COVID-2019) was declared as a pandemic on March 11, 2020 by the WHO. This disease was complicated by its association with an opportunistic fungal infection, termed as COVID-19-associated mucormycosis (CAM). CAM is well described in adults, but only a few case reports and series were published about pediatric CAM.Objectives This systematic review aimed to describe the clinical spectrum and outcome of CAM cases in children.Patients and methods A systematic review of literature was done in agreement with PRISMA guidelines to understand the clinical profile of pediatric CAM. Pubmed, Scopus, Google Scholar databases, and news websites were searched to identify any relevant article on pediatric CAM..References within the included articles were reviewed. All articles that met the criteria were analyzed for demographics, clinical, laboratory, radiographic, treatment, and outcome data.Results We retrieved a total of 13 cases of pediatric CAM, which were included in this systematic review. The mean age at presentation was 11.6 years (range, 5–16 years). Diabetes mellitus was the underlying cause in four cases, whereas three of them presented with diabetic ketoacidosis. Five children were immunocompromised, which included two cases of acute lymphoreticular malignancy. Rhinocerebral, orbital, and gastrointestinal mucormycosis was seen in three, two, and one case, respectively. Out 13 cases, two succumbed to the illness.Conclusion Most children with CAM had definite underlying risk factors like diabetes mellitus, lymphoreticular malignancies, and immunodeficiency status. The clinical presentation and outcome in children were similar to adults.