Orbital mycoses in a pediatric subtropical population: a case series
Allister S Lee1, Timothy J Sullivan1
1Department of Ophthalmology, Queensland Children's Hospital, South Brisbane, Australia; University of Queensland, Brisbane, Australia.
Insights
Orbital fungal infections in children are serious, especially in subtropical areas. Aggressive surgical treatment, including debridement and potentially exenteration, is crucial for survival.
Area of Science:
- Ophthalmology
- Pediatric Infectious Diseases
- Medical Mycology
Background:
- Invasive fungal infections (IFIs) with orbital involvement pose a significant challenge in pediatric care.
- Subtropical regions may present a unique spectrum of fungal pathogens responsible for these infections.
Observation:
- A retrospective review of six pediatric patients (<18 years) with orbital mycosis in a subtropical setting was conducted.
- Commonly identified pathogens included mucormycosis and Exserohilum species.
- Underlying conditions such as hematological malignancy and diabetic ketoacidosis were prevalent among affected children.
Findings:
- Patients received treatment with liposomal amphotericin B and surgical debridement.
- One patient underwent orbital exenteration.
- The overall survival rate in this series was 67%.
Implications:
- Orbital mycoses can occur in children of all ages, with immunocompromised individuals at higher risk.
- Prompt and aggressive surgical intervention, including extensive debridement and exenteration when necessary, is vital for managing severe pediatric orbital fungal infections.
- Understanding the specific fungal spectrum in subtropical zones is essential for effective diagnosis and treatment strategies.
Purpose:
To report our experience in the diagnosis and management of invasive fungal infections with orbital involvement in children from a subtropical population.
Methods:
The medical records of children (<18 years of age) with orbital mycosis and treated by the senior author (TJS) from 1995 to 2017 in multiple pediatric tertiary centers were reviewed retrospectively.
Results:
Six patients (aged 12 weeks to 15 years) were included in this series. Four patients had confirmed infection with isolated pathogens, including mucormycosis (3) and Exserohilum (2). One patient rapidly deteriorated and died before biopsy could be performed; however, the patient was presumed to have invasive fungal disease. Four patients had underlying hematological malignancy, and 1 presented in diabetic ketoacidosis. Orbital apex syndrome was observed in one patient. All patients received liposomal amphotericin B and five underwent at least one debridement surgery. One patient proceeded to orbital exenteration and survived. The overall survival rate was 67%.
Conclusions:
Orbital mycoses can affect children of all ages. Immunocompromised patients are particularly at risk, and mortality rates are high. In a subtropical population, these infections may be caused by a different spectrum of fungi compared to other climate zones. We believe extensive surgical debridement, including exenteration may still be necessary in the management of this disease in a young population, particularly if there is extensive orbital involvement.
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