Invasive Cunninghamella bertholletiae Infections in children: a case series and literature review

Pediatric infections caused by Cunninghamella bertholletiae (C. bertholletiae) are exceedingly rare with only few published case reports. Herein, we describe five cases of C. bertholletiae diagnosed and treated in Pediatric Hematology-Oncology Patients. These cases indicated that pediatric C. bertholletiae infection presents with non-specific clinical features, is associated with high fatality, and frequently involves multiple anatomical sites, most commonly the lungs, demonstrating epidemiological patterns distinct from those observed in adults. From a diagnostic perspective, mNGS enables rapid pathogen identification, facilitates timely initiation of antifungal therapy, and may improve survival. Therapeutically, surgical intervention is associated with a significant reduction in mortality. Although combination therapy and monotherapy appear to have comparable overall efficacy, sequential monotherapy demonstrates a more pronounced survival benefit. Furthermore, Isavuconazole represents an effective salvage option and is linked to a significant decrease in mortality.