Neonatal Mucormycosis
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Neonatal Mucormycosis Santhanakrishnan Ramakrishnan 1 & Dhanam Venkatachalam Suresh 1 & Siddhuraj Rangesh 1 & Jani Basha Mehrunnissa 2 & Jani Basha Nilofer Aqthar 3 Received: 6 May 2020 / Accepted: 24 August 2020 # Dr. K C Chaudhuri Foundation 2020
A 22-d-old term male neonate was referred for poor feeding, oral ulcer, and mild respiratory distress for two days. Mother’s antenatal health was normal and serology, including HIV status, was negative. The infant’s birth weight and admission weight was 2.2 kg. There was a curdy white lesion over the left upper gum anteriorly (Fig. 1). Potassium Hydroxide (KOH) mount microscopy of the lesion revealed aseptate hyphae branching at right angles, suggestive of mucor. Analysis of cerebrospinal fluid, blood, urine, echocardiogram and ultrasound abdomen was normal. He responded to a 10 d course of IV liposomal amphotercin B followed by oral posaconazole for one month. Fungi that belong to the order ‘mucorales’ cause mucormycosis [1]. It is a very rare fungal infection amongst neonates, associated with angioinvasion and carries a high fatality rate of 64% [2]. These are saprophytic fungi, found within soil and decaying matter, with broad ribbon-like aseptate hyphae that characteristically branch at right angles [3]. Vallabhaneni et al. [4] described a preterm infant with necrotising enterocolitis and histopathological evidence of angioinvasive fungal infection consistent with mucormycosis. Unopened bottles of a dietary supplement from the lot consumed by the infant revealed Rhizopus species on culture. The neonate in present report did not receive dietary supplement. On few occasions, particularly at night, when the infant screamed due to hunger, parents did not wait to bring
the cow’s milk to boil. Instead, they administered lukewarm cow milk. There was no history of use of pacifiers or feeding bottles, instead parents had used a spouted ever silver cup to administer milk. Mucor species were identified in 15.3% of raw cow milk samples [5]. Roilides et al. [6], published in their review article comprising 59 neonates that 54% of mucormycosis infection was located in the gastrointestinal tract and necrotising enterocolitis was a common presentation. Cutaneous involvement contributed to 36% and disseminated infection accounted for 56% [6]. Whether administering partially boiled milk might have contributed to oral lesion remains uncertain as there was no evidence of involvement of the intestines or stomach. Mother was advised against using cow’s milk in infants under one year of age. Incidentally, a natal tooth was identified once the infection resolved. To authors’ knowledge, there are no published
* Santhanakrishnan Ramakrishnan [email protected] 1
Department of Pediatrics & Neonatology, SKS Hospital & Postgraduate Medical Institute, 23, SKS Hospital Road, Alagapuram, Salem, Tamil Nadu 636004, India
2
Department of Microbiology, SKS Hospital & Postgraduate Medical Institute, 23, SKS Hospital Road, Alagapuram, Salem, Tamil Nadu 636004, India
3
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