Clinical spectrum and outcome of invasive filamentous fungal infections in children with Type 1 diabetes: North Indian experience

Abstract

There is scarcity of data on spectrum and outcome of invasive filamentous fungal infections (IFIs) in children with Type 1 diabetes (T1D) from developing countries. A retrospective review of medical records of children with T1D hospitalized with IFI over the past decade at the Pediatric Endocrinology and Diabetes Unit of a large tertiary care hospital of North India was performed with an aim to study their clinical spectrum, hospital course and final outcome. Of the 10 patients studied, nasal/paranasal involvement was seen in 6 and pulmonary involvement in 5 patients. One patient developed disseminated disease. Majority of the identified mycoses belonged to Class Zygomycetes Order Mucorales. Early surgery along with antifungal therapy helped limit the extension of infection and achieve a good outcome in majority of patients. Two patients died; one with a late diagnosis of pulmonary mucormycosis and the other with disseminated disease. The longterm morbidity in the survivors was minimal. In conclusion, rapid diagnosis followed by a multimodal approach involving aggressive surgical debridement, appropriate antifungal therapy and control of hyperglycemic state is the key to good outcome in this otherwise lethal infection.

Keywords: Type 1 diabetes; children; filamentous; invasive fungal infections; zygomycosis.

Fig. 1.

a: Soft tissue opacities in frontal and ethmoid sinuses with blocked osteomeatal complex. b: Opacification of right maxillary sinus.

Fig. 2.

a & b: CECT chest showing cavitatory pneumonia on right side.