{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,2]],"date-time":"2026-06-02T09:39:46Z","timestamp":1780393186771,"version":"3.54.1"},"reference-count":37,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2022,3,8]],"date-time":"2022-03-08T00:00:00Z","timestamp":1646697600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Cunninghamella spp. is a group of fungi belonging to the Mucorales order. Cases of fungal endocarditis are sporadic, but more frequent in immunocompromised patients. COVID-19 (SARS-CoV-2 Infection Disease 2019) infections, prematurity, deferoxamine treatment, iron overload, neutropenia, diabetes, and malignant hemopathies proved to be risk factors for mucormycosis. We present the case of a 7-year-old boy who was treated every three weeks with blood transfusion for major beta-thalassemia, receiving deferoxamine for secondary hemochromatosis. After two weeks with nonspecific respiratory and digestive symptoms, he was admitted for fever, followed by lower limb ischemia and neurological signs. Echocardiography revealed massive endocarditis affecting the mitral and tricuspid valves with embolization phenomena in the brain, lungs, kidney, spleen, and lower limbs. As a particular finding, IgG antibodies for COVID-19 were positive. Emergency cardiac surgery was performed. The mitral valve necessitated replacement with CarboMedics prosthesis. Unfortunately, the patient did not survive. Cunninghamella spp. was confirmed via the PCR analysis of vegetations. Cunninghamella endocarditis in the context of a systemic infection presented as an opportunistic infection affecting a child who had several risk factors. Mucormycosis is challenging to treat, with high mortality. Prophylactic treatment in beta-thalassemia patients with iron-chelator deprivation drugs, such as deferiprone, may help in preventing these particular fungal infections.<\/jats:p>","DOI":"10.3390\/diagnostics12030657","type":"journal-article","created":{"date-parts":[[2022,3,8]],"date-time":"2022-03-08T12:35:37Z","timestamp":1646742937000},"page":"657","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":16,"title":["Disseminated Cunninghamella spp. Endocarditis in a Beta-Thalassemia Patient after Asymptomatic COVID-19 Infection"],"prefix":"10.3390","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3239-0704","authenticated-orcid":false,"given":"Eliza","family":"Cinteza","sequence":"first","affiliation":[{"name":"Department of Pediatrics, \u201cCarol Davila\u201d University of Medicine and Pharmacy, 020021 Bucharest, Romania"},{"name":"Department of Pediatric Cardiology, \u201cMarie Curie\u201d Emergency Children\u2019s Hospital, 041451 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alin","family":"Nicolescu","sequence":"additional","affiliation":[{"name":"Department of Pediatric Cardiology, \u201cMarie Curie\u201d Emergency Children\u2019s Hospital, 041451 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tatiana","family":"Ciomartan","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, \u201cCarol Davila\u201d University of Medicine and Pharmacy, 020021 Bucharest, Romania"},{"name":"Department of Pediatrics, \u201cAlessandrescu Rusescu\u201d National Institute for Mother and Child Health, 020395 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4832-2044","authenticated-orcid":false,"given":"Liana-C\u0103t\u0103lina","family":"Gavriliu","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, \u201cCarol Davila\u201d University of Medicine and Pharmacy, 020021 Bucharest, Romania"},{"name":"Department of Pediatric Cardiology, \u201cMarie Curie\u201d Emergency Children\u2019s Hospital, 041451 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cristiana","family":"Voicu","sequence":"additional","affiliation":[{"name":"Department of Pediatric Cardiology, \u201cMarie Curie\u201d Emergency Children\u2019s Hospital, 041451 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adelina","family":"Carabas","sequence":"additional","affiliation":[{"name":"Department of Pediatric Cardiology, \u201cMarie Curie\u201d Emergency Children\u2019s Hospital, 041451 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Monica","family":"Popescu","sequence":"additional","affiliation":[{"name":"Department of Pediatric Cardiology, \u201cMarie Curie\u201d Emergency Children\u2019s Hospital, 041451 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Irina","family":"Margarint","sequence":"additional","affiliation":[{"name":"Department of Pediatric Cardiology, \u201cMarie Curie\u201d Emergency Children\u2019s Hospital, 041451 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2022,3,8]]},"reference":[{"key":"ref_1","first-page":"271","article-title":"Invasive fungal infection\u2014New treatments to meet new challenges","volume":"116","author":"Wagener","year":"2019","journal-title":"Dtsch. Arztebl. Int."},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Pana, Z.D., Seidel, D., Skiada, A., Groll, A.H., Petrikkos, G., and Roilides, E. (2016). Invasive mucormycosis in children: An epidemiologic study in European and non-European countries based on two registries. BMC Infect. Dis., 16.","DOI":"10.1186\/s12879-016-2005-1"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"143","DOI":"10.1016\/j.idc.2015.10.011","article-title":"Mucormycoses","volume":"30","author":"Farmakiotis","year":"2016","journal-title":"Infect. Dis. Clin. N. Am."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"S35","DOI":"10.1093\/cid\/cir880","article-title":"Global Analysis of Mucormycosis in France: The RetroZygo Study (2005\u20132007)","volume":"54","author":"Lanternier","year":"2012","journal-title":"Clin. Infect. Dis."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"S23","DOI":"10.1093\/cid\/cir866","article-title":"Epidemiology and clinical manifestations of mucormycosis","volume":"54","author":"Petrikkos","year":"2012","journal-title":"Clin. Infect. Dis."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"634","DOI":"10.1086\/432579","article-title":"Epidemiology and outcome of zygomycosis: A review of 929 reported cases","volume":"41","author":"Roden","year":"2005","journal-title":"Clin. Infect. Dis."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"236","DOI":"10.1128\/CMR.13.2.236","article-title":"Zygomycetes in Human Disease","volume":"13","author":"Ribes","year":"2000","journal-title":"Clin. Microbiol. Rev."},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Hallur, V., Prakash, H., and Sable, M. (2021). Cunninghamella arunalokei a New Species of Cunninghamella from India Causing Disease in an Immunocompetent Individual. J. Fungi, 7.","DOI":"10.3390\/jof7080670"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1350","DOI":"10.1086\/428780","article-title":"Zygomycosis in a tertiary-care cancer center in the era of Aspergillus-active antifungal therapy: A case-control observational study of 27 recent cases","volume":"191","author":"Kontoyiannis","year":"2005","journal-title":"J. Infect. Dis."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"111643","DOI":"10.1016\/j.envres.2021.111643","article-title":"Mucormycosis: An opportunistic pathogen during COVID-19","volume":"201","author":"Mahalaxmi","year":"2021","journal-title":"Environ. Res."},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Lanternier, F. (2019). Disease Entities in Mucormycosis. J. Fungi, 5.","DOI":"10.3390\/jof5010023"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"102146","DOI":"10.1016\/j.dsx.2021.05.019","article-title":"Mucormycosis in COVID-19: A systematic review of cases reported worldwide and in India","volume":"15","author":"Singh","year":"2021","journal-title":"Diabetes Metab. Syndr."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"406","DOI":"10.1016\/j.mib.2011.07.004","article-title":"Host cell invasion in mucormycosis: Role of iron","volume":"14","author":"Ibrahim","year":"2011","journal-title":"Curr. Opin. Microbiol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"594","DOI":"10.1016\/S1473-3099(05)70220-6","article-title":"Zygomycete infection following voriconazole prophylaxis","volume":"5","author":"Zwaan","year":"2005","journal-title":"Lancet Infect. Dis."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"667","DOI":"10.1038\/ki.1994.89","article-title":"Deferoxamine augments growth and pathogenicity of Rhizopus, while hydroxypyridinone chelators have no effect","volume":"45","author":"Boelaert","year":"1994","journal-title":"Kidney Int."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"S16","DOI":"10.1093\/cid\/cir865","article-title":"Pathogenesis of mucormycosis","volume":"54","author":"Ibrahim","year":"2012","journal-title":"Clin. Infect. Dis."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"579","DOI":"10.1097\/00006454-199507000-00005","article-title":"Prospective study of Yersinia enterocolitica infection in thalassemic patients","volume":"14","author":"Cherchi","year":"1995","journal-title":"Pediatr. Infect. Dis. J."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"50","DOI":"10.1111\/j.1469-0691.2009.02981.x","article-title":"Invasive zygomycosis in neonates and children","volume":"15","author":"Roilides","year":"2009","journal-title":"Clin. Microbiol. Infect."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"42","DOI":"10.1093\/ajcp\/78.1.42","article-title":"Cardiac Mucormycosis: A Report of Five Patients and Review of 14 Previously Reported Cases","volume":"78","author":"Virmani","year":"1982","journal-title":"Am. J. Clin. Pathol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"186","DOI":"10.1111\/j.0886-0440.2005.200382q.x","article-title":"Successful Treatment of Mucormycosis in the Pulmonary Artery After Cardiac Surgery","volume":"20","author":"Chen","year":"2005","journal-title":"J. Card. Surg."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1781","DOI":"10.2169\/internalmedicine.48.2611","article-title":"Cardiac Mucormycosis Presenting as a \u201cFungus Ball\u201d in the Left Atrium","volume":"48","author":"Chinen","year":"2009","journal-title":"Intern. Med."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"156","DOI":"10.1016\/j.euje.2003.09.001","article-title":"Native aortic valve vegetative endocarditis with Cunninghamella","volume":"5","author":"Mehta","year":"2004","journal-title":"Eur. J. Echocardiogr."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"50","DOI":"10.1086\/317550","article-title":"Fungal Endocarditis: Evidence in the World Literature, 1965\u20131995","volume":"32","author":"Ellis","year":"2001","journal-title":"Clin. Infect. Dis."},{"key":"ref_24","first-page":"241791","article-title":"Acute Cardiac Failure due to Intra-Atrial Mass Caused by Zygomycetes in an Immunocompromised Paediatric Patient","volume":"2010","author":"Gidding","year":"2010","journal-title":"Case Rep. Med."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"257","DOI":"10.1055\/s-2006-924502","article-title":"Successful Treatment of Mucormycosis Endocarditis Complicated by Pulmonary Involvement","volume":"55","author":"Gubarev","year":"2007","journal-title":"Thorac. Cardiovasc. Surg."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1733","DOI":"10.1378\/chest.101.6.1733","article-title":"The Clinical Manifestations of Cardiac Mucormycosis","volume":"101","author":"Jackman","year":"1992","journal-title":"Chest"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"387","DOI":"10.1007\/BF02719474","article-title":"Floating ball thrombus in the left atrium with mitral stenosis","volume":"51","author":"Misumi","year":"2003","journal-title":"Jpn. J. Thorac. Cardiovasc. Surg."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"632","DOI":"10.1136\/pgmj.55.647.632","article-title":"Fungal endocarditis: Patients at risk and their treatment","volume":"55","author":"Seelig","year":"1979","journal-title":"Postgrad. Med. J."},{"key":"ref_29","first-page":"257","article-title":"Cardiac mucormycosis with T-cell immunodeficiency","volume":"46","author":"Shah","year":"2009","journal-title":"Indian Pediatr."},{"key":"ref_30","first-page":"e4760","article-title":"Disseminated Mucormycosis with Extensive Cardiac Involvement","volume":"11","author":"Soliman","year":"2019","journal-title":"Cureus"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"70","DOI":"10.1136\/jcp.40.1.70","article-title":"Myocardial infarction caused by cardiac disease in disseminated zygomycosis","volume":"40","author":"Benbow","year":"1987","journal-title":"J. Clin. Pathol."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"227","DOI":"10.3109\/03630269.2010.483662","article-title":"The Role of Iron and Chelators on Infections in Iron Overload and Non Iron Loaded Conditions: Prospects for the Design of New Antimicrobial Therapies","volume":"34","author":"Kontoghiorghes","year":"2010","journal-title":"Hemoglobin"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"776","DOI":"10.1007\/s12288-018-0958-5","article-title":"Primary Cutaneous Mucormycosis in a Beta-Thalassemia Patient","volume":"34","author":"Sepaskhah","year":"2018","journal-title":"Indian J. Hematol. Blood Transfus."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"1144","DOI":"10.1093\/cid\/cir122","article-title":"The diagnostic value of halo and reversed halo signs for invasive mold infections in compromised hosts","volume":"52","author":"Georgiadou","year":"2011","journal-title":"Clin. Infect. Dis."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"1743","DOI":"10.1086\/599105","article-title":"Recent advances in the management of mucormycosis: From bench to bedside","volume":"48","author":"Spellberg","year":"2009","journal-title":"Clin. Infect. Dis."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"2353","DOI":"10.1128\/JCM.02331-07","article-title":"Real-Time PCR Method for Detection of Zygomycetes","volume":"46","author":"Hata","year":"2008","journal-title":"J. Clin. Microbiol."},{"key":"ref_37","doi-asserted-by":"crossref","unstructured":"Millon, L., Caillot, D., Berceanu, A., Bretagne, S., Lanternier, F., Morio, F., Letscher-Bru, V., Dalle, F., Denis, B., and Alanio, A. (2022). Evaluation of serum Mucorales PCR for the diagnosis of Mucormycoses: The MODIMUCOR prospective trial. Clin. Infect. Dis., ciab1066.","DOI":"10.1093\/cid\/ciab1066"}],"container-title":["Diagnostics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4418\/12\/3\/657\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T22:33:49Z","timestamp":1760135629000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4418\/12\/3\/657"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,3,8]]},"references-count":37,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2022,3]]}},"alternative-id":["diagnostics12030657"],"URL":"https:\/\/doi.org\/10.3390\/diagnostics12030657","relation":{},"ISSN":["2075-4418"],"issn-type":[{"value":"2075-4418","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,3,8]]}}}