The role of gastrostomy in the therapy of mucoromycosis on the background of insulin-dependent diabetes mellitus

The paper analyzes nutritional support for a child with disseminated mucormycosis against the background of newly diagnosed diabetes mellitus. Mucormycosis is an aggressive fungal infection, especially dangerous for immunocompromised individuals, which include patients with primary and secondary immunodeficiencies. Diabetes mellitus acts as the main disease leading to secondary immunodeficiency, especially in the presence of ketoacidosis. Pain syndrome, cosmetic defect of the hard and soft palate, lack of ability to eat in the usual way against the background of the underlying disease contributed to the development of progressive cachexia. Gastrostomy and specialized enteral nutrition gave a chance for recovery. All medications were administered through a gastrostomy tube without causing pain. The dynamics of nutritional status were monitored using bioimpedancemetry data. With nutritional support from mixtures based on deeply hydrolyzed protein with medium-chain triglycerides at the beginning of feeding through a gastrostomy, it was possible to restore the mucous membrane of the gastrointestinal tract. Subsequently, the patient received specialized mixtures recommended for carbohydrate metabolism disorders. A balanced composition of enteral nutrition made it possible to achieve a stable blood glucose level, correct hypoproteinemia, hypoalbuminemia and hypokalemia that arose during therapy with an antifungal agent. Restoration of swallowing and removal of gastrostomy is possible with stable positive dynamics of nutritional status, control over the underlying disease and restoration of cosmetic defects.

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