Factors associated with all-cause mortality in pediatric invasive fungal rhinosinusitis

Azamar, Alejandro; Gonzalez, Claudia L. R.; Mantilla, Edgar; Villamor, Perla

doi:10.1016/j.ijporl.2019.109734

Cited by 7 publications

(38 citation statements)

References 14 publications

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“…Consistent with prior reports, 2,4–8 a slight male predominance was appreciated in our cohort, with acute lymphoblastic leukemia serving as the most common primary diagnosis. A retrospective review from Guatemala demonstrated 44% of children with IFS were admitted to the ICU (mean, 16 days) 9 .…”

Section: Discussionsupporting

confidence: 92%

“…20 Despite the substantial tilt toward endoscopic intervention, overall mortality from pediatric IFS continues to remain unacceptably high, with recent estimates ranging between 41% and 56%. 4,5 Pathology Contrary with published data, 2,4,9,21 mucormycosis (n = 10, 55.6%) was the predominant organism isolated in our cohort. Variations in fungal disease may certainly be due to differences in locoregional geography, climate patterns, and commensal host colonization.…”

Section: Surgical Characteristicscontrasting

confidence: 99%

“…In our cohort, radiographic features consistent with pediatric IFS were also appreciated, consistent with prior reports 1,5,12,16 . Although multiple articles 2,4,12 have suggested extrasinus disease is not associated with survival, this analysis supports cerebral involvement as a negative prognostic factor for survival ( p = 0.0010) as it likely indicates advanced‐stage disease. As neither standard criteria nor evidence‐based guidelines exist for the radiographic identification of IFS, additional scholarly efforts are necessary to outline indications for ancillary imaging.…”

Section: Discussionsupporting

confidence: 90%

“…15 In our cohort, radiographic features consistent with pediatric IFS were also appreciated, consistent with prior reports. 1,5,12,16 Although multiple articles 2,4,12 have suggested extrasinus disease is not…”

Section: Radiographic Imagingmentioning

confidence: 99%

“…Alejandro also explored this concept and identified an extensive delay (>7 days) from diagnosis to surgery as a risk factor for both overall (p = 0.0177) and IFS-related (p = 0.0152) survival in children. 4 Without a clear survival benefit shown for emergency surgery, perhaps in these scenarios, less risk would be incurred by first initiating empiric antifungal therapy with planned surgical intervention within 24 h of diagnosis. This would allow for a judicious window of perioperative optimization in conjunction with collaborating pediatric anesthesiology and hematology-oncology services to ensure patient stability and adequate procedural tolerance.…”

Section: Temporal Parametersmentioning

confidence: 99%

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Pediatric Invasive Fungal Rhinosinusitis: A Comprehensive Analysis of Prognostic Factors for Survival

et al. 2022

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Objective Pediatric invasive fungal rhinosinusitis (IFS) is a devastating infection that manifests almost exclusively in immunocompromised children. The goal of this work was to determine which clinical features carry prognostic value for survival. Methods A retrospective review of children with a histopathological diagnosis of IFS was performed at an academic tertiary care institution from 1990 to 2021. Clinical variables were collected to generate survival and life‐table estimators at 6‐months and 1‐year. Results Eighteen patients were included in this analysis, with a mean age of 9.8 years (range, 1–17 years). Most children were neutropenic (n = 15, 83.3%), with acute lymphoblastic leukemia (n = 10, 55.6%) representing the most common primary diagnosis. A mean of 3.2 operations (range 1–7 operations) was performed per patient for either mucormycosis (n = 10, 55.6%) or aspergillosis (n = 8, 44.4%). The mean time to absolute neutrophil count recovery was 65.8 days (range 20–137 days), with a 6‐month and 1‐year survival rate of 47.6% and 41.7%, respectively. Gross total resection (p = 0.006, p < 0.001), number of antifungals (p = 0.0004, p = 0.0003), and total operation number (p = 0.0032, p = 0.0035), served as positive prognostic factors for 6‐month and 1‐year survival. Conversely, altered mental status (p = 0.0026), cerebral involvement (p = 0.0010), cranial neuropathies (p < 0.0001), hyperglycemia (p = 0.0445, p = 0.0208), and intensive care unit status (p = 0.0013) served as negative prognostic factors for 6‐month and 1‐year survival. Conclusion Several key elements were identified and found to play a vital role in influencing survival for pediatric IFS. Early diagnosis, prompt medical therapy, and aggressive surgical intervention remain at the forefront in the treatment of this complex opportunistic infection. Level of Evidence 4 Laryngoscope, 133:1239–1250, 2023

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Section: Discussionsupporting

confidence: 92%

Section: Surgical Characteristicscontrasting

confidence: 99%

Section: Discussionsupporting

confidence: 90%

Section: Radiographic Imagingmentioning

confidence: 99%

Section: Temporal Parametersmentioning

confidence: 99%

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Pediatric Invasive Fungal Rhinosinusitis: A Comprehensive Analysis of Prognostic Factors for Survival

et al. 2022

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Diagnosis, Prognosticators, and Management of Acute Invasive Fungal Rhinosinusitis: Multidisciplinary Consensus Statement and Evidence‐Based Review with Recommendations

Roland

Humphreys

et al. 2023

Int Forum Allergy Rhinol

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BackgroundAcute invasive fungal sinusitis (AIFS) is an aggressive disease that requires prompt diagnosis and multidisciplinary treatment given its rapid progression. However, there is currently no consensus on diagnosis, prognosis, and management strategies for AIFS, with multiple modalities routinely employed. The purpose of this multi‐institutional and multidisciplinary evidence‐based review with recommendations (EBRR) is to thoroughly review the literature on AIFS, summarize the existing evidence, and provide recommendations on the management of AIFS.MethodsThe PubMed, EMBASE, and Cochrane databases were systematically reviewed from inception through January 2022. Studies evaluating management for orbital, non‐sinonasal head and neck, and intracranial manifestations of AIFS were included. An iterative review process was utilized in accordance with EBRR guidelines. Levels of evidence and recommendations on management principles for AIFS were generated.ResultsA review and evaluation of published literature was performed on 12 topics surrounding AIFS (signs and symptoms, laboratory and microbiology diagnostics, endoscopy, imaging, pathology, surgery, medical therapy, management of extrasinus extension, reversing immunosuppression, and outcomes and survival). The aggregate quality of evidence was varied across reviewed domains.ConclusionBased on the currently available evidence, judicious utilization of a combination of history and physical examination, laboratory and histopathologic techniques, and endoscopy provide the cornerstone for accurate diagnosis of AIFS. In addition, AIFS is optimally managed by a multidisciplinary team via a combination of surgery (including resection whenever possible), antifungal therapy, and correcting sources of immunosuppression. Higher quality (i.e., prospective) studies are needed to better define the roles of each modality and determine diagnosis and treatment algorithms.

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Contemporary Management of Pediatric Invasive Fungal Rhinosinusitis

Zhou,

Yu,

Frank

et al. 2024

Curr Infect Dis Rep

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Factors associated with all-cause mortality in pediatric invasive fungal rhinosinusitis

Cited by 7 publications

References 14 publications

Pediatric Invasive Fungal Rhinosinusitis: A Comprehensive Analysis of Prognostic Factors for Survival

Pediatric Invasive Fungal Rhinosinusitis: A Comprehensive Analysis of Prognostic Factors for Survival

Diagnosis, Prognosticators, and Management of Acute Invasive Fungal Rhinosinusitis: Multidisciplinary Consensus Statement and Evidence‐Based Review with Recommendations

Contemporary Management of Pediatric Invasive Fungal Rhinosinusitis

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