Fungal Sinusitis in Immunocompromised Children with Neoplasms

Abstract

This paper reviews the treatment and diagnosis of immunocompromised patients with fungal sinusitis at St Jude Children's Research Hospital. Sinusitis of all types was found to be more common in patients with hematopoietic neoplasms than in patients with solid tumors; 42% of patients with leukemia had abnormal sinus radiographs. Eight cases of pathologically proven fungal sinusitis were identified. All patients were undergoing chemotherapy for either acute myeloblastic leukemia or acute lymphoblastic leukemia and had neutrophil counts less than 100 cells/mm3. The most common findings were fever, facial pain, and abnormal sinus radiographs. Surveillance cultures of the upper aerodigestive system did not reliably predict sinus pathogens. An aggressive treatment approach consisting of early administration of amphotericin B (intravenously and via catheter irrigations of the sinuses) and surgical drainage is advocated. There was an 80% survival rate in patients in remission who were undergoing maintenance chemotherapy. All patients undergoing chemotherapy for relapse died.

Clinical manifestations and diagnosis of invasive aspergillosis in immunocompromised children

“…For PCR, serum seems to be the most suitable specimen to minimise false-positive results since no organisms are usually isolated from these samples [104]. For the diagnosis of aspergilloma from serum samples, a nested PCR assay was found superior to the latex agglutination test and GM-antigen detection by ELISA [43,104]. In one study by Hebart et al [34], prospective examination of blood samples by PCR following allogeneic stem cell transplantation allowed identification of patients at very high risk for IA.…”

Invasive Aspergillosis in Paediatric Patients

“…The lungs are the most frequently affected sites, and disseminated disease is found in approximately 30% of cases. Whilst paranasal sinus aspergillosis appears to be less common than in adults [27,29], primary cutaneous aspergillosis has been preferentially reported in the paediatric setting in association with lacerations by arm boards, tapes, and electrodes and at the insertion site of peripheral or central venous catheters [5,27,30]. With combined surgical and medical therapy, primary cutaneous aspergillosis has a comparatively more favourable prognosis [27].…”

Recomendaciones para el tratamiento de la infección por Aspergillus spp.

“…En caso de intolerancia, pueden usarse las formas lipídicas (50 mg) 34 (CIII). En situaciones concretas, con presencia de masas miceliales en la tráquea, la retirada de éstas mediante técnicas broncoscópicas es útil dada la escasa penetrancia de los antifúngicos a este nivel 35 .…”

“…Aunque por lo general es el único foco de enfermedad aspergilosa, puede extenderse hacia el paladar y coexistir con enfermedad pulmonar. La mortalidad es elevada; oscila entre el 20% en pacientes afectados de leucemia en remisión y el 100% en pacientes con recidiva de enfermedad o en sometidos a trasplante de médula ósea 35,36 . La radiología convencional y la TC de senos no permite distinguirla de la etiología bacteriana.…”