Fungal sinusitis in immunocompromised children with neoplasms

Area of Science:

• Medical Mycology
• Pediatric Oncology
• Infectious Diseases

Background:

• Fungal sinusitis presents diagnostic and therapeutic challenges in immunocompromised pediatric patients.
• Hematopoietic neoplasms are associated with a higher incidence of sinusitis compared to solid tumors.

Purpose of the Study:

• To review the diagnosis and treatment of fungal sinusitis in immunocompromised patients at St Jude Children's Research Hospital.
• To evaluate the efficacy of an aggressive treatment strategy for invasive fungal sinusitis.

Main Methods:

• Retrospective review of pediatric patients with fungal sinusitis.
• Analysis of clinical findings, treatment protocols, and outcomes.
• Correlation of neutrophil counts and chemotherapy status with disease progression.

Main Results:

• Fungal sinusitis was identified in 8 patients undergoing chemotherapy for acute leukemia with low neutrophil counts.
• Common symptoms included fever, facial pain, and abnormal sinus radiographs.
• Surveillance cultures were unreliable predictors of sinus pathogens.
• An aggressive treatment approach involving amphotericin B and surgical drainage yielded an 80% survival rate in patients in remission on maintenance chemotherapy.

Conclusions:

• Fungal sinusitis requires prompt diagnosis and aggressive management in immunocompromised children, particularly those with leukemia.
• Early administration of amphotericin B and surgical intervention are crucial for improving survival rates.
• Patients undergoing chemotherapy for relapse have a poor prognosis, highlighting the importance of remission-based treatment.