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Published on: June 20, 2018
Surgery for pediatric invasive fungal sinonasal disease
Farhad Ardeshirpour1, Lauren A Bohm, Kiran K Belani
1Children's ENT and Facial Plastic Surgery, Children's Hospitals and Clinics of Minnesota, Minneapolis, Minnesota; Department of Otolaryngology-Head and Neck Surgery, University of Minnesota, Minneapolis, Minnesota.
Insights
Radical surgery effectively treated invasive fungal sinonasal disease in immunocompromised children, achieving a 100% cure rate. Aggressive surgical and antifungal therapies are crucial for managing this life-threatening condition in pediatric patients.
Area of Science:
- Pediatric Otolaryngology
- Pediatric Oncology
- Infectious Diseases
Background:
- Invasive fungal sinonasal disease (IFSD) is a severe complication in immunocompromised children, particularly those with relapsed leukemia.
- Early diagnosis and prompt intervention are critical for favorable outcomes.
Purpose of the Study:
- To assess the management strategies and treatment outcomes for pediatric patients with IFSD.
- To evaluate the efficacy of radical surgical intervention in treating IFSD in children.
Main Methods:
- Retrospective case series of 11 pediatric patients diagnosed with IFSD between 1994 and 2007.
- Data collected included patient demographics, oncologic diagnoses, neutrophil counts, clinical presentation, imaging, microbiological results, surgical procedures, and outcomes.
- All patients underwent surgical treatment by a single pediatric otolaryngologist.
Main Results:
- The study included 11 patients (4 males, 7 females, average age 10 years) with acute lymphoblastic leukemia or acute myeloid leukemia, 10 of whom had relapsed disease.
- Cultures identified Alternaria (7 patients) and Aspergillus (4 patients). Surgical procedures included external medial maxillectomy and septectomy.
- All 11 patients (100%) achieved a cure of IFSD without relapse; 3 patients later died from unrelated causes.
Conclusions:
- Radical surgical management, combined with antifungal and supportive therapies, leads to excellent outcomes in pediatric IFSD.
- This study highlights the importance of aggressive surgical approaches for IFSD in immunocompromised children, presenting the largest series with the best outcomes to date.
Objectives/Hypothesis:
To evaluate the management and outcomes of children with invasive fungal sinonasal disease treated with radical surgery.
Study Design:
Retrospective case series.
Methods:
From 1994 to 2007, 11 pediatric patients were identified with invasive fungal sinonasal disease treated surgically by the same pediatric otolaryngologist. Collected data included demographics, oncologic diagnoses, absolute neutrophil counts, symptoms, computed tomography scan findings, biopsy and culture results, surgical procedures, concurrent medical therapies, complications, and survival.
Results:
The studied patient population consisted of four males and seven females with an average age of 10 years (range, 2-14 years). Six patients were diagnosed with acute lymphoblastic leukemia and five with acute myeloid leukemia, which included 10 cases of relapsed disease. The average number of severely neutropenic days prior to diagnosis of an invasive fungal infection was 18 (range, 8-41 days). Culture results demonstrated Alternaria in seven patients and Aspergillus in four. Nine patients underwent an external medial maxillectomy, five of which were bilateral, and six underwent septectomy. All 11 patients (100%) were cured of their invasive fungal sinonasal disease without relapse. Three patients eventually died from unrelated causes.
Conclusions:
Invasive fungal sinonasal disease is a life-threatening problem in immunocompromised children, especially with relapsed leukemia. Successful treatment depends on timely and aggressive surgical, antifungal, and supportive therapies. To our knowledge, this study represents the largest series of pediatric patients with invasive fungal sinonasal disease managed via an aggressive surgical approach with the best outcomes to date.
Level Of Evidence:
4.
