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Aspergillus sinusitis in neutropenic patients with cancer: a review
1Baltimore College of Dental Surgery, Dental School, MD.
Abstract:
Aspergillosis typically occurs in patients with reduced host defenses; such patients include renal and marrow recipients as well as patients with chemotherapy-induced myelosuppression. Pulmonary structures are most frequently involved; non-pulmonary involvement (including sinus) has not been frequently reported. In the present study, paranasal sinusitis occurred in 52 myelosuppressed cancer patients treated over 5 years at the UMCC with chemotherapy. Twenty-one patients had Aspergillus sinusitis; Aspergillus spp., including flavus and niger, were directly recovered from sinus in 19 of the 21 infections. Two other patients were considered clinically, although not microbiologically, documented. Multiple predisposing factors for Aspergillus sinusitis during the 60 days prior to infection diagnosis appear to exist; these include: 1) granulocyte count less than 500 mm3 (mean duration, 42 days versus 14 days for sinusitis of other etiology; P less than 0.001); 2) prolonged hospitalization (mean duration, 22 days versus 14 days for patients with non-fungal sinusitis; P less than 0.001); and 3) prolonged antibiotic therapy (mean duration, 22 days versus 9 days; P less than 0.001). The Aspergillus sinusitis resolved in 18 of 21 patients following treatment with amphotericin B; however, 11 of 18 patients had infection recurrence that always developed when tumor recurred and chemotherapy was reinstituted.
Insights
Aspergillus sinusitis is a rare complication in myelosuppressed cancer patients, often linked to low granulocyte counts, hospitalization, and antibiotic use. Treatment with amphotericin B can be effective, but recurrence is common with disease progression.
Area of Science:
- Medical Mycology
- Oncology
- Infectious Diseases
Background:
- Aspergillosis commonly affects immunocompromised individuals, primarily impacting pulmonary structures.
- Non-pulmonary aspergillosis, particularly paranasal sinusitis, is less frequently reported in clinical literature.
Purpose of the Study:
- To investigate the occurrence, predisposing factors, and treatment outcomes of Aspergillus sinusitis in myelosuppressed cancer patients.
- To highlight the significance of non-pulmonary aspergillosis in this vulnerable patient population.
Main Methods:
- Retrospective analysis of 52 myelosuppressed cancer patients treated with chemotherapy over a 5-year period.
- Microbiological confirmation of Aspergillus species (e.g., flavus, niger) in sinus cultures.
- Statistical comparison of predisposing factors (granulocyte count, hospitalization duration, antibiotic therapy) between fungal and non-fungal sinusitis.
Main Results:
- Twenty-one patients were diagnosed with Aspergillus sinusitis, with Aspergillus species identified in 19 cases.
- Significant predisposing factors included granulocytopenia (less than 500 cells/mm³), prolonged hospitalization, and extended antibiotic therapy.
- Amphotericin B led to resolution in 18 of 21 patients, but 11 experienced recurrence, often coinciding with tumor relapse and chemotherapy reinitiation.
Conclusions:
- Aspergillus sinusitis is an important, albeit uncommon, non-pulmonary manifestation in myelosuppressed cancer patients.
- Identifying and managing predisposing factors is crucial for preventing and treating this infection.
- Recurrence of Aspergillus sinusitis is associated with disease progression and treatment intensification.