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Published on: June 20, 2018
An investigation of operative outcomes: Pediatric invasive fungal sinusitis
Curtis Hanba1, Peter F Svider1, Wanda Lai2
1Department of Otolaryngology - Head and Neck Surgery, Wayne State University School of Medicine, Detroit, MI, USA.
Insights
Invasive fungal sinusitis in children is rare but deadly, with nearly a quarter of surgically treated patients dying. Leukemia/lymphoma patients are most affected, and Mucormycosis predicts death.
Area of Science:
- Pediatric Infectious Diseases
- Otolaryngology
- Hematology/Oncology
Background:
- Invasive fungal sinusitis (IFS) is a rare but severe condition in children.
- Early diagnosis and treatment are critical to minimize morbidity and mortality.
Purpose of the Study:
- To identify patient characteristics associated with high-risk surgical invasive fungal sinusitis in a pediatric population.
- To analyze outcomes and risk factors in pediatric cases of invasive fungal sinusitis.
Main Methods:
- Retrospective analysis of the Kids' Inpatient Database (KID) for 2009 and 2012.
- Identified 102 pediatric patients with likely invasive fungal sinusitis through specific diagnostic and procedural queries.
- Collected data on fungal species, disease extension, mortality, and clinical characteristics.
Main Results:
- Leukemia/lymphoma patients comprised 90.2% of the cohort.
- Mortality rate was 24.9% among surgically treated pediatric patients.
- Aspergillus was the most common species; Mucormycosis independently predicted death (OR=3.835).
- Orbital involvement was higher in younger children (0-5 years, 56.3%); brain extension occurred in 33.7%.
- Average hospital stay was 59.3 days, with costs averaging $746,299.
Conclusions:
- This study represents the largest pediatric cohort of invasive fungal sinusitis to date.
- Demographics, cytology, and disease extension predict patient outcomes.
- High clinical suspicion and prompt treatment are essential to reduce prolonged hospitalizations and costs.
Objectives/Hypothesis:
Invasive fungal sinusitis is an uncommon entity among children. Early recognition is crucial for facilitating successful treatment with minimal morbidity. The goal of this analysis was to identify patient characteristics associated with high-risk surgical disease through a population-based examination into this rare and deadly disease process.
Methods:
A retrospective chart review of the 2009 and 2012 Kids' Inpatient Database (KID) was conducted. A series of queries (Fungal infection→immunocompromised diagnosis→sinus procedure) identified 102 patients with likely invasive fungal sinusitis. Outcomes included: species, invasive extension, death, and other clinical characteristics.
Results:
Patients with leukemia/lymphoma constituted 90.2% of individuals evaluated in this analysis. Nearly a quarter of pediatric patients receiving surgical treatment for invasive fungal sinusitis died during their hospital stay -24.9%. Aspergillus was the most commonly recorded mycotic species. Average hospital stay was 59.3 days, and associated hospital costs averaged $746,299 per stay. Patients 0-5 years old were more likely to have orbital involvement -56.3%. Brain extension was noted in 33.7% of this cohort as well. Mucormycosis was an independent predictor of death (p = 0.03), with an odds ratio of 3.835.
Conclusion:
To the best of our knowledge, this is the largest pediatric cohort with invasive fungal sinusitis in the literature. Patient demographics, cytology, and disease extension offer predictive information regarding patient outcomes for invasive fungal sinusitis. A high clinical suspicion and early treatment may decrease the lengthy and costly hospitalizations in this population.
