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Published on: March 9, 2018
Paediatric Acute Invasive Fungal Sinusitis Outcomes Over a 13-Year Period
Matthew James Wu1, Marie-Ange Munyemana1, Lauren Roland1
1Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine in St. Louis, St. Louis, Missouri, USA.
Insights
Male sex, immunodeficiency disorders, and aspergillosis infections are linked to higher mortality in pediatric acute invasive fungal sinusitis (AIFS) patients. This study identified key prognostic factors for AIFS.
Area of Science:
- Pediatric Infectious Diseases
- Otolaryngology
- Mycology
Background:
- Acute invasive fungal sinusitis (AIFS) is a severe infection in immunocompromised children.
- Identifying prognostic factors is crucial for improving outcomes in pediatric AIFS patients.
- Previous studies have not comprehensively analyzed national data for pediatric AIFS.
Purpose of the Study:
- To determine the prognostic factors associated with mortality in pediatric patients undergoing surgical treatment for AIFS.
- To analyze clinical characteristics, fungal species, and comorbidities impacting survival rates.
Main Methods:
- A weighted cross-sectional analysis of a public national hospitalisation database from 2006-2019.
- Included immunocompromised pediatric patients (<21 years) treated surgically for sinonasal fungal infections.
- Statistical analysis included Fisher's exact test and Bonferroni correction to compare mortality rates.
Main Results:
- A total of 408 pediatric AIFS patients were analyzed, with a median age of 12 years.
- The overall mortality rate was 16.1%. Increased mortality was associated with male sex, immunodeficiency disorders, and aspergillosis infections.
- Neoplasms (75.7%) and hematologic disorders (71.2%) were the most common comorbidities; 'other unspecified mycoses' (53.8%) and mucormycoses (35%) were the most frequent fungal types.
Conclusions:
- Male sex, immunodeficiency disorders, and aspergillosis are significant negative prognostic indicators in pediatric AIFS.
- The findings highlight the critical need for early identification and management of these risk factors.
- This study provides the largest national data set on pediatric AIFS, offering valuable insights for clinical practice.
Objectives:
To identify prognostic factors of paediatric acute invasive fungal sinusitis (AIFS) patients.
Design:
Weighted cross-sectional analysis over 13-year period (2006-2019).
Setting:
Public national hospitalisation database.
Participants:
Immunocompromised paediatric (age < 21 years) patients with sinonasal fungal infection who underwent sinonasal surgical treatment.
Main Outcome Measures:
Clinical characteristics (e.g., medical comorbidities, fungal species, age), mortality rate.
Statistical Analysis:
To compare mortality rates, the Fisher's exact test was used for individual conditions, each fungal species, and hospital treatment setting. The sample's median age (12 years) divided patients into younger and older groups. For two-sided tests, a p value of < 0.05 was considered significant. A Bonferroni correction was applied to evaluate fungal species and mortality, where a p value < 0.0167 was considered significant.
Results:
A weighted total of 408 surgically treated AIFS patients were identified (median age 12 years). The most common immunocompromised comorbidities were neoplasms (75.7%) and hematologic disorders (71.2%). The most common fungal species were "other unspecified mycoses" as defined by ICD codes (53.8%) then mucormycoses (35%). The overall mortality rate was 16.1%. The only immunocompromised comorbidity associated with increased mortality was immunodeficiency disorders (25.3%; p = 0.023). Demographics associated with increased mortality were being male (12.3% vs. 3.9%; p = 0.004), but not older age (56.1% vs. 43.9%; p = 0.588). Patients with aspergillosis infections had increased mortality (26.2%; p = 0.003), but not other fungal species.
Conclusion:
In the largest national sample of paediatric AIFS patients, the overall mortality rate was 16.1%. Negative prognostic indicators included male sex, immunodeficiency disorder, and aspergillosis infections.
