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Invasive aspergillosis of paranasal tissues in children with malignancies
Abstract:
Paranasal aspergillosis was encountered in five children with relapsed malignancies. All had received broad-spectrum antibiotics within two weeks of development of aspergillosis, and all had absolute granulocyte counts less than 200/mm3 for at least three weeks. None had received prior antifungal therapy. There was an average delay of eight days before the correct diagnosis was established by either biopsy or culture. These data emphasize the need to obtain surveillance cultures of the upper respiratory tract passages in severely neutropenic patients receiving prolonged antibiotic therapy, and raise a question concerning prophylactic use of antifungal therapy in this group.
Insights
Five children with relapsed malignancies developed invasive fungal infections, specifically paranasal aspergillosis. This highlights the need for early diagnosis and potential antifungal prophylaxis in severely neutropenic patients.
Area of Science:
- Medical Mycology
- Pediatric Oncology
- Infectious Diseases
Background:
- Severely neutropenic pediatric patients with relapsed malignancies are susceptible to opportunistic infections.
- Invasive fungal infections, such as aspergillosis, pose a significant threat in immunocompromised individuals.
Observation:
- Five cases of paranasal aspergillosis were identified in children with relapsed malignancies.
- Patients had received broad-spectrum antibiotics and presented with prolonged severe neutropenia (absolute granulocyte count < 200/mm3).
- Diagnosis was delayed by an average of eight days, with no prior antifungal treatment received.
Findings:
- Paranasal aspergillosis occurred in severely neutropenic children with relapsed malignancies.
- Risk factors included recent broad-spectrum antibiotic use and prolonged neutropenia.
- Delayed diagnosis impacted patient outcomes, underscoring the need for prompt recognition.
Implications:
- Routine upper respiratory tract surveillance cultures are recommended for severely neutropenic patients on prolonged antibiotics.
- The findings suggest a potential role for prophylactic antifungal therapy in this high-risk pediatric population.
- Early diagnosis and intervention are critical for managing invasive fungal infections in immunocompromised children.