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Alternaria: a sinonasal pathogen of immunocompromised hosts
1Department of Medicine, University of Minnesota Health Sciences Center, Minneapolis.
Summary
Emerging fungal pathogen Alternaria can cause localized sinonasal infections in immunocompromised patients, particularly bone marrow-transplant recipients. Prompt treatment with antifungals and surgery leads to successful outcomes.
Area of Science:
- Mycology
- Infectious Diseases
- Hematology
Background:
- Fungal infections pose significant risks to immunocompromised individuals.
- While Candida and Aspergillus are common, less frequent fungi like Alternaria are increasingly recognized as opportunistic pathogens.
Purpose of the Study:
- To describe the clinical presentation, treatment, and outcomes of invasive sinonasal Alternaria infections in bone marrow-transplant recipients.
- To highlight Alternaria's role as an emerging pathogen in this vulnerable population.
Main Methods:
- A retrospective review of six bone marrow-transplant recipients with sinonasal Alternaria infection over 16 years.
- Analysis of patient presentation, diagnostic findings, treatment strategies, and outcomes.
Main Results:
- Infections were localized to the sinonasal region, often asymptomatic at presentation, and diagnosed incidentally.
- Most infections occurred before white blood cell recovery, with normal sinus roentgenograms in most cases.
- Combined systemic antifungal therapy and surgical debridement, with granulocyte transfusions in some, led to resolution in five of six patients.
Conclusions:
- Alternaria species demonstrate a predilection for causing localized invasive sinonasal infections in immunocompromised hosts.
- An aggressive, combined-modality treatment approach is effective for managing these infections.