ABSTRACT
Objectives: Acute invasive fungal rhinosinusitis has been
associated with high mortality rates. We aimed to explore the
contribution of novel detection and treatment methods on the outcome of
immunosuppressed children with acute invasive fungal rhinosinusitis.
Design: Retrospective observational cohort study.
Setting: A tertiary children’s hospital.
Participants: The records of all children with a hematologic or
oncologic disease who developed AIFR between 2005-2020 were reviewed.
Results: Thirty-four patients were included. Aspergillosis and
mucormycosis were diagnosed in 20 patients (59%) and 12 patients
(35%), respectively. Panfungal polymerase chain reaction (PCR) was
associated with a change of treatment in 36% of patients. A more
aggressive surgical approach as well as treatment with liposomal
amphotericin B and novel antifungals were adopted in recent years.
Overall, 26% of patients died of disease, however no disease-specific
death occurred since 2012. Diagnosis using panfungal PCR (p=.04 )
and treatment with novel antifungal medications (p=.017 ) were
significantly associated with disease-specific survival.
Conclusions: Enhanced fungal detection using panfungal PCR and
treatment with novel antifungal agents, combined with rapid diagnosis
and treatment, aggressive surgical approach and better control over the
underlying oncological disease, may significantly improve the outcome of
immunosuppressed children with acute invasive fungal rhinosinusitis.
Key words: Infectious/inflammatory, Pediatric sinus/nose,
Pediatric rhinology.