Aggressive combined modality treatment of progressive sinonasal fungal infections in immunocompromised patients.
OBJECTIVE
Invasive fungal infections of the paranasal sinuses in immunocompromised hosts are often fatal despite therapeutic interventions. In an effort to achieve a better outcome in patients with these infections, aggressive management was combined with medical/surgical intervention.


METHODS
A series of 18 immunocompromised patients with invasive sinonasal fungal infections was retrospectively analyzed. Management consisted of a combined modality clinical approach, including aggressively sought early diagnosis; early amphotericin use; extensive surgical debridement; and liberal use of granulocyte transfusion support.


RESULTS
Eight of 13 patients with eventual neutrophil recovery survived with control of all local and systemic signs of fungal infection. All patients with persisting neutropenia died of progressive infection.


CONCLUSIONS
We conclude that meticulous surveillance of patients in high-risk groups for fungal infection should be maintained due to the apparent value of rapid intervention with a combination of surgical resection and medical management (antifungal chemotherapy and white blood cell transfusions). Infection control and survival are ultimately dependent on recovery of marrow function and circulating neutrophils.
Goering
P
P
Department of Medicine, University of Minnesota Medical School, Minneapolis.
Berlinger
N T
NT
Weisdorf
D J
DJ
D000293:Adolescent; D000328:Adult; D002648:Child; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D007165:Immunosuppression Therapy; D007938:Leukemia / Q000628:therapy; D008297:Male; D008875:Middle Aged; D009181:Mycoses / Q000175:diagnosis / Q000628:therapy*; D009503:Neutropenia / Q000150:complications; D009668:Nose Diseases / Q000175:diagnosis / Q000628:therapy*; D010254:Paranasal Sinus Diseases / Q000175:diagnosis / Q000628:therapy*; D012189:Retrospective Studies; D012307:Risk Factors