Invasive Aspergillus sinusitis in pediatric bone marrow transplant patients. Evaluation and management.
OBJECTIVE
To evaluate the following: the incidence of invasive Aspergillus sinusitis (AS); the value of surveillance nasal cultures and screening radiologic studies in predicting AS; the clinical criteria used to decide on surgical biopsy in patients suspected of having AS; the surgical and medical management of AS; and the outcome of AS in the peritransplantation period of children who underwent bone marrow transplantation.


METHODS
Retrospective medical chart review.


METHODS
Tertiary care children's hospital.


METHODS
Eighty pediatric patients who underwent bone marrow transplantation for a variety of refractory malignant neoplasms or lymphohematopoietic disorders at the Children's National Medical Center, Washington, DC, from April 1, 1988, to September 30, 1993.


METHODS
Diagnostic surgical biopsies, surgical débridement, and treatment with amphotericin B.


METHODS
Resolution of AS and discharge from the hospital.


RESULTS
Seventy-two patients had screening sinus radiographs, 27 of which showed abnormalities. Aspergillus sinusitis developed in three of the patients with abnormal screening radiographs. Fifty-eight patients had screening nasal cultures. One culture was positive for Aspergillus, and histopathologically proved AS developed in this patient. Twelve diagnostic biopsies were done in nine patients. Three biopsy specimens showed histopathologic evidence of AS. The three patients with AS were successfully treated with aggressive surgical and medical therapy and were discharged from the hospital.


CONCLUSIONS
The incidence of AS was 4% (3/80) in the patients who underwent bone marrow transplantation. Screening radiographs, while not a good predictor of AS, have a role in evaluation of patients undergoing bone marrow transplantation to define preexisting sinus disease. Screening nasal cultures do not reliably predict AS. When AS is suspected and diagnostic biopsy is considered, the seven clinical criteria outlined in this article should be used. Survival of immunocompromised patients with AS requires early diagnosis and aggressive surgical and medical therapy.
Choi
S S
SS
Department of Otolaryngology-Head and Neck Surgery, Children's National Medical Center, George Washington University, Washington, DC, USA.
Milmoe
G J
GJ
Dinndorf
P A
PA
Quinones
R R
RR
D000293:Adolescent; D000328:Adult; D000666:Amphotericin B / Q000627:therapeutic use; D000935:Antifungal Agents / Q000627:therapeutic use; D001228:Aspergillosis / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000601:surgery; D001706:Biopsy; D016026:Bone Marrow Transplantation / Q000009:adverse effects; D002648:Child; D002675:Child, Preschool; D003646:Debridement; D005260:Female; D005500:Follow-Up Studies; D005544:Forecasting; D006801:Humans; D016867:Immunocompromised Host; D015994:Incidence; D007223:Infant; D007938:Leukemia / Q000628:therapy; D008297:Male; D009666:Nose / Q000382:microbiology; D011183:Postoperative Complications; D011859:Radiography; D012189:Retrospective Studies; D012852:Sinusitis / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000382:microbiology* / Q000601:surgery; D016896:Treatment Outcome
D000935:Antifungal Agents; D000666:Amphotericin B