title: Invasive fungal sinusitis in patients with hematological malignancy: 15 years experience in a single university hospital in Taiwan.
abstract: BACKGROUND
  Risk factors and outcomes in hematological patients who acquire invasive fungal sinusitis (IFS) are infrequently reported in the modern medical era.
  
  
  METHODS
  A retrospective study of hospitalized patients with hematological disease was conducted at National Taiwan University Hospital between January 1995 and December 2009.
  
  
  RESULTS
  Clinical characteristics and outcomes with their associated radiographic and microbiological findings were analyzed. Forty-six patients with IFS and 64 patients with chronic non-invasive sinusitis were enrolled as comparsion. IFS developed more commonly in patients with acute myeloid leukemia (AML) and with prolonged neutropenia (absolute neutrophil count less than 500/mm³ for more than 10 days) (p < 0.001). Aspergillus flavus was the most common pathogen isolated (44%). Serum Aspergillus galactomannan antigen was elevated in seven of eleven patients (64%) with IFS caused by aspergillosis but negative for all three patients with mucormycosis. Bony erosion and extra-sinus infiltration was found in 15 of 46 (33%) patients on imaging. Overall, 19 of 46 patients (41.3%) died within 6 weeks. Patients with disease subtype of AML (p = 0.044; Odds Ratio [OR], 5.84; 95% confidence interval [95% CI], 1.02-30.56) and refractory leukemia status (p = 0.05; OR, 4.27; 95% CI, 1.003-18.15) had worse prognosis. Multivariate analysis identified surgical debridement as an independent good prognostic factor (p = 0.047) in patients with IFS.
  
  
  CONCLUSIONS
  Patients of AML with prolonged neutropenia (> 10 days) had significantly higher risk of IFS. Early introduction of anti-fungal agent and aggressive surgical debridement potentially decrease morbidity and mortality in high risk patients with IFS.
authors.affiliation: Department of Internal Medicine, Division of Hematology, National Taiwan University Hospital, Taipei, Taiwan.
authors.forename: Chien-Yuan
authors.initials: CY
authors.lastname: Chen
authors.forename: Wang-Huei
authors.initials: WH
authors.lastname: Sheng
authors.forename: Aristine
authors.initials: A
authors.lastname: Cheng
authors.forename: Yee-Chun
authors.initials: YC
authors.lastname: Chen
authors.forename: Woei
authors.initials: W
authors.lastname: Tsay
authors.forename: Jih-Luh
authors.initials: JL
authors.lastname: Tang
authors.forename: Shang-Yi
authors.initials: SY
authors.lastname: Huang
authors.forename: Shan-Chwen
authors.initials: SC
authors.lastname: Chang
authors.forename: Hwei-Fang
authors.initials: HF
authors.lastname: Tien
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005658:Fungi / Q000145:classification / Q000302:isolation & purification; D019337:Hematologic Neoplasms / Q000150:complications*; D006785:Hospitals, University; D006801:Humans; D016867:Immunocompromised Host; D008297:Male; D008875:Middle Aged; D009181:Mycoses / Q000453:epidemiology* / Q000382:microbiology / Q000401:mortality / Q000473:pathology; D012189:Retrospective Studies; D018570:Risk Assessment; D012852:Sinusitis / Q000453:epidemiology* / Q000382:microbiology / Q000401:mortality / Q000473:pathology; D013624:Taiwan / Q000453:epidemiology