title: Application of a standardized screening protocol for diagnosis of invasive mold infections in children with hematologic malignancies.
abstract: This study describes a standardized screening protocol for diagnosis of invasive mold infections in pediatric oncology patients with neutropenia and prolonged or recurrent fever.
  
  
  
  A retrospective chart review was performed of children receiving intensive chemotherapy for hematologic malignancies who developed invasive mold infections from 2004 to 2011. Characteristics and outcomes were compared before and after implementation of the screening protocol in November 2006. The screen includes direct nasal endoscopy performed at the bedside by an otorhinolaryngologist, noncontrast computed tomography (CT) of the chest, and abdominal ultrasound in patients with neutropenia and prolonged or recurrent fever.
  
  
  
  Fifty patients had proven, probable, or possible invasive mold infections. Before routine use of direct nasal endoscopy, invasive nasosinal disease was detected in 5 of 19 patients (26 %) and all had a compatible clinical presentation. Thirteen of 31 patients (42 %) in the post-screen group had nasosinal disease, and fever was the only sign for 8 patients (62 %). Twenty-four patients with nasosinal disease had a sinus CT, and radiologic findings of bony erosion or peri-sinus invasion were never detected. Eight of 19 patients in the pre-screen group died from mold infection (42.1 %) versus 4 of 31 (12.9 %) in the post-screen group (p = 0.04).
  
  
  
  A screening protocol including direct nasal endoscopy, noncontrast chest CT, and abdominal ultrasound was effective in detecting invasive mold infections in at-risk patients. Nasosinal involvement often occurs before specific symptoms develop, and sinus CTs are insensitive and nonspecific. Bedside nasal endoscopy precludes radiation exposure associated with sinus CT and was associated with decrease in mold-related mortality, likely due to earlier diagnosis and initiation of appropriate antifungal therapy.
authors: University of Texas Southwestern Medical Center, Dallas, TX, USA. shannonmitch@gmail.com.|Children's Blood and Cancer Center, Dell Children's Medical Center of Central Texas, 1301 Barbara Jordan Blvd, Suite 401, Austin, TX, 78723, USA. shannonmitch@gmail.com.
authors: Shannon M
authors: SM
authors: Cohn
authors: University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA.
authors: Hanumantha R
authors: HR
authors: Pokala
authors: University of Texas Southwestern Medical Center, Dallas, TX, USA.
authors: Jane D
authors: JD
authors: Siegel
authors: Children's Medical Center of Dallas, Dallas, TX, USA.
authors: John E
authors: JE
authors: McClay
authors: Children's Medical Center of Dallas, Dallas, TX, USA.
authors: David
authors: D
authors: Leonard
authors: University of Texas Southwestern Medical Center, Dallas, TX, USA.
authors: Jeannie
authors: J
authors: Kwon
authors: University of Texas Southwestern Medical Center, Dallas, TX, USA.
authors: Charles F
authors: CF
authors: Timmons
authors: University of Texas Southwestern Medical Center, Dallas, TX, USA.
authors: Naomi J
authors: NJ
authors: Winick
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D002985:Clinical Protocols; D064147:Febrile Neutropenia / Q000175:diagnosis*; D005260:Female; D019337:Hematologic Neoplasms / Q000150:complications*; D006801:Humans; D007223:Infant; D008297:Male; D008403:Mass Screening; D009181:Mycoses / Q000150:complications / Q000175:diagnosis*; D012015:Reference Standards; D012189:Retrospective Studies
keywords: Febrile neutropenia; Invasive fungal infections; Pediatric leukemia