title: Invasive fungal sinusitis in the pediatric population: Systematic review with quantitative synthesis of the literature.
abstract: BACKGROUND
  Invasive fungal sinusitis (IFS) represents an often fatal condition within the pediatric population. In an effort to characterize demographics, treatment modalities, and prognostic factors, we performed a systematic review.
  
  
  METHODS
  We systematically reviewed EMBASE, Medline, TRIPdatabase, SCOPUS and the Cochrane database for invasive fungal nasal and sinus infections limited to individuals <18 years of age. Case series including 3 or more patients were included. Demographics, treatment and outcomes were analyzed using R Gui statistical software.
  
  
  RESULTS
  Twelve studies met inclusion criteria (103 patients). There was male preponderance of 48.5% with median age of 11 years old. Majority of patients had underlying leukemia (44.6%). Aspergillus was the predominant organism (47%). Isolated nasal findings occurred in 14% of patients and nasal findings occurred in 49% overall. Absolute neutrophil count (ANC) of immunocompromised patients was below 600 in most patients (99%). Average and median length of neutropenia was 2 weeks. All patients were prescribed amphoterocin with 50% as single medicinal therapy. Surgery occurred in 82.8% of cases. The mortality rate was 46%. Univariate analysis identified presenting with facial pain as a negative predictor of overall mortality (OR 0.296, 95% CI: 0.104-0.843, p < 0.05).
  
  
  CONCLUSIONS
  Mortality remains high in pediatric patients with IFS. An ANC of <600 occurred in the majority of immunocompromised patients at a duration of 2 weeks. Presenting with facial pain was a negative predictor of mortality. Many studies label this condition as invasive fungal sinusitis; however, approximately one seventh presented with only nasal findings and half overall had nasal involvement.
authors.affiliation: Department of Otolaryngology, University of Tennessee Health Science Center, Memphis, TN, USA.
authors.forename: Aaron
authors.initials: A
authors.lastname: Smith
authors.affiliation: Department of Otolaryngology, University of Tennessee Health Science Center, Memphis, TN, USA.
authors.forename: Vikrum
authors.initials: V
authors.lastname: Thimmappa
authors.affiliation: Department of Otolaryngology, University of Mississippi, Jackson, MS, USA.
authors.forename: Brandon
authors.initials: B
authors.lastname: Shepherd
authors.affiliation: University of Memphis, Department of Biostatistics, Memphis, TN, USA.
authors.forename: Meredith
authors.initials: M
authors.lastname: Ray
authors.affiliation: Department of Otolaryngology, University of Tennessee Health Science Center, Memphis, TN, USA.
authors.forename: Anthony
authors.initials: A
authors.lastname: Sheyn
authors.affiliation: Department of Otolaryngology, University of Tennessee Health Science Center, Memphis, TN, USA. Electronic address: jthomp18@uthsc.edu.
authors.forename: Jerome
authors.initials: J
authors.lastname: Thompson
mesh_terms: D000666:Amphotericin B / Q000627:therapeutic use; D000741:Anemia, Aplastic / Q000276:immunology; D000935:Antifungal Agents / Q000627:therapeutic use*; D001228:Aspergillosis / Q000276:immunology / Q000382:microbiology / Q000401:mortality / Q000628:therapy; D002051:Burkitt Lymphoma / Q000276:immunology; D058365:Candidiasis, Invasive / Q000276:immunology / Q000382:microbiology / Q000401:mortality / Q000628:therapy; D002648:Child; D005157:Facial Pain / Q000209:etiology; D005260:Female; D060585:Fusariosis / Q000276:immunology / Q000382:microbiology / Q000401:mortality / Q000628:therapy; D006801:Humans; D016867:Immunocompromised Host; D007938:Leukemia / Q000276:immunology; D008297:Male; D009091:Mucormycosis / Q000276:immunology / Q000382:microbiology / Q000401:mortality / Q000628:therapy; D009181:Mycoses / Q000276:immunology / Q000382:microbiology / Q000401:mortality / Q000628:therapy*; D009503:Neutropenia / Q000276:immunology; D013517:Otorhinolaryngologic Surgical Procedures; D011379:Prognosis; D012189:Retrospective Studies; D012852:Sinusitis / Q000276:immunology / Q000382:microbiology / Q000401:mortality / Q000628:therapy*
chemical_list: D000935:Antifungal Agents; D000666:Amphotericin B
keywords: Aspergillus; Immunocompromised; Invasive fungal sinusitis; Mucormycosis; Otolaryngology; Pediatrics