Abstract
BackgroundRisk factors and outcomes in hematological patients who acquire invasive fungal sinusitis (IFS) are infrequently reported in the modern medical era.MethodA retrospective study of hospitalized patients with hematological disease was conducted at National Taiwan University Hospital between January 1995 and December 2009.ResultsClinical 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.ConclusionsPatients 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.
Highlights
Risk factors and outcomes in hematological patients who acquire invasive fungal sinusitis (IFS) are infrequently reported in the modern medical era
Patients with disease subtype of acute myeloid leukemia (AML)
The diagnosis of invasive fungal sinusitis was made in 46 patients with hematological disorders, and 64 patients with hematological disorders and chronic non-invasive sinusitis admitted in the same period of time cohort were enrolled as controls
Summary
Risk factors and outcomes in hematological patients who acquire invasive fungal sinusitis (IFS) are infrequently reported in the modern medical era. Chemotherapy is still the current standard treatment for hematological malignancy and febrile neutropenia is a common complication of chemotherapy in most patients [1]. If fever persists 72-96 hours after treatment with broad-spectrum antibacterial antibiotics during neutropenia, invasive fungal infection may be suspected and treated empirically with antifungal agents [1,2,3]. An international consensus on the diagnosis of opportunistic invasive fungal infections in immunocompromised patients with cancer and hematopoietic stem cell transplants was established by the Invasive Fungal Infections Cooperative Group of the European. Organization for Research and Treatment of Cancer (EORTC) and the Mycoses Study Group of the National. Delay in the treatment of invasive fungal infection during neutropenia causes high mortality in patients with transplants and hematological malignancy [4,5,7].
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