Pediatric Invasive Fungal Rhinosinusitis: A Comprehensive Analysis of Prognostic Factors for Survival.

Abstract

Pediatric invasive fungal rhinosinusitis (IFS) is a devastating infection that manifests almost exclusively in immunocompromised children. The goal of this work was to determine which clinical features carry prognostic value for survival. A retrospective review of children with a histopathological diagnosis of IFS was performed at an academic tertiary care institution from 1990 to 2021. Clinical variables were collected to generate survival and life-table estimators at 6-months and 1-year. Eighteen patients were included in this analysis, with a mean age of 9.8 years (range, 1-17 years). Most children were neutropenic (n=15, 83.3%), with acute lymphoblastic leukemia (n=10, 55.6%) representing the most common primary diagnosis. A mean of 3.2 operations (range 1-7 operations) was performed per patient for either mucormycosis (n=10, 55.6%) or aspergillosis (n=8, 44.4%). The mean time to absolute neutrophil count recovery was 65.8 days (range 20-137 days), with a 6-month and 1-year survival rate of 47.6% and 41.7%, respectively. Gross total resection (p=0.006, p < 0.001), number of antifungals (p=0.0004, p=0.0003), and total operation number (p=0.0032, p=0.0035), served as positive prognostic factors for 6-month and 1-year survival. Conversely, altered mental status (p=0.0026), cerebral involvement (p=0.0010), cranial neuropathies (p < 0.0001), hyperglycemia (p=0.0445, p=0.0208), and intensive care unit status (p=0.0013) served as negative prognostic factors for 6-month and 1-year survival. Several key elements were identified and found to play a vital role in influencing survival for pediatric IFS. Early diagnosis, prompt medical therapy, and aggressive surgical intervention remain at the forefront in the treatment of this complex opportunistic infection. 4 Laryngoscope, 133:1239-1250, 2023.