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Pediatric invasive fungal rhinosinusitis: An investigation of 17 patients.

Abstract To investigate outcomes of pediatric patients at a single institution with invasive fungal rhinosinusitis (IFRS) and to determine variables that impact overall survival.
PMID
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Authors

Mayor MeshTerms
Keywords

Fungal

IFRS

Invasive

Pediatric

Rhinosinusitis

Sinusitis

Journal Title international journal of pediatric otorhinolaryngology
Publication Year Start




 
PMID- 28688551
OWN - NLM
STAT- MEDLINE
DA  - 20170709
DCOM- 20170803
LR  - 20170803
IS  - 1872-8464 (Electronic)
IS  - 0165-5876 (Linking)
VI  - 99
DP  - 2017 Aug
TI  - Pediatric invasive fungal rhinosinusitis: An investigation of 17 patients.
PG  - 111-116
LID - S0165-5876(17)30219-7 [pii]
LID - 10.1016/j.ijporl.2017.05.015 [doi]
AB  - PURPOSE: To investigate outcomes of pediatric patients at a single institution
      with invasive fungal rhinosinusitis (IFRS) and to determine variables that impact
      overall survival. METHODS: All pediatric patients at a large tertiary children's 
      hospital diagnosed with IFRS confirmed by surgical pathology from 2009 to 2015
      were retrospectively reviewed. Demographics, underlying diseases, symptoms,
      antifungal therapy, absolute neutrophil count (ANC), surgical management,and
      outcomes were analyzed. RESULTS: Seventeen patients were identified with IFRS
      with an average age of 8.7 years and 53% male. Hematologic malignancy was the
      most common (n = 13) underlying disease. The most common presenting symptoms were
      fever (82%) and congestion (41%). 15 patients had severe neutropenia (Absolute
      Neutrophil Count (ANC) < 500) within 2 weeks prior to diagnosis. The average ANC 
      at time of diagnosis was 1420 cells/uL. 16 patients were treated with serial
      nasal endoscopy and debridement, while 1 patient was treated with an open
      approach. 16 received combination antifungals while 1 was treated with
      amphotericin monotherapy. The most common genus cultured was Fusarium (n = 6).
      The average number of surgical interventions was 3.4, with the average interval
      between interventions 6.2 days. 13 of 17 (76%) were cleared of IFRS. Overall
      survival at 6 months was 41%. CONCLUSION: Pediatric IFRS is a life-threatening
      disease that requires a coordinated surgical and medical approach. Despite a
      relatively high local control rate, overall mortality remains disappointingly
      high, reflecting the disease's underlying pathogenesis - lack of host defense and
      risk of disseminated fungal infection. Further investigation is necessary to
      reveal optimal management with regards to antifungal therapy, surgery, and
      utility of labs.
CI  - Copyright (c) 2017 Elsevier B.V. All rights reserved.
FAU - Vinh, Daniel
AU  - Vinh D
AD  - Baylor College of Medicine Department of Otolaryngology-Head & Neck Surgery,
      Houston, TX, USA. Electronic address: [email protected]
FAU - Yim, Michael
AU  - Yim M
AD  - Baylor College of Medicine Department of Otolaryngology-Head & Neck Surgery,
      Houston, TX, USA.
FAU - Dutta, Ankhi
AU  - Dutta A
AD  - Baylor College of Medicine Department of Otolaryngology-Head & Neck Surgery,
      Houston, TX, USA; Texas Children's Hospital Department of Otolaryngology-Head &
      Neck Surgery, Houston, TX, USA.
FAU - Jones, John K
AU  - Jones JK
AD  - Baylor College of Medicine Department of Otolaryngology-Head & Neck Surgery,
      Houston, TX, USA; Texas Children's Hospital Department of Otolaryngology-Head &
      Neck Surgery, Houston, TX, USA.
FAU - Zhang, Wei
AU  - Zhang W
AD  - Texas Children's Hospital Department of Statistics, Houston, TX, USA.
FAU - Sitton, Matthew
AU  - Sitton M
AD  - Baylor College of Medicine Department of Otolaryngology-Head & Neck Surgery,
      Houston, TX, USA; Texas Children's Hospital Department of Otolaryngology-Head &
      Neck Surgery, Houston, TX, USA.
LA  - eng
PT  - Journal Article
DEP - 20170525
PL  - Ireland
TA  - Int J Pediatr Otorhinolaryngol
JT  - International journal of pediatric otorhinolaryngology
JID - 8003603
RN  - 0 (Antifungal Agents)
SB  - IM
MH  - Adolescent
MH  - Antifungal Agents/*therapeutic use
MH  - Child
MH  - Child, Preschool
MH  - Debridement
MH  - Endoscopy
MH  - Female
MH  - Humans
MH  - Infant
MH  - Male
MH  - Mycoses/*diagnosis/mortality/therapy
MH  - Retrospective Studies
MH  - Rhinitis/*microbiology/mortality/therapy
MH  - Sinusitis/*microbiology/mortality/therapy
MH  - Survival Rate
MH  - Young Adult
OTO - NOTNLM
OT  - Fungal
OT  - IFRS
OT  - Invasive
OT  - Pediatric
OT  - Rhinosinusitis
OT  - Sinusitis
EDAT- 2017/07/10 06:00
MHDA- 2017/08/05 06:00
CRDT- 2017/07/10 06:00
PHST- 2017/03/12 [received]
PHST- 2017/05/19 [revised]
PHST- 2017/05/22 [accepted]
AID - S0165-5876(17)30219-7 [pii]
AID - 10.1016/j.ijporl.2017.05.015 [doi]
PST - ppublish
SO  - Int J Pediatr Otorhinolaryngol. 2017 Aug;99:111-116. doi:
      10.1016/j.ijporl.2017.05.015. Epub 2017 May 25.