Mulvey Carolyn L, Rizzi Mark D, Buzi Adva
Department of Otorhinolaryngology, Head and Neck Surgery, University of Pennsylvania, Philadelphia, PA, 19104, USA.
Division of Otolaryngology, Children's Hospital of Philadelphia, Philadelphia, PA, 19104, USA.
Int J Pediatr Otorhinolaryngol. 2018 Dec;115:82-88. doi: 10.1016/j.ijporl.2018.09.019. Epub 2018 Sep 19.
Invasive fungal sinusitis (IFS) is a rare but deadly clinical entity that occurs in immunocompromised patients. Diagnosis in children typically requires operative biopsies under general anesthesia, which has associated risks. Findings on bedside nasal endoscopy (BNE) can be used with history, exam, and imaging to determine the need for surgery, however, the accuracy of this tool has not been established among pediatric patients.
Patients who underwent BNE for evaluation of IFS from 2008 to 2016 at the Children's Hospital of Philadelphia were identified using Current Procedural Terminology (CPT) codes. Retrospective chart analysis was performed and included underlying diagnoses, presenting signs and symptoms, imaging findings, endoscopic findings and outcomes.
Nineteen patients were identified who underwent evaluation for IFS using BNE during the period studied. Eight patients had exam findings that were concerning for IFS, including debris or crusting, darkened or pale mucosa, or copious, thick and/or purulent secretions. Immediate operative biopsies and debridement revealed IFS in six of eight patients. Eleven patients had exam findings deemed not concerning for IFS including mucosal edema, mucous without purulence, or normal findings. Six of eleven patients underwent operative biopsy despite negative endoscopy, and five were observed clinically. None of the 11 patients with negative bedside endoscopy developed IFS.
All patients with IFS had concerning exam findings on endoscopy and were treated with immediate biopsies and debridement. No patient with normal or non-concerning findings on BNE progressed to have invasive fungal sinusitis. While suspicion for IFS in immunocompromised children must remain high, BNE is feasible and useful in its assessment.
侵袭性真菌性鼻窦炎（IFS）是一种罕见但致命的临床病症，发生于免疫功能低下的患者。儿童的诊断通常需要在全身麻醉下进行手术活检，这存在相关风险。床边鼻内镜检查（BNE）的结果可与病史、体格检查和影像学检查相结合，以确定是否需要手术，然而，该工具在儿科患者中的准确性尚未得到证实。
使用当前操作术语（CPT）编码确定2008年至2016年在费城儿童医院接受BNE评估IFS的患者。进行回顾性病历分析，包括基础诊断、临床表现和症状、影像学检查结果、内镜检查结果及治疗结果。
在研究期间，共确定19例接受BNE评估IFS的患者。8例患者的检查结果提示可能为IFS，包括碎屑或结痂、黏膜变黑或苍白，或大量、浓稠和/或脓性分泌物。立即进行的手术活检和清创显示，8例患者中有6例为IFS。11例患者的检查结果被认为与IFS无关，包括黏膜水肿、无脓性黏液或正常表现。尽管内镜检查结果为阴性，但11例患者中有6例接受了手术活检，5例进行了临床观察。11例床边内镜检查结果为阴性的患者均未发生IFS。
所有IFS患者的内镜检查结果均提示异常，并立即接受了活检和清创治疗。BNE检查结果正常或无异常的患者均未进展为侵袭性真菌性鼻窦炎。虽然对免疫功能低下儿童的IFS怀疑度必须保持较高，但BNE在评估中是可行且有用的。
