Department of Otolaryngology Head and Neck Surgery, 36632Rabin Medical Center, Petah Tikva, Israel.
Sackler Faculty of Medicine, 26745Tel Aviv University, Tel Aviv, Israel.
Am J Rhinol Allergy. 2022 Sep;36(5):568-573. doi: 10.1177/19458924221090915. Epub 2022 Mar 31.
Acute invasive fungal rhinosinusitis has been associated with high mortality rates.
We aimed to explore the contribution of novel detection and treatment methods on the outcome of immunosuppressed children with acute invasive fungal rhinosinusitis.
The records of all children with a hematologic or oncologic disease who developed acute invasive fungal rhinosinusitis between 2005-2020 were reviewed.
Thirty-four patients were included. Aspergillosis and mucormycosis were diagnosed in 20 patients (59%) and 12 patients (35%), respectively. Panfungal polymerase chain reaction (PCR) was associated with a change of treatment in 36% of patients. A more aggressive surgical approach as well as treatment with liposomal amphotericin B and novel antifungals were adopted in recent years. Overall, 26% of patients died of disease, however no disease-specific death occurred since 2012. Diagnosis using panfungal PCR ( .04) and treatment with novel antifungal medications ( .017) were significantly associated with disease-specific survival.
Enhanced fungal detection using panfungal PCR and treatment with novel antifungal agents, combined with rapid diagnosis and treatment, aggressive surgical approach and better control over the underlying oncological disease, may significantly improve the outcome of immunosuppressed children with acute invasive fungal rhinosinusitis.
急性侵袭性真菌性鼻-鼻窦炎与高死亡率相关。
我们旨在探讨新型检测和治疗方法对免疫抑制儿童急性侵袭性真菌性鼻-鼻窦炎结局的影响。
回顾了 2005 年至 2020 年间所有患有血液系统或肿瘤疾病并发生急性侵袭性真菌性鼻-鼻窦炎的儿童的记录。
共纳入 34 例患者。20 例（59%）和 12 例（35%）患者分别诊断为曲霉菌病和毛霉菌病。全真菌聚合酶链反应（PCR）检测可使 36%的患者改变治疗方案。近年来，我们采取了更积极的手术方法以及使用脂质体两性霉素 B 和新型抗真菌药物进行治疗。总体而言，26%的患者死于疾病，但自 2012 年以来未发生与疾病相关的死亡。使用全真菌 PCR 检测（ .04）和新型抗真菌药物治疗（ .017）与疾病特异性生存显著相关。
使用全真菌 PCR 增强真菌检测，并使用新型抗真菌药物治疗，结合快速诊断和治疗、积极的手术方法以及更好地控制基础肿瘤疾病，可能显著改善免疫抑制儿童急性侵袭性真菌性鼻-鼻窦炎的结局。
