Changing trends in the survival of immunosuppressed children with
invasive fungal rhinosinusitis: a retrospective observational cohort
study
Abstract
Objectives: 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. Design:
Retrospective observational cohort study. Setting: A tertiary children’s
hospital. Participants: The records of all children with a hematologic
or oncologic disease who developed AIFR between 2005-2020 were reviewed.
Results: 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. Aggressive
surgical approach was adopted and 71% of the patients underwent
multiple surgical procedures. Overall, 26% of patients died of disease,
however no disease-specific death occurred since 2012. Diagnosis using
panfungal PCR (p=.04) and treatment with novel antifungal medications
(p=.017) were significantly associated with disease-specific survival.
Conclusions: 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.