Acute invasive fungal rhinosinusitis in pediatric patients with oncohematological diseases

Rodrigues, Lorrane Caroline Braga; Guimaraes, Alessandro Fernandes; Oliveira, Isamara Simas de; Sousa, Pedro Henrique Medici de; Romanelli, Roberta Maia de Castro; Kakehasi, Fabiana Maria; Rodrigues, Karla Emília de Sá

doi:10.1016/j.htct.2020.08.016

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Hematology, Transfusion and Cell Therapy

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Original article • Hematol., Transfus. Cell Ther. 44 (1) • Jan-Mar 2022 • https://doi.org/10.1016/j.htct.2020.08.016 copy

Acute invasive fungal rhinosinusitis in pediatric patients with oncohematological diseases

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Introduction

Invasive fungal diseases represent important causes of morbidity and mortality among pediatric oncohematological patients. Acute invasive fungal rhinosinusitis is a rare and aggressive disease that occurs mainly in immunocompromised patients. The mortality rate is high and therefore, accurate and early diagnosis is essential.

Objectives

The aim of this study was to describe the frequency of acute invasive fungal rhinosinusitis among pediatric oncohematological patients and characterize them with confirmed diagnoses.

Methods

This was a retrospective study that analyzed the medical records of pediatric patients diagnosed with oncohematological diseases and suspected fungal infections, who were included after obtaining informed consent, from January to December 2017, in the pediatric unit of a tertiary university hospital. Data collected from medical record analysis included the following: underlying diagnosis, absolute neutrophil count, clinical presentation, culture and biopsy results, surgical procedures performed, survival and mortality.

Results

A total of 27 patients were evaluated, with three suspected cases of acute invasive fungal rhinosinusitis. Histopathological and microbiological analyses confirmed two cases. In both cases, the pathogen isolated in the culture was Fusarium sp. The two confirmed cases were female, aged 12 and 14 years, both with an absolute neutrophil count of 10 cells/μL. The underlying disease of the first patient was acute myeloid leukemia (subtype M5), whereas the second patient presented idiopathic bone marrow aplasia.

Conclusion

Both confirmed cases of acute invasive fungal rhinosinusitis presented with constitutional symptoms and signs of nasal and sinusital inflammation. This demonstrates the importance of fever as a symptom in immunocompromised patients and it should prompt otorhinolaryngological investigation.

Keywords
Pediatrics; Hematologic diseases; Febrile neutropenia; Invasive fungal infection; Fusarium

Patient	Age	Sex	Diagnosis	Number of ORL evaluations	Main reason for the evaluation	ORL symptoms	ORL evaluation findings	CRP mg/L	Absolute neutrophil count (cells × 10³/μL)	Platelet count (×10³/μL)	GMN^a a GALACTOMANNAN, ANTIGENO ASPERGILLUS, Method: Enzyme Immunoassay (ELISA), REFERENCE VALUES: NEGATIVE SERUM: less than 0.5. at the ORL evaluation	Outcome
1	12	Female	AML; AIFRS	11	Fever persistence or recurrence and ORL symptoms	Rhinorrhea	Paleness and crusting of septum and middle turbinate	135	0,01	63	NP	Infection resolved
2	14	Female	BMA; AIFRS	3	Fever persistence or recurrence and ORL symptoms	Crusting	Paleness, Crusting, and Necrosis of Septum and Inferior turbinate	414	0,01	29	4.12	Death
3	1	Male	AML	1	Fever persistence or recurrence	No	Normal	170.72	0,03	15	0,13	Discharged by the ORL clinic
4	16	Male	NHL	2	ORL symptoms	Rhinorrhea, posterior nasal discharge and cough	Normal	NP	6,170	177	NP	Discharged by the ORL clinic
5	8	Male	NHL	4	Fever persistence or recurrence	No	Paleness of the middle turbinate	89.36	0	36	0.39	Discharged by the ORL clinic
6	5	Male	RMS	2	Fever persistence or recurrence	No	NP	34.97	0,06	355	NP	Discharged by the ORL clinic
7	10	Female	RMS	2	Fever persistence or recurrence	No	Normal	NP	0,13	416	0.5	Discharged by the ORL clinic
8	14	Male	ALL	2	Fever persistence or recurrence and ORL symptoms	Cough	Paleness of the middle turbinate and nasal septum	383.41	0,01	8	NP	Death
9	12	Male	Fanconi’s anemia	1	Fever persistence or recurrence and ORL symptoms	Rhinorrhea, nasal congestion and nasal sinus pain	NP	NP	8,33	16	NP	Discharged by the ORL clinic
10	15	Male	ALL	1	Fever persistence or recurrence	No	NP	168.19	0	37	NP	Infection resolved
11	13	Male	AML	1	ORL symptoms	Cough	Normal	NP	0,98	324	NP	Discharged by the ORL clinic
12	7	Female	MDS	1	ORL symptoms	Rhinorrhea, nasal congestion, cough and nasal sinus pain	Normal	NP	0,280	27	NP	Discharged by the ORL clinic
13	7	Male	ALL	3	Fever persistence or recurrence and ORL symptoms	Rhinorrhea, cough and headache	Hyalin secretion on nasal floor	321.51	0,050	31	0.09	Discharged by the ORL clinic
14	8	Male	ALL	5	Fever persistence or recurrence4and ORL symptoms	Rhinorrhea, nasal congestion and cough	Bilateral mucoid secretion and crusts On the left nasal septum	226.15	0,020	29	3.2	Death
15	15	Female	MDS	1	Fever persistence or recurrence and ORL symptoms	Rhinorrhea, nasal congestion and nasal sinus pain	Mucosal edema and hyalin secretion on nasal floor	87.03	1,740	97	NP	Discharged by the ORL clinic
16	5	Male	ALL	1	Fever persistence or recurrence and ORL symptoms	Rhinorrhea and cough	Hyalin secretion on nasal floor and congestion of the inferior turbinate	187.19	0,550	240	0.33	Discharged by the ORL clinic
17	5	Female	MDS	1	Fever persistence or recurrence and ORL symptoms	Rhinorrhea, cough and headache	Hyalin secretion on the middle turbinate	46.68	0,038	429	NP	Discharged by the ORL clinic
18	10	Female	NBL	1	Fever persistence or recurrence and ORL symptoms	Rhinorrhea and cough	NP	43.45	0,01	22	NP	Discharged by the ORL clinic
19	14	Female	ALL	1	Fever persistence or recurrence and ORL symptoms	No	Normal	NP	0,19	34	NP	Discharged by the ORL clinic
20	14	Male	NHL	1	ORL symptoms	Rhinorrhea, nasal congestion, cough, nasal sinus pain and sneezing	Hyalin secretion on nasal floor and congestion of the Inferior turbinate	78.07	4,7	371	NP	Discharged by the ORL clinic
21	12	Male	AML	1	ORL symptoms	Rhinorrhea and cough	Hyalin secretion on the middle meatus and congestion of the inferior turbinate	NP	0,470	20	NR	Discharged by the ORL clinic
22	13	Female	Fanconi’s anemia	2	Fever persistence or recurrence and ORL symptoms	Cough	NP	168.67	0,06	1	NP	Death
23	7	Female	AML	2	Fever persistence or recurrence and ORL symptoms	Nasal congestion, cough, nasal sinus pain	Normal	248.7	0,05	13	0,13	Discharged by the ORL clinic
24	10	Female	BMA	7	Fever persistence or recurrence and ORL symptoms	Cough	Normal	147.42	0	7	0.11	Discharged by the ORL clinic
25	14	Female	AML	12	Fever persistence or recurrence and ORL symptoms; previous RSFIA	Nasal bleeding	Diffuse pallor, hematic crust on nasal floor	NP	0,02	36	NP	Discharged by the ORL clinic
26	16	Female	LNH	2	ORL symptoms	Rhinorrhea, posterior nasal Discharge and sneezing	Purulent secretion in right middle meatus	20.83	2,470	248	NP	Discharged by the ORL clinic
27	3	Male	BMA	1	Fever persistence or recurrence	No	Normal	155.67	0,07	16	NP	Discharged by the ORL clinic

Associação Brasileira de Hematologia, Hemoterapia e Terapia Celular (ABHH) R. Dr. Diogo de Faria, 775 cj 133, 04037-002, São Paulo / SP - Brasil - São Paulo - SP - Brazil
E-mail: htct@abhh.org.br

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[1] *Corresponding author at: Hospital das Clínicas da Universidade Federal Minas Gerais (HC UFMG), Belo Horizonte, MG, Brazil. E-mail address: karlaemilia@ufmg.br (K.E. de Sá Rodrigues).