Invasive fungal sinusitis in patients with hematological malignancy: 15 years experience in a single university hospital in Taiwan
Journal
BMC Infectious Diseases
Journal Volume
11
Pages
250
Date Issued
2011
Abstract
Background: Risk factors and outcomes in hematological patients who acquire invasive fungal sinusitis (IFS) are infrequently reported in the modern medical era.Method: A retrospective study of hospitalized patients with hematological disease was conducted at National Taiwan University Hospital between January 1995 and December 2009.Results: Clinical characteristics and outcomes with their associated radiographic and microbiological findings were analyzed. Forty-six patients with IFS and 64 patients with chronic non-invasive sinusitis were enrolled as comparsion. IFS developed more commonly in patients with acute myeloid leukemia (AML) and with prolonged neutropenia (absolute neutrophil count less than 500/mm3for more than 10 days) (p < 0.001). Aspergillus flavus was the most common pathogen isolated (44%). Serum Aspergillus galactomannan antigen was elevated in seven of eleven patients (64%) with IFS caused by aspergillosis but negative for all three patients with mucormycosis. Bony erosion and extra-sinus infiltration was found in 15 of 46 (33%) patients on imaging. Overall, 19 of 46 patients (41.3%) died within 6 weeks. Patients with disease subtype of AML (p = 0.044; Odds Ratio [OR], 5.84; 95% confidence interval [95% CI], 1.02-30.56) and refractory leukemia status (p = 0.05; OR, 4.27; 95% CI, 1.003-18.15) had worse prognosis. Multivariate analysis identified surgical debridement as an independent good prognostic factor (p = 0.047) in patients with IFS.Conclusions: Patients of AML with prolonged neutropenia (> 10 days) had significantly higher risk of IFS. Early introduction of anti-fungal agent and aggressive surgical debridement potentially decrease morbidity and mortality in high risk patients with IFS. ? 2011 Chen et al; licensee BioMed Central Ltd.
SDGs
Other Subjects
amphotericin B; amphotericin B lipid complex; antineoplastic agent; caspofungin; fungus antigen; galactomannan; voriconazole; acute granulocytic leukemia; adult; article; Aspergillus flavus; bone erosion; cancer classification; cancer mortality; chronic sinusitis; clinical assessment; controlled study; debridement; disease association; disease duration; drug megadose; female; fungal sinusitis; fungus isolation; high risk patient; hospital patient; human; infection risk; invasive aspergillosis; low drug dose; major clinical study; male; mucormycosis; neutropenia; neutrophil count; nonhuman; outcome assessment; prognosis; retrospective study; Taiwan; university hospital; aged; blood disease; classification; fungus; immunocompromised patient; isolation and purification; microbiology; middle aged; mortality; mycosis; pathology; risk assessment; sinusitis; Taiwan; Adult; Aged; Aged, 80 and over; Female; Fungi; Hematologic Neoplasms; Hospitals, University; Humans; Immunocompromised Host; Male; Middle Aged; Mycoses; Retrospective Studies; Risk Assessment; Sinusitis; Taiwan
Type
journal article