This Article  • References  • Full text PDF  • Reply to article  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Contact me when this article is cited  Related Content  • Similar articles in this journal  Social Bookmarking   What's this?

Evaluation and Management

Sukgi S. Choi, MD; Gregory J. Milmoe, MD; Patricia A. Dinndorf, MD; Ralph R. Quinones, MD

Arch Otolaryngol Head Neck Surg. 1995;121(10):1188-1192.

Abstract
Objectives
To evaluate the following: the incidence of invasive Aspergillus sinusitis (AS); the value of surveillance nasal cultures and screening radiologic studies in predicting AS; the clinical criteria used to decide on surgical biopsy in patients suspected of having AS; the surgical and medical management of AS; and the outcome of AS in the peritransplantation period of children who underwent bone marrow transplantation.

Design
Retrospective medical chart review.

Setting
Tertiary care children's hospital.

Patients
Eighty pediatric patients who underwent bone marrow transplantation for a variety of refractory malignant neoplasms or lymphohematopoietic disorders at the Children's National Medical Center, Washington, DC, from April 1, 1988, to September 30, 1993.

Intervention
Diagnostic surgical biopsies, surgical débridement, and treatment with amphotericin B.

Main Outcome Measure
Resolution of AS and discharge from the hospital.

Results
Seventy-two patients had screening sinus radiographs, 27 of which showed abnormalities. Aspergillus sinusitis developed in three of the patients with abnormal screening radiographs. Fifty-eight patients had screening nasal cultures. One culture was positive for Aspergillus, and histopathologically proved AS developed in this patient. Twelve diagnostic biopsies were done in nine patients. Three biopsy specimens showed histopathologic evidence of AS. The three patients with AS were successfully treated with aggressive surgical and medical therapy and were discharged from the hospital.

Conclusion
The incidence of AS was 4% (3/80) in the patients who underwent bone marrow transplantation. Screening radiographs, while not a good predictor of AS, have a role in evaluation of patients undergoing bone marrow transplantation to define preexisting sinus disease. Screening nasal cultures do not reliably predict AS. When AS is suspected and diagnostic biopsy is considered, the seven clinical criteria outlined in this article should be used. Survival of immunocompromised patients with AS requires early diagnosis and aggressive surgical and medical therapy.

(Arch Otolaryngol Head Neck Surg. 1995;121:1188-1192)

Author Affiliations
From the Departments of Otolaryngology—Head and Neck Surgery (Drs Choi and Milmoe) and Hematology-Oncology (Drs Dinndorf and Quinones), Children's National Medical Center, George Washington University, Washington, DC.

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Fungal Mastoiditis in Immunocompromised Children
Slack et al.
Arch Otolaryngol Head Neck Surg 1999;125:73-75.
ABSTRACT | FULL TEXT  

An Approach to Fulminant Invasive Fungal Rhinosinusitis in the Immunocompromised Host
Gillespie et al.
Arch Otolaryngol Head Neck Surg 1998;124:520-526.
ABSTRACT | FULL TEXT  

A New Classification and Diagnostic Criteria for Invasive Fungal Sinusitis
deShazo et al.
Arch Otolaryngol Head Neck Surg 1997;123:1181-1188.
ABSTRACT