Open Access Highly Accessed Research article

Invasive fungal sinusitis in patients with hematological malignancy: 15 years experience in a single university hospital in Taiwan

Chien-Yuan Chen1, Wang-Huei Sheng2*, Aristine Cheng2, Yee-Chun Chen2, Woei Tsay1, Jih-Luh Tang1, Shang-Yi Huang1, Shan-Chwen Chang2 and Hwei-Fang Tien1

Author Affiliations

1 Departments of Internal Medicine, Division of Hematology, National Taiwan University Hospital, (No. 7 Chung-Shan South Road), Taipei, (100), Taiwan

2 Departments of Internal Medicine, Division of Infectious Disease, National Taiwan University Hospital, (No. 7 Chung-Shan South Road), Taipei, (100), Taiwan

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BMC Infectious Diseases 2011, 11:250  doi:10.1186/1471-2334-11-250

Published: 22 September 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/mm3 for 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.

Keywords:
Invasive fungal sinusitis (IFS) ; hematological disease; Aspergillus galactomanan