INVASIVE ASPERGILLUS SINUSITIS IN PEDIATRIC BONE-MARROW TRANSPLANT PATIENTS - EVALUATION AND MANAGEMENT

Objectives: To evaluate the following: the incidence of invasive Asper gillus: sinusitis (AS); the value of surveillance nasal cultures and s creening radiologic studies in predicting AS; the clinical criteria us ed to decide on surgical biopsy in patients suspected of having AS; th e surgical and medical management of AS; and the outcome of AS in the peritransplantation period of children who underwent bone marrow trans plantation. Design: Retrospective medical chart review. Setting: Terti ary care children's hospital. Patients: Eighty pediatric patients who underwent bone marrow transplantation for a variety of refractory mali gnant neoplasms or lymphohematopoietic disorders at the Children's Nat ional Medical Center, Washington, DC, from April 1, 1988, to September 30, 1993. Intervention: Diagnostic surgical biopsies, surgical debrid ement, and treatment with amphotericin B. Main Outcome Measure: Resolu tion of AS and discharge from the hospital. Results: Seventy-two patie nts had screening sinus radiographs, 27 of which showed abnormalities. Aspergillus sinusitis developed in three of the patients with abnorma l screening radiographs. Fifty-eight patients had screening nasal cult ures. One culture was positive for Aspergillus, and histopathologicall y 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 w ith aggressive surgical and medical therapy and were discharged from t he hospital. Conclusion: The incidence of AS was 4% (3/80) in the pati ents who underwent bone marrow transplantation. Screening radiographs, while not a good predictor of AS, have a role in evaluation of patien ts 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 c riteria outlined in this article should be used. Survival of immunocom promised patients with AS requires early diagnosis and aggressive surg ical and medical therapy.