Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
Supportive Care in Cancer
Published in: Supportive Care in Cancer 12/2016

01-12-2016 | Original Article

Application of a standardized screening protocol for diagnosis of invasive mold infections in children with hematologic malignancies

Authors: Shannon M. Cohn, Hanumantha R. Pokala, Jane D. Siegel, John E. McClay, David Leonard, Jeannie Kwon, Charles F. Timmons, Naomi J. Winick

Published in: Supportive Care in Cancer | Issue 12/2016

Login to get access

Abstract

Purpose

This study describes a standardized screening protocol for diagnosis of invasive mold infections in pediatric oncology patients with neutropenia and prolonged or recurrent fever.

Methods

A retrospective chart review was performed of children receiving intensive chemotherapy for hematologic malignancies who developed invasive mold infections from 2004 to 2011. Characteristics and outcomes were compared before and after implementation of the screening protocol in November 2006. The screen includes direct nasal endoscopy performed at the bedside by an otorhinolaryngologist, noncontrast computed tomography (CT) of the chest, and abdominal ultrasound in patients with neutropenia and prolonged or recurrent fever.

Results

Fifty patients had proven, probable, or possible invasive mold infections. Before routine use of direct nasal endoscopy, invasive nasosinal disease was detected in 5 of 19 patients (26 %) and all had a compatible clinical presentation. Thirteen of 31 patients (42 %) in the post-screen group had nasosinal disease, and fever was the only sign for 8 patients (62 %). Twenty-four patients with nasosinal disease had a sinus CT, and radiologic findings of bony erosion or peri-sinus invasion were never detected. Eight of 19 patients in the pre-screen group died from mold infection (42.1 %) versus 4 of 31 (12.9 %) in the post-screen group (p = 0.04).

Conclusions

A screening protocol including direct nasal endoscopy, noncontrast chest CT, and abdominal ultrasound was effective in detecting invasive mold infections in at-risk patients. Nasosinal involvement often occurs before specific symptoms develop, and sinus CTs are insensitive and nonspecific. Bedside nasal endoscopy precludes radiation exposure associated with sinus CT and was associated with decrease in mold-related mortality, likely due to earlier diagnosis and initiation of appropriate antifungal therapy.
Literature
1.
Rosen GP et al. (2005) Invasive fungal infections in pediatric oncology patients: 11 year experience at a single institution. J Pediatr Hematol Oncol 27(3):135–140CrossRefPubMed
2.
Mor M, Gilad G, Kornreich L, Fisher S, Yaniv I, Levy I (2011) Invasive fungal infections in pediatric oncology. Pediatr Blood Cancer 56:1092–1097CrossRefPubMed
3.
Castagnola et al. Fungal infections in children with cancer. A prospective, multicenter surveillance study. 2006: 25(7):634–39
4.
Kobayashi R, Kaneda M, Sato T, et al. (2008) The clinical feature of invasive fungal infection in pediatric patients with hematologic and malignant diseases. A 10-year analysis at a single institution at Japan. J Pediatr Hematol Oncol 30:886–890CrossRefPubMed
5.
Grigull L et al. (2003) Invasive fungal infections are responsible for one-fifth of the infectious deaths in children with ALL. Mycoses 46:441–446CrossRefPubMed
6.
Groppo E, El-Sayed I, Aiken A, Glastonbury C (2011) Magnetic resonance imaging characteristics of acute invasive fungal sinusitis. Arch Otolaryngol Head Neck Surg. 137(10):1005–1010CrossRefPubMed
7.
DelGaudio JM, Clemson LA (2009) An early detection protocol for invasive fungal sinusitis in neutropenic patients successfully reduces extent of disease at presentation and long term morbidity. Laryngoscope 119:180–183CrossRefPubMed
8.
DelGaudio JM, Swain RE, Kingdom TT, Muller S, Hudgins PA (2003) Computed tomographic findings in patients with invasive fungal sinusitis. Arch Otolaryngol Head Neck Surg 129:236–240CrossRefPubMed
9.
De Pauw B et al. (2008) Revised definitions of invasive fungal disease from the European Organization for Research and Treatment of Cancer/Invasive Fungal Infections Cooperative Group and the National Institute of Allergy and Infectious Diseases Mycoses Study Group (EORTC/MSG) Consensus Group. Clin Infect Dis 46(12):1813–1821CrossRefPubMedPubMedCentral
10.
Park AH, Muntz HR, Smith ME, Afify Z, Pysher T, Pavia A (2005) Pediatric invasive fungal rhinosinusitis in immunocompromised children with cancer. Otolaryngol Head Neck Surg 133:411–416CrossRefPubMed
11.
Lehrnbecher T, Phillips R, Alexander S, Alvaro F, Carlesse F, Fisher B, Hakim H, Sanolaya M, Castagnola E, Davis B, Dupuis L, Gibson F, Groll A, Gaur A, Gupta A, Kebudi R, Petrilli S, Steinbach W, Villarroel M, Zaoutis T, Sung L (2012) Guideline for the management of fever and neutropenia in children with cancer and/or undergoing hematopoietic stem-cell transplantation. J Clin Oncol 30:4427–4438CrossRefPubMed
12.
Rassi SJ, Melkane AE, Rizk HG, Dahoui HA (2009) Sinonasal mucormycosis in immunocompromised pediatric patients. J Pediatr Hematol Oncol 31(12):907–910CrossRefPubMed
13.
Ardeshirpour F et al. (2014) Surgery for pediatric invasive fungal Sinonasal disease. Laryngoscope 124:1008–1012CrossRefPubMed
14.
Milito MA, Kontoyiannis DP, Lewis RE, Liu P, Mawlawi OR, Truong MT, Marom EM (2010) Influence of host immunosuppression on CT findings in invasive pulmonary aspergillosis. Med Mycol 48(6):817–823CrossRefPubMed
15.
Burgos A, Zaoutis TE, Dvorak CC, Hoffman JA, Knapp KM, Nania JJ, Prasad P, Steinbach WJ (2008) Pediatric invasive aspergillosis: a multicenter retrospective analysis of 139 contemporary cases. Pediatrics 121(5):e1286–e1294CrossRefPubMed
16.
Agrawal AK, Saini N, Gildengorin G, Feusner JH (2001) Is routine computed tomography scanning justified in the first week of persistent febrile neutropenia in children with malignancies? Pediatr Blood Cancer 57:620–624CrossRef
17.
Lambert J, MacKenzie JD, Cody D, Gould R (2014) Techniques and tactics for optimizing CT dose in adults and children: state of the art and future advances. J Am Coll Radiol 11:262–266CrossRefPubMed
18.
Raman SP, Johnson PT, Deshmukh S, Mahesh M, Grant KL, Fishman EK (2013) CT dose reduction applications: available tools on the latest generation of CT scanners. J Am Coll Radiol 10:37–41CrossRefPubMed
19.
Nelson TR (2014) Practical strategies to reduce pediatric CT radiation dose. J Am Coll Radiol 11:292–299CrossRefPubMed
20.
Castagnola E, Bagnasco F, Amoroso L, Caviglia I, Caruso S, Faraci M, Cavillo M, Moroni C, Bandettini R, Cangegmi G, Magnano GM, Buffa P, Moscatelli A, Haupt R (2014) Role of management strategies in reducing mortality from invasive fungal disease in children with cancer or receiving hematopoietic stem cell transplant. Pediatr Infect Dis J 33(3):233–237CrossRefPubMed
21.
Wingard JR, Hiemenz JW, Jantz MA (2012) How I manage pulmonary nodular lesions and nodular infiltrates in patients with hematologic malignancies or undergoing hematopoietic stem cell transplantation. Blood 120(9):1791–1800CrossRefPubMed
22.
Franquet T, Rodriguez S, Martino R, Salinas T, Giménez A, Hidalgo A (2005) Human metapneumovirus infection in hematopoietic stem cell transplant recipients: high-resolution computed tomography findings. J Comput Assist Tomogr 29(2):223–227CrossRefPubMed
23.
Franquet T, Müller NL, Giménez A, Martínez S, Madrid M, Domingo P. Infectious pulmonary nodules in immunocompromised patients: usefulness of computed tomography in predicting their etiology. J Comput Assist Tomogr 2003: 27(4): 461–8.
Metadata
Title
Application of a standardized screening protocol for diagnosis of invasive mold infections in children with hematologic malignancies
Authors
Shannon M. Cohn
Hanumantha R. Pokala
Jane D. Siegel
John E. McClay
David Leonard
Jeannie Kwon
Charles F. Timmons
Naomi J. Winick
Publication date
01-12-2016
Publisher
Springer Berlin Heidelberg
Published in
Supportive Care in Cancer / Issue 12/2016
Print ISSN: 0941-4355
Electronic ISSN: 1433-7339
DOI
https://doi.org/10.1007/s00520-016-3367-z

Other articles of this Issue 12/2016

Supportive Care in Cancer 12/2016 Go to the issue

Original Article

Post-treatment problems of African American breast cancer survivors

Original Article

Lymphedema self-care in patients with head and neck cancer: a qualitative study

Original Article

Experiences of colorectal cancer patients in the 2-years post-diagnosis and patient factors predicting poor outcome

Original Article

Evaluation of the perceptions and cosmetic satisfaction of breast cancer patients undergoing totally implantable vascular access device (TIVAD) placement

Original Article

Cost savings of home bortezomib injection in patients with multiple myeloma treated by a combination care in Outpatient Hospital and Hospital care at Home

Original Article

Comparison of oxaliplatin and paclitaxel-induced neuropathy (Alliance A151505)
Webinar | 19-02-2024 | 17:30 (CET)

Keynote webinar | Spotlight on antibody–drug conjugates in cancer

Watch now

Antibody–drug conjugates (ADCs) are novel agents that have shown promise across multiple tumor types. Explore the current landscape of ADCs in breast and lung cancer with our experts, and gain insights into the mechanism of action, key clinical trials data, existing challenges, and future directions.

Dr. Véronique Diéras
Prof. Fabrice Barlesi
Developed by: Springer Medicine
Image Credits