Invasive Aspergillus Rhinosinusitis in Patients with Acute Leukemia

Invasive aspergillus rhinosinusitis is a potentially lethal complication of chemotherapy-induced neutropenia in patients with acute leukemia. The majority of cases are caused by Aspergillus flavus. The infection is difficult to diagnose early but should be suspected when a neutropenic patient develo...

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Bibliographic Details
Published in:Reviews of infectious diseases 1991-03, Vol.13 (2), p.219-232
Main Authors: TALBOT, G. H, HUANG, A, PROVENCHER, M
Format: Article
Language:English
Subjects:
Acute Disease
Adult
Aged
Amphotericin B - therapeutic use
Antifungals
Aspergillosis
Aspergillosis - diagnosis
Aspergillosis - drug therapy
Aspergillosis - etiology
Aspergillus
Aspergillus flavus - isolation & purification
Aspergillus niger - isolation & purification
Biological and medical sciences
Clinical Infectious Disease Articles
Female
Fever
Fungal infections
Hematologic and hematopoietic diseases
Humans
Infections
Leukemia
Leukemia - complications
Leukemias. Malignant lymphomas. Malignant reticulosis. Myelofibrosis
Lung diseases
Male
Medical sciences
Middle Aged
Nasal Mucosa - microbiology
Nasal Mucosa - pathology
Neutropenia - chemically induced
Neutropenia - complications
Rhinitis - diagnosis
Rhinitis - drug therapy
Rhinitis - etiology
Sinuses
Sinusitis
Sinusitis - diagnosis
Sinusitis - drug therapy
Sinusitis - etiology
Tomography, X-Ray Computed
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Summary:Invasive aspergillus rhinosinusitis is a potentially lethal complication of chemotherapy-induced neutropenia in patients with acute leukemia. The majority of cases are caused by Aspergillus flavus. The infection is difficult to diagnose early but should be suspected when a neutropenic patient develops persistent fever without a known source, symptoms of rhinitis or sinusitis, cutaneous findings over the nose or sinuses, symptoms and signs of orbital or cavernous sinus disease, or an ulcerating lesion of the hard palate or gingiva. Careful anterior rhinoscopy followed by computed tomography of the sinus helps establish the diagnosis, which should be confirmed by histologic study and culture of biopsied material. Early treatment with aggressive surgery, high-dose amphotericin B and 5-fluorocytosine, and possibly white blood cell transfusions may produce a cure if the patient's bone marrow recovers. Newer antifungal agents offer promise for prophylaxis and treatment of this infection.
ISSN:0162-0886