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

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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.

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Authors and Affiliations

  1. University of Texas Southwestern Medical Center, Dallas, TX, USA

    Shannon M. Cohn, Jane D. Siegel, Jeannie Kwon, Charles F. Timmons & Naomi J. Winick

  2. Children’s Blood and Cancer Center, Dell Children’s Medical Center of Central Texas, 1301 Barbara Jordan Blvd, Suite 401, Austin, TX, 78723, USA

    Shannon M. Cohn

  3. University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA

    Hanumantha R. Pokala

  4. Children’s Medical Center of Dallas, Dallas, TX, USA

    John E. McClay & David Leonard

Authors
  1. Shannon M. Cohn
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  2. Hanumantha R. Pokala
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  3. Jane D. Siegel
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  4. John E. McClay
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  5. David Leonard
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  6. Jeannie Kwon
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  7. Charles F. Timmons
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  8. Naomi J. Winick
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Correspondence to Shannon M. Cohn.

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The authors declare that they have no conflict of interest.

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Cohn, S.M., Pokala, H.R., Siegel, J.D. et al. Application of a standardized screening protocol for diagnosis of invasive mold infections in children with hematologic malignancies. Support Care Cancer 24, 5025–5033 (2016). https://doi.org/10.1007/s00520-016-3367-z

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  • DOI: https://doi.org/10.1007/s00520-016-3367-z

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