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Methods: We performed a retrospective review of all children who underwent HSCT at our institution from January 2011 until June 2014. Children were identified who underwent nasal endoscopy after a minimum of three days of fever despite the initiation of broad-spectrum antibiotics and who had negative bacterial blood cultures. The results of the endoscopy and any cultures obtained were reviewed. Demographic, clinical, microbiologic, management and outcome data were collected.
Results: A total of 44 nasal endoscopies were performed in 42 children. Three of the children had positive nasal endoscopies. Two were asymptomatic and were found to have suspicious lesions which were subsequently biopsied. These were found to be positive for Fusarium spp and Rhizopus spp. The third had rapid development of eye swelling and sinus pain and was found to have Rhizopus spp. The three children were then treated with aggressive serial debridement and initiation of multiagent antifungal therapy. All three of the children survived their fungal infection although one remains on antifungal therapy. Mild discomfort during the procedure was the only adverse event related to the use of endoscopy reported in this patient group. In those with a negative endoscopy, there were no children who subsequently developed fungal sinus disease. Three of these patients were later identified with a fungal infection at other sites: one had bipolaris spp of the skin, one had Aspergillus flavus isolated from an endotracheal tube aspirate and one had disseminated Histoplasmosis capsulatum isolated on post-mortem examination.
Conclusions: We conclude that nasal endoscopy is safe and effective in the evaluation of pediatric HSCT patients as part of the evaluation of prolonged fever to rule out fungal sinusitis. Early detection of fungal sinusitis by nasal endoscopy and aggressive surgical and antifungal therapy may improve the survival of HSCT patients.