Acute invasive fungal rhinosinusitis in pediatric patients with oncohematological diseases

Abstract Introduction Invasive fungal diseases represent important causes of morbidity and mortality among pediatric oncohematological patients. Acute invasive fungal rhinosinusitis is a rare and aggressive disease that occurs mainly in immunocompromised patients. The mortality rate is high and therefore, accurate and early diagnosis is essential. Objectives The aim of this study was to describe the frequency of acute invasive fungal rhinosinusitis among pediatric oncohematological patients and characterize them with confirmed diagnoses. Methods This was a retrospective study that analyzed the medical records of pediatric patients diagnosed with oncohematological diseases and suspected fungal infections, who were included after obtaining informed consent, from January to December 2017, in the pediatric unit of a tertiary university hospital. Data collected from medical record analysis included the following: underlying diagnosis, absolute neutrophil count, clinical presentation, culture and biopsy results, surgical procedures performed, survival and mortality. Results A total of 27 patients were evaluated, with three suspected cases of acute invasive fungal rhinosinusitis. Histopathological and microbiological analyses confirmed two cases. In both cases, the pathogen isolated in the culture was Fusarium sp. The two confirmed cases were female, aged 12 and 14 years, both with an absolute neutrophil count of 10 cells/μL. The underlying disease of the first patient was acute myeloid leukemia (subtype M5), whereas the second patient presented idiopathic bone marrow aplasia. Conclusion Both confirmed cases of acute invasive fungal rhinosinusitis presented with constitutional symptoms and signs of nasal and sinusital inflammation. This demonstrates the importance of fever as a symptom in immunocompromised patients and it should prompt otorhinolaryngological investigation.

Coinfecção por leishmaniose visceral e vírus da imunodeficiência humana: uma evolução clínica desfavorável / Visceral leishmaniasis and human immunodeficiency virus co-infection, an unfavorable clinical outcome: case report

A leishmaniose visceral (LV) é uma zoonose endêmica na América Latina e 96% dos casos de LV são diagnosticados no Brasil. A coinfecção HIV-LV tem sido diagnosticada em áreas endêmicas e não endêmicas para LV. O aumento do número de casos de coinfecções em todo o mundo deve-se, em parte, à coincidência das áreas de circulação desses organismos. Deve-se ressaltar que a concomitância das duas infecções é potencialmente deletéria, portanto a associação dos dois patógenos constitui um desafio para o diagnóstico e controle da LV. A interação entre Leishmania e HIV é prejudicial, pois há o risco de progressão rápida de ambas as doenças por compartilharem mecanismos imunológicos semelhantes. Neste relato, é apresentado o caso de um paciente com infecção pelo HIV associada à LV, que evoluiu rapidamente para o óbito.