Increased Survival in Pediatric Invasive Fungal Rhinosinusitis After Implementation of a Diagnostic Protocol

Sunday, October 18, 2026

4:24 PM - 4:30 PM PT

Location: 409AB

Presenting Author(s)

ER

Emily Shores Richardson, MD

Clinical Research Fellow
University of Tennessee Health Science Center - Department of Otolaryngology
Memphis, Tennessee, United States

Co-Author(s)

JJ

Joel James, MD

Resident Physician
University of Tennessee
Memphis, TN, United States
KR

Kristen Ryan, RN

Clinical Research Associate
St. Jude Children's Research Hospital
Memphis, Tennessee, United States
RT

Robert M. Tuliszewski, Jr., MD

Medical Doctor
University of Tennessee Health Science Center - Department of Otolaryngology
Memphis, TN, United States
CR

Celine C. Richard, MD, PhD

Division Chief, Pediatric Otolaryngology
St Jude Research Hospital
Memphis, TN, United States

Senior Author(s)

AS

Anthony M. Sheyn, MD, FACS

Professor
University of Tennessee Health Science Center, Department of Otolaryngology, Head & Neck Surgery
Memphis, Tennessee, United States

Disclosure(s):

Celine C. Richard, MD, PhD:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Introduction: Invasive fungal sinusitis (IFS) is frequently encountered in immunocompromised patients with a high mortality rate, however, there remains ill-defined guidelines for pediatric patients. We aimed to describe our outcomes at a quaternary pediatric oncology center after the design and implementation of a diagnostic algorithm.

Methods: A retrospective chart review of pediatric patients admitted from January 2011-June 2025 who were diagnosed with IFS. Primary outcomes included overall survival, highest pre-operative temperature (Tmax), absolute neutrophil count (ANC), presenting symptoms, history of bone marrow transplant (BMT), and sociodemographics.

Results: 35 patients were identified with definitive IFS. Most patients were male (n=21), White, non-Hispanic (n=19), and did not have a history of prior BMT (n=29). Mean pre-operative ANC was 20 (IQR 0-100), Tmax 37.2 (36.9-37.7). Of the 35 patients, two were noted to have succumbed to IFS-related complications while 13 other deaths were attributed to cancer-related complications. All patients had been on azole antifungal therapy prior to diagnosis and then switched to amphotericin B upon suspicion or diagnosis of IFS. All patients underwent initial biopsy for diagnosis and subsequent debridement. Frequent debridement was performed until negative cultures and biopsies were found. Overall, we had a 94.6% survival rate.

Conclusions: Since implementation of a multidisciplinary diagnostic algorithm, we have noted our survival rates to be greater than 90%. We believe the use of prophylactic antifungal therapy in the setting of febrile neutropenia, diagnostic imaging, nasal endoscopy, and frequent debridement contributes to the high survival rate.