Episode # 3 • 17 Jan 2025
Multidisciplinary Management of Pediatric Invasive Fungal Sinusitis
When a child with cancer develops invasive fungal sinusitis, how do you balance urgent surgery, antifungal therapy, and the wait for neutrophil recovery? On this episode of the BackTable Creator Weekend™ series on pediatric head and neck cancer, host Dr. Rob Tuliszewski welcomes Dr. Dennis Kuo, a pediatric hematologist-oncologist, and Dr. Leidy Tovar Padua, a pediatric infectious diseases specialist, both at Rady Children's Hospital-San Diego and UC San Diego, to walk through pediatric invasive fungal sinusitis from first suspicion to recovery. They discuss who is at highest risk, the fever and neutropenia workup, imaging and plasma next-generation sequencing, how urgently to call ENT, and antifungal prophylaxis.
Timestamps
00:00 - Introduction
02:40 - Defining Pediatric Invasive Fungal Sinusitis and Risk Factors
06:53 - Fever, Neutropenia and the Initial Workup
11:21 - Imaging Strategy: CT, MRI and Combined Scans
15:44 - Timing of the ENT Evaluation
19:04 - Antifungal Prophylaxis
21:35 - Biopsy, Margins and Antifungal Selection
24:46 - Neutrophil Recovery, Chemotherapy Holds and Adjunctive Therapy
27:40 - Biomarkers, Susceptibility Testing and Treatment Endpoints
33:40 - Advanced Disease and Family Decision-Making
36:16 - Prevention and Closing Remarks
Resources
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More about this episode
The discussion details the surgical approach to margins, the difference in management between mucormycosis and aspergillosis, and when to escalate antifungal therapy. The team explains why tissue, not blood tests, guides decisions in invasive fungal sinusitis, and why antifungal medications can stabilize but not clear infection without neutrophil recovery. They share how chemotherapy is paused to allow marrow recovery, when adjuncts like growth factors or granulocyte transfusions are considered, and the role of hyperbaric oxygen in especially difficult cases. Drs. Kuo and Tovar Padua describe how serial endoscopy and an absolute neutrophil count above 500 are key endpoints, and why educating families about mold exposure and prevention is essential for long-term outcomes.
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