Systemic Antifungal Therapy
Prior to the diagnosis of AIFR, all patients were stratified into categories of risk to develop invasive fungal disease according to accepted guidelines14. High-risk criteria included acute myelogenous leukemia (AML), high-risk acute lymphoblastic leukemia (ALL), relapsing leukemia, and post-BMT. High-risk patients received prophylactic antifungal therapy with itraconazole or fluconazole, as part of the institutional policy. In addition, all other children with hematologic malignancies were prophylactically treated with nystatin or clotrimazole.
Empirical systemic antifungal therapy was administered as soon as AIFR was suspected. Indications for empirical antifungal treatment included persistence of fever and neutropenia despite broad spectrum antibiotic therapy, signs of locally advanced rhinosinusitis, nasal biopsy positive for calcofluor-white stain or evidence of invasive fungus in frozen section. Therapy was adjusted after definitive diagnosis and identification of the pathogen, in accordance with accepted guidelines15.