INTRODUCTION
The expanding use of bone marrow transplantation (BMT) and intensive chemotherapy in the treatment of children with hematologic and oncologic disease has placed them at an increased risk for opportunistic infections such as acute invasive fungal rhinosinusitis (AIFR), a life threatening infection1,2.
The diagnosis of AIFR is challenging owing to the often-nonspecific presenting symptoms3. The disease has a rapidly progressive course, and timely diagnosis and detection of the fungal pathogens is crucial for successful management and clinical outcome of patients4. Direct microscopy and histopathology are the gold standard for diagnosis5. Cultures are used to identify the culprit agents and their antimicrobial susceptibility. Since the late 1990s more rapid and sensitive detection methods, such as in-situ hybridization and polymerase chain reaction (PCR), have been applied. Nevertheless, the detection spectrum of real-time PCR has been mostly restricted to a variety of Candida or Aspergillusspecies6.
In recent years, new panfungal PCR assays have been developed in order to detect a wider range of fungal pathogens7,8. The use of panfungal PCR assay in addition to histopathology and cultures seems to contribute to higher detection rates in cases of AIFR4. Additionally, the introduction of novel antifungal drugs such as posaconazole and isavuconazole may improve patients survival rates9,10. Finally, timely surgical debridement, a cornerstone of the management of AIFR, has been shown to be an independent prognostic factor in the survival of patients11,12. Improved endoscopic surgical skills using advanced instrumentation, high-definition cameras and intraoperative stereotactic navigation may lead to better survival outcomes in the management of children with AIFR13.