Nasal discharge in the oncology patient
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Neutropenic patients with sinusitis may have atypical infections including erosive fungal infections. These patients should be discussed with the paediatric oncologist on call at presentation.
- Viral URTI is still the most common cause.
- Aspergillus may present with nasal/sinus infection in patients with prolonged neutropenia and antibiotic therapy.
Features suggestive of complicated infection are:
- facial/ocular pain and/or nasal discharge.
- unilateral symptoms.
- nasopharyngeal swab for M, C+S, fungal culture, and viral immunofluorescence or PCR, and culture.
- neutropenic and febrile patients - CT sinuses.
- If evidence of sinusitis, ask for EUA by ENT surgeon who should obtain washes and biopsies of the abnormal sites.
- Antibiotics: See antibiotic protocol.
- If neutropenic with sinusitis add liposomal amphotericin 3 mg/kg daily while awaiting results of cultures.
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- Date last published: 01 March 2014
- Document type: Clinical Guideline
- Services responsible: National Child Cancer Network
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