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Nasal discharge in the oncology patient

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Shared care information

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.

Cause

  • Viral URTI is still the most common cause.
  • Aspergillus may present with nasal/sinus infection in patients with prolonged neutropenia and antibiotic therapy.

Clinical features

Features suggestive of complicated infection are:

  • facial/ocular pain and/or nasal discharge.
  • unilateral symptoms.

Investigations

  • 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.

Management

  • Antibiotics: See antibiotic protocol.
  • If neutropenic with sinusitis add liposomal amphotericin 3 mg/kg daily while awaiting results of cultures.

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Document Control

  • Date last published: 01 March 2014
  • Document type: Clinical Guideline
  • Services responsible: National Child Cancer Network