DECH crônica: fator preditivo para rinossinusite no transplante de medula óssea

Abstract

INTRODUÇÃO: transplante de medula óssea (TMO) é uma opção de tratamento para doenças hematológicas, tumorais e imunodeficiências e tem sido realizado com maior freqüência. O TMO predispõe a infecções de VAS e complicações, dentre estas as rinossinusites (RS). Quimioterapia, radioterapia, infecções virais, antibioticoterapia e doença do enxerto versus hospedeiro (DECH) são fatores predisponentes para RS. OBJETIVO: Verificar freqüência das RS no TMO e relação com DECH. Tentar estabelecer qual melhor tratamento para as RS no TMO. MÉTODO: Avaliação otorrinolaringológica de 2 grupos com 35 (gI) e 24 (gII) pacientes, antes e depois do TMO; e tratados individualmente com antibióticos e/ou punção de seios maxilares e/ou sinusectomia endoscópica. RESULTADOS: Nenhum apresentou RS antes do TMO; 42,8% dos TMO do gI tiveram RS e 34%, DECH; enquanto 58% do gII tiveram RS e 25%, DECH. No total, 49% tiveram RS e 30,5% com DECH. Houve significativa maior freqüência de RS em DECH crônica. A cirurgia foi indicada para tratamento de RS no TMO com DECH crônica. CONCLUSÃO: A freqüência de RS no TMO foi de 49%; DECH crônica é um fator predisponente para RS; a sinusectomia pode ser necessária nos pacientes com DECHc e RS.

Sinonasal disorders in hematopoietic stem cell transplantation

“…The frequency of rhinosinusitis coincided with the post-HSCT estimate described in the literature (36.7%), but was slightly lower than that in the previous study (42%) performed in this same service. 2 , 3 , 5 , 8 This can be explained by the greater care given to these patients before transplantation, or lower myeloablation during the current HSCT process. As no data were obtained regarding myeloablation, the latter association cannot be explained.…”

“…In spite of advances in the transplantation process, patients are still predisposed to multiple upper airway infections and their complications. 1 , 2 , 3 , 4 , 5 , 7 , 8 Immunosuppressive drugs, chemotherapy, radiation therapy, prolonged antibiotic therapy, graft vs. host disease (GVHD), and long periods of hospitalization are predisposing factors for airway infections described in the literature and observed in the everyday life of these patients. 1 , 2 , 3 , 4 , 5 , 7 , 8 …”

“…However, studies have demonstrated a higher prevalence and recurrence of rhinosinusitis in transplanted patients with GVHD. 5 , 7 , 8 There is evidence that alterations in the ultrastructure and on the surface of the respiratory epithelium occur, as well as immunosuppression. Therefore, in addition to the absence of immune protection, there is an alteration on the surface and in the mucociliary clearance, increasing the vulnerability to airway infections in these patients.…”

“…Supplementary examinations greatly assist in the diagnosis of rhinosinusitis in transplanted patients, especially nasal endoscopy. 4 , 5 , 7 , 8 Computed tomography is used primarily to plan the surgical treatment; however, it does not appear to be useful to predict the occurrence of rhinosinusitis after transplantation. 11 , 12 , 13 , 14 …”

“…The treatment of rhinosinusitis in transplanted patients must be established more promptly and should involve the use of broad-spectrum antibiotics for a long period. 2 , 3 , 4 , 5 , 7 , 8 , 10 More predisposed patients, such as those with GVHD, are candidates to endoscopic sinusectomy in recurrent rhinosinusitis. 4 , 5 , 7 , 15 …”