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Histological Quantification to Determine Lung Fungal Burden in Experimental Aspergillosis
Published on: March 9, 2018
Invasive fungal sinusitis: a 15-year review from a single institution
Shatul L Parikh1, Giridhar Venkatraman, John M DelGaudio
1Department of Otolaryngology--Head and Neck Surgery, Emory University School of Medicine, Atlanta, Georgia, USA.
Background:
The aim of this study was to review our experience with patients with invasive fungal sinusitis (IFS) to determine outcomes and identify factors that may affect patient survival.
Methods:
A retrospective review was performed.
Results:
Forty-three patients were identified accounting for 45 cases of IFS. The underlying reasons for immunosuppression were hematologic malignancy (28 patients), diabetes mellitus (10 patients), solid organ transplant (3 patients), chronic steroid use (3 patients), and acquired immunodeficiency syndrome (1 patient). Eight of 45 cases (18%) died of IFS. Of the 28 cases associated with hematologic malignanancy, 3 patients died of IFS (11%) and 4 patients (14%) died of other causes with persistent IFS. None of these 7 patients had recovery of their absolute neutrophil count, and all patients who recovered from IFS recovered to a normal absolute neutrophil count. Four of 10 (40%) diabetic patients died of IFS, and 66% of survivors had persistent neurological or visual morbidity. The imortality rate was 29% for patients infected with Mucor and 11% for patients injected with Aspergillus.
Conclusion:
We have found the overall mortality rate directly related to IFS to be 18%. The rate is higher for diabetic patients than for patients with hematologic causes for their immunosuppression. This is likely because of the higher index of suspicion and early diagnosis and treatment of patients with neutropenia and a less-fulminant, slower-progressing form of IFS from Aspergillus, apparently a less virulent fungus than Mucor. Intracranial involvement and failure to recover from neutropenia are the factors that led to poor prognosis in this series.
Insights
Invasive fungal sinusitis (IFS) has an 18% mortality rate, with diabetic patients facing higher risks than those with hematologic malignancy. Intracranial spread and persistent neutropenia significantly worsen prognosis in invasive fungal sinusitis outcomes.
Area of Science:
- Infectious Diseases
- Otolaryngology
- Oncology
Background:
- Invasive fungal sinusitis (IFS) is a serious infection affecting immunocompromised individuals.
- Understanding patient outcomes and survival factors in IFS is crucial for clinical management.
Purpose of the Study:
- To review institutional experience with invasive fungal sinusitis (IFS).
- To determine patient outcomes and identify factors influencing survival in IFS.
Main Methods:
- A retrospective review of patient cases was conducted.
- Data analysis focused on underlying immunosuppression, causative fungi, and patient outcomes.
Main Results:
- Forty-five cases of IFS were identified in 43 patients, with common causes of immunosuppression including hematologic malignancy and diabetes mellitus.
- The overall mortality rate directly attributed to IFS was 18%.
- Diabetic patients had a higher mortality rate (40%) compared to those with hematologic malignancy (11%).
- Infection with Mucor (29% mortality) was associated with higher mortality than Aspergillus (11% mortality).
- Intracranial involvement and failure to recover from neutropenia were linked to poor prognosis.
- Survivors, particularly diabetic patients, frequently experienced persistent neurological or visual morbidity.
Conclusions:
- The overall mortality rate for invasive fungal sinusitis is 18%, with diabetic patients experiencing a worse prognosis.
- Factors such as intracranial involvement and persistent neutropenia significantly impact survival.
- Early diagnosis and treatment, potentially influenced by the virulence of the infecting fungus (Mucor vs. Aspergillus), play a role in outcomes.
