Invasive fungal sinusitis: an effective combined treatment in five haematological patients

Area of Science:

• Infectious Diseases
• Otolaryngology
• Hematology

Background:

• Invasive fungal rhinosinusitis (IFR) is a severe infection with subtle onset, often leading to delayed diagnosis and poor outcomes.
• Hematological patients are particularly vulnerable to IFR, with high mortality rates if not treated promptly.

Purpose of the Study:

• To describe a comprehensive pre- and post-operative management strategy for hematological patients diagnosed with IFR.
• To evaluate the efficacy of a novel treatment approach combining systemic antifungals, surgical debridement, and local sinus instillation.

Main Methods:

• A retrospective review of five hematological patients with IFR.
• Treatment involved systemic antifungal therapy, endoscopic surgical debridement, and post-operative local amphotericin-B instillation via a new ethmoidal drainage system.

Main Results:

• All five patients achieved remission of IFR.
• After a median follow-up of 32 months, three patients survived, with two deaths attributed to other causes.
• Two patients with initial brain progression of IFR survived.

Conclusions:

• A multidisciplinary approach incorporating surgery, systemic antifungals, and innovative local post-operative sinus therapy can effectively manage IFR in hematological patients.
• This comprehensive strategy may improve survival rates and facilitate radical antifungal sinus treatment.