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Published on: June 20, 2018
Invasive fungal rhinosinusitis: a 15-year experience with 29 patients
Marcus M Monroe1, Max McLean, Nathan Sautter
1Department of Otolaryngology-Head and Neck Surgery, Oregon Health and Science University, Portland, Oregon 97239-3098, USA.
Objectives/Hypothesis:
Document a 15-year experience with 29 cases of acute invasive fungal rhinosinusitis (AIFR) and evaluate factors predictive of disease clearance and overall survival.
Study Design:
Case series with chart review.
Methods:
Patients were identified by review of department billing records between 1995 and 2010. Medical records were reviewed for patient demographics, disease characteristics, clinical course including surgical and medical therapy, treatment outcomes, and long-term survival.
Results:
Twenty-nine patients with AIFR were identified. Causes of immunosuppression included hematologic malignancy (n=16), diabetes (n=12), medication (n=10), and acquired immunodeficiency syndrome (n=1), with 10 patients having multiple causes of immunosuppression. Facial pain, swelling and orbital symptoms were the most common presenting symptoms. Fungal organisms included Mucor (n=18) and Aspergillus (n=10) species, with one patient infected with both. Disease-specific survival (DSS) from AIFR was 57%. Intracranial (P=.01) and ethmoid sinus (P=.05) involvement were significantly linked with short-term disease-related mortality. Overall survival (OS) at 6 months was 18%. For OS, intracranial involvement (hazard ratio [HR], 4.47; 95% confidence interval [CI], 1.51-13.22) and cranial neuropathy at presentation (HR, 3.2; 95% CI, 1.3-8.2) were significantly associated with shortened survival. Of the five patients surviving >6 months, two developed long-term major sinonasal complications.
Conclusions:
DSS and OS remain low for patients with AIFR. Extensive surgical resection in patients with these poor prognostic signs should be considered carefully in light of their poor survival. Long-term survivors are at significant risk of sinonasal complications and should be followed closely.
Insights
Acute invasive fungal rhinosinusitis (AIFR) has a low survival rate, with intracranial involvement and cranial neuropathy being poor prognostic indicators. Survivors face significant long-term sinonasal complications.
Area of Science:
- Otolaryngology
- Infectious Diseases
- Mycology
Background:
- Acute invasive fungal rhinosinusitis (AIFR) is a severe infection often seen in immunocompromised patients.
- Early diagnosis and management are crucial for patient outcomes.
Purpose of the Study:
- To document a 15-year experience with 29 cases of AIFR.
- To identify factors predicting disease clearance and overall survival in AIFR patients.
Main Methods:
- A retrospective case series design was employed.
- Patient data were collected via chart review of billing records from 1995 to 2010.
- Demographics, disease characteristics, treatment, and outcomes were analyzed.
Main Results:
- Twenty-nine AIFR cases were identified, with immunosuppression from hematologic malignancy and diabetes being common.
- Mucor and Aspergillus were the most frequent fungal pathogens.
- Disease-specific survival was 57%, with intracranial and ethmoid sinus involvement linked to mortality. Overall survival at 6 months was 18%.
Conclusions:
- AIFR is associated with low disease-specific and overall survival rates.
- Intracranial involvement and cranial neuropathy at presentation are poor prognostic indicators.
- Long-term survivors require close follow-up due to the risk of sinonasal complications.
