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Acute Invasive Fungal Rhinosinusitis in Immunocompromised Patients: Role of an Early Diagnosis

Ignacio Javier Fernandez1, Francesco Maria Crocetta1, Marco Demattè1

  • 11 Otorhinolaryngology Head and Neck Surgery Unit, Head and Neck and Sensory Organs Department, Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy.

Otolaryngology--Head and Neck Surgery : Official Journal of American Academy of Otolaryngology-Head and Neck Surgery
|March 21, 2018
PubMed

Insights

Prompt diagnosis and surgical treatment are crucial for acute invasive fungal rhinosinusitis (AIFRS) in hematologic patients. An early diagnosis protocol significantly reduced treatment delays, improving patient outcomes.

Area of Science:

  • Mycology
  • Hematology
  • Otolaryngology

Background:

  • Acute invasive fungal rhinosinusitis (AIFRS) poses a significant threat to immunocompromised patients, particularly those with hematologic conditions.
  • Timely diagnosis and intervention are critical for managing AIFRS, but delays in treatment can negatively impact prognosis.

Purpose of the Study:

  • To assess the clinical significance of delayed surgical treatment for AIFRS in hematologic patients.
  • To identify prognostic factors, including clinical, pathological, and microbiological variables, associated with AIFRS outcomes.
  • To evaluate the effectiveness of a proposed early diagnosis and treatment protocol over a 10-year period.

Main Methods:

  • A monocentric retrospective analysis of patients with histologically and microbiologically confirmed AIFRS from 2001 to 2017.
  • Analysis of treatment delay, clinical, pathological, and microbiological data to determine prognostic value.
  • Comparison of patient outcomes before and after the implementation of an early diagnosis and treatment protocol.

Main Results:

  • Nineteen patients with AIFRS were included in the study.
  • Treatment delays exceeding 4 days, infection by Mucorales, and disease extension were identified as negative prognostic variables (P = .002, P = .015, P = .017, respectively).
  • The early diagnosis protocol reduced the average time to diagnosis and treatment by 7.3 days (P = .02).

Conclusions:

  • Prompt diagnosis and surgical intervention are significantly associated with improved outcomes in AIFRS patients.
  • The developed early diagnosis and treatment protocol effectively reduces diagnostic and treatment delays in high-risk hematologic patients.
  • Implementing this protocol can enhance the management and prognosis of AIFRS.
Keywords:
early diagnosishematologic malignancyinvasive fungal rhinosinusitisnasal endoscopyprognosis

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