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Definition and management of invasive fungal rhinosinusitis: a single-centre retrospective study
Gian Luca Fadda1, Federica Martino1,2, Giacomo Andreani3
1Department of Otolaryngology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy.
Objectives:
The purpose of this study was to correlate acute invasive fungal rhinosinusitis (AIFRS) and chronic invasive fungal rhinosinusitis with underlying diseases, aetiological microorganisms, clinical symptoms, radiological findings, and surgical and medical treatment to determine the subset of patients who require more accurate diagnostic investigation and to prevent irreversible complications.
Methods:
This retrospective monocentric study included 17 patients who underwent endoscopic sinus surgery evaluated by paranasal computed tomography and magnetic resonance imaging. Age, sex and symptoms, and location of the invasive fungal infection and the causative fungus were analysed.
Results:
In total, 4 patients were affected by the AIFRS form, and 13 by the chronic form. Diabetes mellitus was reported in 41.17% of cases, and haematological diseases in 23.52%. The maxillary sinuses were involved in 47.05% of cases and sphenoidal sinuses in 52.94%; Aspergillus fumigatus was the fungus in 76.47% of cases, and Zygomycetes in 23.53%.
Conclusions:
An understanding of the different types of fungal sinusitis and knowledge of their features play a crucial role in reaching prompt diagnosis and initiation of appropriate therapy, which is essential to avoid a protracted or fatal outcome.
Insights
This study analyzed invasive fungal rhinosinusitis, finding diabetes and hematological diseases common in patients. Prompt diagnosis and treatment are crucial for better outcomes in acute invasive fungal rhinosinusitis (AIFRS) and chronic forms.
Area of Science:
- Otolaryngology
- Infectious Diseases
- Radiology
Background:
- Invasive fungal rhinosinusitis (IFRS) encompasses acute (AIFRS) and chronic forms.
- Accurate diagnosis and timely treatment are vital to prevent severe complications and mortality.
Purpose of the Study:
- To correlate AIFRS and chronic invasive fungal rhinosinusitis with patient comorbidities, causative fungi, clinical presentation, and imaging findings.
- To identify patient subsets requiring enhanced diagnostic evaluation.
- To guide appropriate surgical and medical management strategies.
Main Methods:
- Retrospective monocentric study of 17 patients undergoing endoscopic sinus surgery.
- Evaluation using paranasal computed tomography and magnetic resonance imaging.
- Analysis of patient demographics, symptoms, fungal etiology, and infection site.
Main Results:
- 4 patients had AIFRS, 13 had chronic IFRS.
- Diabetes mellitus (41.17%) and hematological diseases (23.52%) were prevalent comorbidities.
- Maxillary (47.05%) and sphenoidal (52.94%) sinuses were most frequently involved. Aspergillus fumigatus (76.47%) was the predominant pathogen.
Conclusions:
- Understanding the distinct features of AIFRS and chronic IFRS is essential for prompt diagnosis.
- Early initiation of appropriate therapy is critical to avoid prolonged illness or fatal outcomes.
- Radiological findings and etiological identification aid in targeted treatment.
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