Invasive Fungal Rhinosinusitis with and without Orbital Complications: Clinical and Laboratory Differences

Area of Science:

• Otolaryngology
• Infectious Diseases
• Ophthalmology

Background:

• Invasive fungal rhinosinusitis (IFS) is a rare, potentially fatal condition.
• Limited research exists on IFS with orbital complications (IFSwOC).
• This study identifies clinical indicators of IFSwOC and prognostic factors.

Purpose of the Study:

• To identify clinical signs associated with IFSwOC.
• To determine prognosticators for patients with IFSwOC.

Main Methods:

• Retrospective case series of patients with histopathologically confirmed IFS or IFSwOC undergoing surgery (2008-2018).
• Data collected included demographics, symptoms, signs, cultures, lab results, and outcomes.
• Comparison between patients with and without orbital complications.

Main Results:

• 38 patients identified: 9 IFSwOC, 29 IFS without orbital complications (IFSsOC).
• Orbital complication risk factors: headache, fever, sphenoid/posterior ethmoid sinus involvement, elevated CRP (≥1.025 mg/dL), or ESR (≥46.5 mm/h).
• Poorer prognosis in IFSwOC linked to male sex, posterior ethmoid sinus involvement, elevated WBC (≥9000 μL), CRP (≥6.91 mg/dL), or ESR (≥69 mm/h).

Conclusions:

• Sphenoid/posterior ethmoid sinus involvement, headache, fever, and elevated inflammatory markers (CRP, ESR) indicate risk for IFSwOC.
• Prompt surgical intervention and systemic antifungal therapy are crucial for better outcomes.