Risk factors and predictors of mortality in acute invasive fungal sinusitis - a single-institution experience

Area of Science:

• Otolaryngology
• Infectious Diseases
• Medical Mycology

Background:

• Acute invasive fungal sinusitis is a severe infection often associated with significant morbidity and mortality.
• Diabetes mellitus is a common comorbidity, observed in 82.6% of patients in this cohort.
• Zygomycetes, particularly *Rhizopus arrhizus*, are the predominant fungal pathogens identified.

Purpose of the Study:

• To identify risk factors associated with mortality in patients diagnosed with acute invasive fungal sinusitis.
• To inform clinical decision-making and patient counseling regarding prognostic indicators.

Main Methods:

• An observational cohort study was conducted over a five-year period.
• Data were collected on 109 patients diagnosed with acute invasive fungal sinusitis.
• Multivariate and univariate analyses were performed to determine significant prognostic factors.

Main Results:

• Mortality was significantly associated with female sex (p=0.022), delayed intervention (less than two weeks from symptoms to first intervention, p=0.01), and intracranial involvement (p=0.034).
• Other univariate factors included peri-orbital swelling, restricted ocular movements, intracranial symptoms, posterior disease, ocular involvement on imaging, zygomycete infection, and post-operative cavity infection.
• Bilateral, palatal, and retromaxillary involvement did not correlate with poor prognosis.

Conclusions:

• A high index of clinical suspicion is essential for diagnosing acute invasive fungal sinusitis.
• Identifying prognostic factors aids in patient counseling and guides the initiation of urgent debridement and antifungal therapy.
• Effective post-operative nasal and sinus cavity care is vital for reducing mortality rates.