Identifying predictors for the diagnosis of acute invasive fungal rhinosinusitis: a comprehensive analysis

Acute Invasive Fungal Sinusitis (AIFS) is an aggressive infection with significant morbidity and mortality. Early and accurate diagnosis is critical, but its nonspecific clinical presentation often complicates timely detection. This study aims to identify clinical, laboratory, and radiological predictors associated with biopsy-confirmed AIFS in patients with suspected disease.

A retrospective analysis was conducted on 134 adult patients who underwent biopsies for suspected AIFS at a tertiary referral center between January 2009 and January 2024. Patients diagnosed with chronic invasive fungal sinusitis were excluded. Among the patients, 60 cases (44.8%) were biopsy-confirmed AIFS. Key variables analyzed included demographic data, comorbidities, clinical signs, endoscopic findings, laboratory markers, and imaging findings. Backward stepwise and multivariable logistic regression analyses were used to identify independent predictors.

Of 36 clinical variables initially assessed, stepwise regression identified 5 significant variables for multivariable analysis. Mucosal necrosis in the nasal cavity (OR 39.853; 95% CI 10.278-154.535; p = 0.000) and cranial nerve palsies (OR 25.826; 95% CI 2.738-140.769; p = 0.000) were the strongest predictors. Other significant factors included unilateral mucosal thickening (OR 5.694; 95% CI 1.720-18.855; p = 0.004), diabetes mellitus (OR 3.462; 95% CI 1.202-9.970; p = 0.021), and female sex (OR 2.959; 95% CI 1.060-8.259; p = 0.038).

Cranial nerve palsies and mucosal necrosis in the nasal cavity are strong predictors of biopsy-confirmed AIFS, highlighting the importance of these clinical signs in early diagnosis.