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An approach to fulminant invasive fungal rhinosinusitis in the immunocompromised host
M B Gillespie1, B W O'Malley, H W Francis
1Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD 21203-6402, USA.
Objective:
To examine the pathogenesis of fulminant invasive fungal rhinosinusitis to determine factors that may affect patient survival.
Methods:
Retrospective chart review of 25 patients treated for invasive fungal rhinosinusitis over a 10-year period at an academic tertiary referral center. Evaluation of the medical and surgical records, radiographic studies, surgical pathology specimens, and culture results allowed for a multifactorial comparison between survivors and nonsurvivors. Survivors were patients who left the hospital with the invasive fungal disease stable or cured.
Results:
Fungal invasion often occurs within the nasal cavity (92% of patients), most commonly at the middle turbinate (62% of patients receiving biopsy). Survivors had complete surgical resection more often than nonsurvivors (90% vs 0%), and were more likely to respond to granulocyte colony-stimulating factor than nonsurvivors (100% vs 0% of those treated).
Conclusions:
Rigid nasal endoscopy with frozen section biopsy of suspicious nasal lesions and high-incidence areas (ie, middle turbinate) allows for the timely diagnosis of invasive fungal rhinosinusitis. Survival improves if the disease is limited to the nasal or sinus cavities, which may represent an earlier stage of disease. Favorable prognostic signs include the ability to achieve a complete surgical resection and a positive response to granulocyte colony-stimulating factor in the neutropenic patient.
Insights
Early diagnosis of invasive fungal rhinosinusitis via nasal endoscopy and biopsy improves survival. Complete surgical resection and response to granulocyte colony-stimulating factor are favorable prognostic indicators.
Area of Science:
- Otolaryngology
- Mycology
- Infectious Diseases
Background:
- Fulminant invasive fungal rhinosinusitis (IFR) is a severe infection requiring prompt diagnosis and treatment.
- Understanding prognostic factors is crucial for improving patient outcomes in IFR.
Observation:
- A retrospective review of 25 patients with IFR over 10 years was conducted.
- Fungal invasion was frequently observed in the nasal cavity, particularly the middle turbinate.
- Survivors were more likely to have undergone complete surgical resection and responded to granulocyte colony-stimulating factor.
Findings:
- Timely diagnosis of IFR is facilitated by rigid nasal endoscopy with frozen section biopsy.
- Disease limited to the nasal or sinus cavities correlates with improved survival.
- Complete surgical resection and positive response to granulocyte colony-stimulating factor in neutropenic patients are favorable prognostic signs.
Implications:
- Early detection and aggressive surgical management are key to improving survival in invasive fungal rhinosinusitis.
- Granulocyte colony-stimulating factor may play a role in managing neutropenic patients with IFR.
- Further research into the pathogenesis and treatment of IFR is warranted.