BACKGROUND: Acute invasive fungal rhinosinusitis (AIFR) is an aggressive opportunistic infection with a high mortality rate. There are few reports that demonstrate an improvement in the overall prognosis. Furthermore, definite prognostic factors related to patient survival remain unclear. OBJECTIVE: The objective of this study was to evaluate the various clinical factors related to survival of patients with AIFR. METHODS: This is a retrospective case series with patients treated for AIFR between 1997 and 2013. A total of 45 patients with AIFR were enrolled for analysis. We evaluated demographics, clinical characteristics, and disease course. RESULTS: Mean age of patients was 59.6 years. AIFR developed most commonly in patients with immunocompromised host, such as diabetes (n = 23) or hematologic malignancy (n = 17). There were two main genera of fungus, Aspergillus (n = 30) and Mucor (n = 14). Headache, cranial neuropathy, visual loss, and orbital pain were the most common presenting symptoms. Overall survival was 53%. Underlying hematologic malignancy and diabetes were significantly associated with overall survival, and accompanying severe neutropenia and elevated C-reactive protein (CRP) were also related to poor prognosis. Initial presentation with facial swelling, involvement of nasal septum, or shorter symptom duration was also associated with survival reduction. Multivariate analysis revealed that CRP more than 5.50 mg/dL (Hazard ratio [HR], 9.04; p = .003) was an independent prognostic factor in patients with AIFR. CONCLUSIONS: Overall survival rate remained approximately 50% in patients with AIFR. The prognosis of AIFR is significantly influenced by underlying diseases, accompanying neutropenia, CRP levels, symptom duration, involvement of septum, and the presence of facial swelling. Elevation of CRP, in particular, was an independent predictor of poor outcomes and should be monitored appropriately.
BACKGROUND: Acute invasive fungal rhinosinusitis (AIFR) is an aggressive opportunistic infection with a high mortality rate. There are few reports that demonstrate an improvement in the overall prognosis. Furthermore, definite prognostic factors related to patient survival remain unclear. OBJECTIVE: The objective of this study was to evaluate the various clinical factors related to survival of patients with AIFR. METHODS: This is a retrospective case series with patients treated for AIFR between 1997 and 2013. A total of 45 patients with AIFR were enrolled for analysis. We evaluated demographics, clinical characteristics, and disease course. RESULTS: Mean age of patients was 59.6 years. AIFR developed most commonly in patients with immunocompromised host, such as diabetes (n = 23) or hematologic malignancy (n = 17). There were two main genera of fungus, Aspergillus (n = 30) and Mucor (n = 14). Headache, cranial neuropathy, visual loss, and orbital pain were the most common presenting symptoms. Overall survival was 53%. Underlying hematologic malignancy and diabetes were significantly associated with overall survival, and accompanying severe neutropenia and elevated C-reactive protein (CRP) were also related to poor prognosis. Initial presentation with facial swelling, involvement of nasal septum, or shorter symptom duration was also associated with survival reduction. Multivariate analysis revealed that CRP more than 5.50 mg/dL (Hazard ratio [HR], 9.04; p = .003) was an independent prognostic factor in patients with AIFR. CONCLUSIONS: Overall survival rate remained approximately 50% in patients with AIFR. The prognosis of AIFR is significantly influenced by underlying diseases, accompanying neutropenia, CRP levels, symptom duration, involvement of septum, and the presence of facial swelling. Elevation of CRP, in particular, was an independent predictor of poor outcomes and should be monitored appropriately.
Authors: Andrew Bryan; James A Mays; Joshua A Lieberman; Karen Stephens; Kyoko Kurosawa; Patrick C Mathias; Dhruba SenGupta; Lori Bourassa; Stephen J Salipante; Brad T Cookson Journal: J Clin Microbiol Date: 2021-08-18 Impact factor: 5.948
Authors: Min Young Seo; Hyeri Seok; Seung Hoon Lee; Ji Eun Choi; Sang Duk Hong; Seung-Kyu Chung; Kyong Ran Peck; Hyo Yeol Kim Journal: J Clin Med Date: 2020-02-24 Impact factor: 4.241
Authors: Clara E Negri; Adam Johnson; Laura McEntee; Helen Box; Sarah Whalley; Julie A Schwartz; V Ramos-Martín; Joanne Livermore; Ruwanthi Kolamunnage-Dona; Arnaldo L Colombo; William W Hope Journal: J Infect Dis Date: 2018-03-13 Impact factor: 5.226