Fabio Pagella1, Francesca De Bernardi2, Daniela Dalla Gasperina3, Alessandro Pusateri4, Elina Matti1, Irene Avato1, Caterina Cavanna5, Patrizia Zappasodi6, Maurizio Bignami2, Elena Bernardini2, Paolo Antonio Grossi3, Paolo Castelnuovo2. 1. Department of Otorhinolaryngology, Istituto di Ricovero e Cura a Carattere Scientifico (I.R.C.C.S.) Policlinico San Matteo, University of Pavia, Pavia, Italy. 2. Department of Otorhinolaryngology, Ospedale di Circolo e Fondazione Macchi, University of Insubria, Varese, Italy. 3. Infectious and Tropical Diseases Unit, Department of Surgical and Morphological Sciences, Ospedale di Circolo e Fondazione Macchi, University of Insubria, Varese, Italy. 4. Department of Otorhinolaryngology, Istituto di Ricovero e Cura a Carattere Scientifico (I.R.C.C.S.) Policlinico San Matteo, University of Pavia, Pavia, Italy. Electronic address: ale.pusateri@gmail.com. 5. Laboratory Medicine/Virology and Microbiology Unit, Istituto di Ricovero e Cura a Carattere Scientifico (I.R.C.C.S.) Policlinico San Matteo, Pavia, Italy. 6. Department of Haematology, Istituto di Ricovero e Cura a Carattere Scientifico (I.R.C.C.S.) Policlinico San Matteo, University of Pavia, Pavia, Italy.
Abstract
BACKGROUND: This paper describes our experience in the management of acute and chronic invasive fungal rhinosinusitis (IFRS) in adults. METHODS: Medical files of all patients aged >18 years treated in our institutions for IFRS from 2002 to 2013 were retrospectively reviewed. RESULTS: A total of 18 cases (10 acute and 8 chronic) were recorded. In acute form, haematological malignancies represented the principal comorbidity (100%), while in chronic form this was diabetes mellitus (87.5%). All patients received systemic antifungal agents. Endoscopic sinus surgery was performed in 16/18 patients (88.9%). Among patients with an acute IFRS, 4/10 died of fungal infection (40%), on the other side 2/8 patients with chronic IFRS died of the evolution of the mycosis (25%). CONCLUSIONS: Acute and chronic IFRS are different entities: in acute form, prognosis is poor, so therapy should be promptly performed, although host immune status and evolution of the haematological disease are key factors for the outcome. In chronic form, a wide surgical excision of the disease is recommended in order to obtain a complete removal of fungal infection. In both forms, early clinical findings are non-specific and ambiguous, so diagnosis depends on a high index of suspicion, taking into account predisposing factors.
BACKGROUND: This paper describes our experience in the management of acute and chronic invasive fungal rhinosinusitis (IFRS) in adults. METHODS: Medical files of all patients aged >18 years treated in our institutions for IFRS from 2002 to 2013 were retrospectively reviewed. RESULTS: A total of 18 cases (10 acute and 8 chronic) were recorded. In acute form, haematological malignancies represented the principal comorbidity (100%), while in chronic form this was diabetes mellitus (87.5%). All patients received systemic antifungal agents. Endoscopic sinus surgery was performed in 16/18 patients (88.9%). Among patients with an acute IFRS, 4/10 died of fungal infection (40%), on the other side 2/8 patients with chronic IFRS died of the evolution of the mycosis (25%). CONCLUSIONS: Acute and chronic IFRS are different entities: in acute form, prognosis is poor, so therapy should be promptly performed, although host immune status and evolution of the haematological disease are key factors for the outcome. In chronic form, a wide surgical excision of the disease is recommended in order to obtain a complete removal of fungal infection. In both forms, early clinical findings are non-specific and ambiguous, so diagnosis depends on a high index of suspicion, taking into account predisposing factors.
Authors: Gian-Luca Fadda; Giovanni Succo; Paolo Moretto; Andrea Veltri; Paolo Castelnuovo; Maurizio Bignami; Giovanni Cavallo Journal: Iran J Otorhinolaryngol Date: 2019-01
Authors: Megan R D'Andrea; Corey M Gill; Melissa Umphlett; Satish Govindaraj; Anthony Del Signore; Joshua B Bederson; Alfred M C Iloreta; Raj K Shrivastava Journal: J Neurol Surg B Skull Base Date: 2020-02-11