Giorgos Sideris1, Antonia Arvaniti2, Evaggelos Giotakis3, Pavlos Maragoudakis2, Alexander Delides2. 1. 2nd Otolaryngology Department, School of Medicine, National & Kapodistrian University of Athens, Attikon" University Hospital, Rimini 1, 124 62, Chaidari, Athens, Greece. siderisgior@gmail.com. 2. 2nd Otolaryngology Department, School of Medicine, National & Kapodistrian University of Athens, Attikon" University Hospital, Rimini 1, 124 62, Chaidari, Athens, Greece. 3. 1st Otolaryngology Department, School of Medicine, National & Kapodistrian University of Athens, "Ippokrateion" General Hospital, Athens, Greece.
Abstract
PURPOSE: Acute invasive fungal rhinosinusitis (AIFRS) is a rare, fulminant, angio-invasive infection with high mortality rate. Treatment of AIFRS includes aggressive surgical debridement combined with antifungal agents and treatment of the underlying disease. The aim of this study is to report our experience with this often fatal disease and estimate the long-term survival of AIFRS patients with more conservative surgery. METHODS: A retrospective study was performed on immunocompromised adults with AIFRS from January 2011 to December 2020. The diagnosis was histologically confirmed by tissue fungus invasion. We analyze epidemiological and microbiological findings, the underlying disease and discuss our patients' treatment plan and long-term survival. RESULTS: Fourteen patients were included in the study. Mean age was 53.8 ± 18.9 years. The underlying disease was hematologic malignancy in nine patients, diabetes mellitus in three, aplastic anemia in one, and renal/liver failure in one. Leukopenia was not significantly correlated with outcome or survival. Histological and culture findings revealed that Mucor/Rhizopus were the causative organisms in nine cases. All patients received systemic antifungal therapy. Surgery was performed in nine patients (endoscopic for all patients, combined in three with an external approach). Overall survival was 35.7% as five patients survived, two who underwent surgery, and three who were treated non-surgically. Nine patients died, two from AIFRS after central nervous system involvement and seven from their primary disease, free of fungi. Older individuals and patients with hematologic malignancies had a worse outcome. CONCLUSION: Early surgical debridement, antifungal agents, and treatment of the underlying disease remain the cornerstones of AIFRS management. Prognosis is overall defined by the underlying disease and in some selected cases, medical treatment alone could be a reasonable option.
PURPOSE: Acute invasive fungal rhinosinusitis (AIFRS) is a rare, fulminant, angio-invasive infection with high mortality rate. Treatment of AIFRS includes aggressive surgical debridement combined with antifungal agents and treatment of the underlying disease. The aim of this study is to report our experience with this often fatal disease and estimate the long-term survival of AIFRS patients with more conservative surgery. METHODS: A retrospective study was performed on immunocompromised adults with AIFRS from January 2011 to December 2020. The diagnosis was histologically confirmed by tissue fungus invasion. We analyze epidemiological and microbiological findings, the underlying disease and discuss our patients' treatment plan and long-term survival. RESULTS: Fourteen patients were included in the study. Mean age was 53.8 ± 18.9 years. The underlying disease was hematologic malignancy in nine patients, diabetes mellitus in three, aplastic anemia in one, and renal/liver failure in one. Leukopenia was not significantly correlated with outcome or survival. Histological and culture findings revealed that Mucor/Rhizopus were the causative organisms in nine cases. All patients received systemic antifungal therapy. Surgery was performed in nine patients (endoscopic for all patients, combined in three with an external approach). Overall survival was 35.7% as five patients survived, two who underwent surgery, and three who were treated non-surgically. Nine patients died, two from AIFRS after central nervous system involvement and seven from their primary disease, free of fungi. Older individuals and patients with hematologic malignancies had a worse outcome. CONCLUSION: Early surgical debridement, antifungal agents, and treatment of the underlying disease remain the cornerstones of AIFRS management. Prognosis is overall defined by the underlying disease and in some selected cases, medical treatment alone could be a reasonable option.
Authors: James Foshee; Chris Luminais; James Casey; Alexander Farag; Anthony Prestipino; Alfred Marc Iloreta; Gurston Nyquist; Marc Rosen Journal: Int Forum Allergy Rhinol Date: 2016-06-07 Impact factor: 3.858
Authors: Marcus M Monroe; Max McLean; Nathan Sautter; Mark K Wax; Peter E Andersen; Timothy L Smith; Neil D Gross Journal: Laryngoscope Date: 2013-02-16 Impact factor: 3.325
Authors: Dae Woo Kim; Sang Taek Heo; Sea-Yuong Jeon; Jin Young Kim; Min Hee Lim; In-Gyu Bae; Jung Wook Yang; Jong Sil Lee Journal: Med Mycol Date: 2010-03 Impact factor: 4.076