A diagnostic algorithm for early diagnosis and management of acute invasive fungal sinusitis

Mahomva, Chengetai R.; Hoying, David; Sbeih, Firas; Chaaban, Mohamad R.

doi:10.1016/j.amjoto.2022.103611

Cited by 4 publications

(5 citation statements)

References 34 publications

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“…The implementation of preventative measures against graft-versus-host disease (GvHD) through immunosuppressive regimens further heightens the risk of individuals undergoing allogeneic stem cell transplants for oncologic treatment [ 5 , 6 ]. Despite the rapid onset and progression of IFS, its clinical presentation is often subtle and insidious resulting in a high mortality rate of approximately 50% [ 7 , 8 ]. Often, initial symptoms include fever, nasal congestion, and rhinorrhea resembling signs of a bacterial or viral upper respiratory tract infection, resulting in frequent misdiagnosis [ 5 , 9 ].…”

Section: Introductionmentioning

confidence: 99%

“…The fungi can rapidly invade the nasal mucosa and sinus into the orbit, cavernous sinus, or intracranial space causing more characteristic symptoms in extensive disease, including neurologic deficits, diplopia, and proptosis [ 4 , 10 ]. Due to this, heightened clinical suspicion in high-risk patients is necessary for timely diagnosis, a critical prognostic component [ 7 ]. Physical examination of patients with suspected IFS should include a comprehensive head and neck examination, ophthalmologic evaluation, and neurologic assessment of all cranial nerves [ 4 ].…”

Section: Introductionmentioning

confidence: 99%

“…Distinct radiologic features apparent on computed tomography (CT) scans, such as mucosal thickening, also assist in facilitating the diagnosis of IFS [ 11 ]. The utilization of imaging is also essential for assessing fungal invasion, often necessitating magnetic resonance imaging (MRI) with contrast enhancement to provide more sensitive information, such as extranasal invasion or orbital extension [ 7 ]. Current treatment protocols encompass a multidisciplinary approach, involving surgical debridement, systemic antifungal therapy, and recovery of underlying immunodeficiency.…”

Section: Introductionmentioning

confidence: 99%

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A Silent Threat Unveiled: Invasive Fungal Sinusitis in a High-Risk Hematologic Malignancy Patient

Price,

Dubey,

Sulaiman

et al. 2024

Cureus

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Invasive fungal sinusitis (IFS) poses a fatal threat to patients with hematological malignancies or a history of allogeneic hematopoietic stem cell transplant (HSCT). While invasive aspergillosis, a subtype of IFS, remains rare in immunocompetent individuals, allogeneic HSCT recipients face a notable surge in incidence. Despite the rapid onset and progression of IFS, its clinical presentation is subtle, contributing to heightened mortality rates. Prompt surgical debridement and systemic antifungal therapy are required to yield positive results. Examining IFS cases in HSCT recipients is vital, providing insights into its clinical course, prevention strategies, and improved evaluation.We present a rare presentation of IFS with Aspergillus niger in a relapsed acute myeloid leukemia patient post-HSCT. Two weeks after chemotherapy, the patient developed headaches and blood-tinged sinus drainage in the setting of pancytopenia. Radiologic and pathological findings confirmed the diagnosis of IFS, necessitating weeks of intensive anti-fungal therapy. Despite the initial positive response, the disease ultimately progressed to a fatal outcome. This case emphasizes that early detection is required for a favorable treatment response. Furthermore, it underscores the importance of heightened clinical suspicion, risk stratification, multidisciplinary care, and ongoing research for optimal management of IFS in allogeneic HSCT recipients.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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A Silent Threat Unveiled: Invasive Fungal Sinusitis in a High-Risk Hematologic Malignancy Patient

Price,

Dubey,

Sulaiman

et al. 2024

Cureus

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“…3 An immunocompromised state prevents neutrophils from mounting a normal response against fungal organisms and commonly stems from poorly controlled diabetes mellitus (DM), lymphovascular malignancies, human immunodeficiency virus/acquired immunodefiency syndrome (HIV/AIDS), solid organ transplantation and other causes of neutropenia. 4,5 Prolonged use of steroids has gained prominence as a risk factor for IFS following COVID-19. 6,7 There is high incidence of Mucor infection in patients with DM, 8 but growing evidence has shown Aspergillus species in addition to zygomycetes (i.e., Rhizopus), to be common causative agents as well.…”

Section: Introductionmentioning

confidence: 99%

“…The infection leads to thrombosis and tissue ischemia resulting in further spread 3 . An immunocompromised state prevents neutrophils from mounting a normal response against fungal organisms and commonly stems from poorly controlled diabetes mellitus (DM), lymphovascular malignancies, human immunodeficiency virus/acquired immunodefiency syndrome (HIV/AIDS), solid organ transplantation and other causes of neutropenia 4,5 . Prolonged use of steroids has gained prominence as a risk factor for IFS following COVID‐19 6,7 .…”

Section: Introductionmentioning

confidence: 99%

Microvascular Free Flap Outcomes in Maxillectomy Defects from Invasive Fungal Sinusitis

Rao,

Knott,

Sweeny

et al. 2023

The Laryngoscope

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ObjectivesMicrovascular free tissue transfer is routinely used for reconstructing midface defects in patients with malignancy, however, studies regarding reconstructive outcomes in invasive fungal sinusitis (IFS) are lacking. We aim to describe outcomes of free flap reconstruction for IFS defects, determine the optimal time to perform reconstruction, and if anti‐fungal medications or other risk factors of an immunocompromised patient population affect reconstructive outcomes.MethodsRetrospective review of reconstruction for IFS (2010–2022). Age, BMI, hemoglobin A1c, number of surgical debridements, and interval from the last debridement to reconstruction were compared between patients with delayed wound healing versus those without. Predictor variables for delayed wound healing and the effect of time on free flap reconstruction were analyzed.ResultsTwenty‐seven patients underwent free flap reconstruction for IFS. Three patients were immunocompromised from leukemia and 21 had diabetes mellitus (DM). Patients underwent an average of four surgical debridements for treatment of IFS. The interval from the last IFS debridement to flap reconstruction was 5.58 months (±5.5). Seven flaps (25.9%) had delayed wound healing. A shorter interval of less than 2 months between the last debridement for IFS and reconstructive free flap procedure was associated with delayed wound healing (Fisher Exact Test p = 0.0062). Other factors including DM, BMI, HgA1c, and bone reconstruction were not associated with delayed wound healing.ConclusionPatients with maxillectomy defects from IFS can undergo microvascular‐free flap reconstruction with good outcomes while on anti‐fungal medication. Early reconstruction in the first 2 months after the last IFS debridement is associated with delayed wound healing.Level of EvidenceIV Laryngoscope, 2023

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Rapid SERS detection of diverse filamentous fungi by superparamagnetic particles and flexible silver nanowires

Hu,

Tian,

et al. 2023

Sensing and Bio-Sensing Research

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A diagnostic algorithm for early diagnosis and management of acute invasive fungal sinusitis

Cited by 4 publications

References 34 publications

A Silent Threat Unveiled: Invasive Fungal Sinusitis in a High-Risk Hematologic Malignancy Patient

A Silent Threat Unveiled: Invasive Fungal Sinusitis in a High-Risk Hematologic Malignancy Patient

Microvascular Free Flap Outcomes in Maxillectomy Defects from Invasive Fungal Sinusitis

Rapid SERS detection of diverse filamentous fungi by superparamagnetic particles and flexible silver nanowires

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