A multi‐institutional review of outcomes in biopsy‐proven acute invasive fungal sinusitis

Wandell, Grace; Miller, Craig; Rathor, Aakanksha; Wai, Travis Hee; Guyer, Richard A.; Schmidt, Rodney A.; Turner, Justin H.; Hwang, Peter H.; Davis, Greg E.; Humphreys, Ian

doi:10.1002/alr.22172

Cited by 47 publications

(111 citation statements)

References 32 publications

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“…Furthermore, LoCE lesions in the orbit, cavernous sinus, infratemporal fossa, and meninges were significantly associated with AIFRS-specific survival rate in univariate analysis but not in multivariate analysis. A recent multicenter study also reported that orbit and intracranial involvement were not statistically significant prognostic factors 16 .…”

Section: Discussionmentioning

confidence: 99%

“…We also found that there was no significant difference between the survival rate of invasive mucormycosis and that of aspergillosis. A recent multicenter study reported that atypical fungi, including Candida, Fusarium, and Alternaria, which are resistant to amphotericin B and other antifungal agents, were associated with poor survival rate 16 . Considering the efficacy of antifungal agents, our results may be because these organisms have individual susceptibilities to amphotericin B and voriconazole.…”

Section: Discussionmentioning

confidence: 99%

“…Previous studies have shown that the involvement of brain, orbit, cavernous sinus, pterygopalatine fossa, and/ or palate may lead to a poor prognosis 6,13,[16][17][18][19] . However, our study showed that brain involvement is not associated with AIFRS-specific survival rate because four of six patients with intracranial fungal abscesses were successfully treated with antifungal agents and/or surgery.…”

Section: Discussionmentioning

confidence: 99%

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Treatment outcomes in acute invasive fungal rhinosinusitis extending to the extrasinonasal area

Nam

Chung

Choi

et al. 2020

Sci Rep

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Acute invasive fungal rhinosinusitis (AifRS) can spread beyond the sinonasal cavity. it is necessary to analyze the association between the specific site involved in the extrasinonasal area and the survival rate to predict patient prognosis. We investigated 50 patients who had extrasinonasal lesions on preoperative gadolinium (Gd)-enhanced magnetic resonance imaging (MRi) scan and underwent wide surgical resection of AIFRS. The specific sites with loss of contrast enhancement (LoCE) on Gd-enhanced MRI were analyzed for AIFRS-specific survival rate. The most common underlying disease was diabetes mellitus followed by hematological malignancy. the most common symptoms were headache and facial pain. Seven patients (14.0%) expired because of AIFRS progression. Poor prognosis was independently associated with Loce at the skull base on preoperative MRi (HR = 35.846, P = 0.004). In patients with AifRS extending to the extrasinonasal area, Loce at the skull base was an independent poor prognostic factor. Acute invasive fungal rhinosinusitis (AIFRS) is a rare but fatal disease, particularly in immune-compromised patients, including those with hematological malignancies, poorly controlled diabetes mellitus (DM), and those who received immunosuppressive treatment following organ transplantation or chemotherapy for solid organ malignancies 1-3. Surgical debridement, systemic antifungal therapy, and prompt correction of the underlying systemic disease are necessary for treatment of AIFRS 4,5. A recent systematic review of AIFRS reported a mortality rate of 49.7% that advanced age and intracranial involvement were independent poor prognostic factors, and that DM and surgical resection were good prognostic factors 6. Surgical resection of necrotic tissue is an important treatment modality for AIFRS; therefore, the extent of AIFRS may be a significant prognostic factor. Recently, it has been shown that information from gadolinium (Gd)-enhanced magnetic resonance imaging (MRI) may be helpful in predicting prognosis 7. Loss of contrast enhancement (LoCE) on MRI reveals tissue infarction secondary to vessel invasion by a fungus 8-10 , which cannot be infiltrated by antifungal agents and requires surgical resection. However, the surgeon may be reluctant to remove the extrasinonasal lesion if there is a lesion on the site that is likely to cause serious postoperative complications, including cerebrospinal fluid (CSF) leakage and large vessel injury. Therefore, analyzing the relationship between the specific site of involvement in the extrasinonasal area and the survival rate is important in predicting patient prognosis. To the best of our knowledge, there are no previous reports on the relationship between specific sites with LoCE on Gd-enhanced MRI and prognosis of AIFRS. In the present study, we aimed to analyze the clinical features of patients with AIFRS extending to the extrasinonasal area and to identify prognostic factors for AIFRS-specific survival rate in terms of specific sites involved. Results Headache and facial pain are...

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Treatment outcomes in acute invasive fungal rhinosinusitis extending to the extrasinonasal area

Nam

Chung

Choi

et al. 2020

Sci Rep

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“…Of the 3 entities AIFS is certainly the most well described, and CGIFS seems to be geographically isolated to the Sudan, Pakistan, and India 2,5,6 . Numerous studies have described AIFS as that with an aggressive disease process and poor survivorship 17‐22 . Conversely, CIFS is less commonly described, has a seemingly indolent clinical course, and is without a known geographic pattern 1‐3,6 .…”

Section: Discussionmentioning

confidence: 99%

A multi‐institutional review of outcomes in biopsy‐proven chronic invasive fungal sinusitis

Humphreys

Wandell

Miller

et al. 2020

Int Forum Allergy Rhinol

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Background: Chronic invasive fungal sinusitis (CIFS) is a rare, life-threatening infection of the nose and sinuses. This study aims to identify factors that impact survival in 1 of the largest cohorts to date.Methods: Pathology records were reviewed for biopsyproven CIFS from 3 tertiary academic institutions from 1995 to 2016. Variables were analyzed using log-rank survival analysis. Univariate Cox regression was performed at 1 and 12 months.Results: Thirty-eight patients were included. Hematologic malignancy and diabetes were the most common underlying diseases (32% each). Aspergillus was the most common fungus (63%). Greater than 75% of the patients had an absolute neutrophil count (ANC) >1000 at the time of diagnosis. Overall survival at 1, 6, and 12 months was 89%, 68%, and 48%, respectively. In univariate analysis, factors associated with worse survival included: ANC <500 at 12 months (hazard ratio [HR] 4.8; p = 0.01), ANC <1000 at 12 months (HR 5.8; p = 0.001), and recent chemotherapy (HR 4; p = 0.01). The following factor was associated with improved survival in univariate analysis: ANC as a linear variable in the entire cohort (HR 0.7; p = 0.005). Conclusion:We present a multi-institutional case-series of CIFS and long-term follow-up. ANC <1000 at time of diagnosis and recent chemotherapy (within 1 month of diagnosis) are associated with poorer survival, whereas a rising ANC >1000 is associated with improved survival at 12 months. Further prospective studies are needed to further define factors that affect outcomes. C 2020 ARS-AAOA, LLC.

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“…Adam Kaplon, BA 1 , Suraj Kedarisetty, MD 2 , and Caitlin McLean, MD 2 This case was institutional review board exempt according to Temple University protocol. A 58-year-old female with history of recurrent refractory chronic lymphocytic leukemia (CLL) on ibrutinib presented with one week of nasal congestion, rhinorrhea, and anosmia.…”

Section: Intranasal Herpes Simplex Virus (Hsv): a Unique Mimicker Of mentioning

confidence: 99%

Intranasal Herpes Simplex Virus (HSV): A Unique Mimicker of Acute Invasive Fungal Rhinosinusitis

2019

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A multi‐institutional review of outcomes in biopsy‐proven acute invasive fungal sinusitis

Abstract: We presented the largest series of AIFS. Further studies are needed to examine the importance of ANC in diagnosis and prognosis. Patients diagnosed with atypical organisms may be at higher risk of death. IST likely improves short-term survival, but prospective studies are needed.

Cited by 47 publications

References 32 publications

Treatment outcomes in acute invasive fungal rhinosinusitis extending to the extrasinonasal area

Treatment outcomes in acute invasive fungal rhinosinusitis extending to the extrasinonasal area

A multi‐institutional review of outcomes in biopsy‐proven chronic invasive fungal sinusitis

Intranasal Herpes Simplex Virus (HSV): A Unique Mimicker of Acute Invasive Fungal Rhinosinusitis

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