Acute Invasive Fungal Rhinosinusitis

Payne, Sakeena J.; Mitzner, Ron; Kunchala, Sudhir; Roland, Lauren T.; McGinn, Johnathan D.

doi:10.1177/0194599815627786

Cited by 74 publications

(56 citation statements)

References 13 publications

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“…By using the bilateral mean model, we demonstrated that Mucor induced AIFR is associated with higher prevalence of bilateral findings. Similar to prior studies evaluating patients with AIFR, facial soft tissue thickening and orbital involvement were not common features 4 , 25 . Mucosal thickening in the sinuses was a common feature both in Mucor and Aspergillus AIFR as has been previously reported 18 , 20 , 26 .…”

Section: Discussionsupporting

confidence: 84%

A model for classification of invasive fungal rhinosinusitis by computed tomography

Slonimsky

McGinn

Goyal

et al. 2020

Sci Rep

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Our purpose was to classify acute invasive fungal rhinosinusitis (AIFR) caused by Mucor versus Aspergillus species by evaluating computed tomography radiological findings. Two blinded readers retrospectively graded radiological abnormalities of the craniofacial region observed on craniofacial CT examinations obtained during initial evaluation of 38 patients with eventually pathology-proven AIFR (13:25, Mucor:Aspergillus). Binomial logistic regression was used to analyze correlation between variables and type of fungi. Score-based models were implemented for analyzing differences in laterality of findings, including the 'unilateral presence' and 'bilateral mean' models. Binary logistic regression was used, with Score as the only predictor and Group (Mucor vs Aspergillus) as the only outcome. Specificity, sensitivity, positive predictive value, negative predictive value and accuracy were determined for the evaluated models. Given the low predictive value of any single evaluated anatomical site, a 'bilateral mean' score-based model including the nasal cavity, maxillary sinuses, ethmoid air cells, sphenoid sinus and frontal sinuses yielded the highest prediction accuracy, with Mucor induced AIFR correlating with higher prevalence of bilateral findings. The odds ratio for the model while integrating the above anatomical sites was 12.3 (p < 0.001). PPV, NPV, sensitivity, specificity and accuracy were 0.85, 0.82, 0.92, 0.69 and 0.84 respectively. The abnormal radiological findings on craniofacial CT scans of Mucor and Aspergillus induced AIFR could be differentiated based on laterality, with Mucor induced AIFR associated with higher prevalence of bilateral findings. Acute invasive fungal rhinosinusitis (AIFR) is a rapidly progressive and life-threatening infection involving the nasal cavity and paranasal sinuses 1-3. Patients with early stage AIFR limited to the nasal cavity and paranasal sinuses, have relatively lower mortality rates 2 , while intracranial extension doubles the mortality 4. While a variety of causative organisms have been identified, Aspergillus and Mucor fungal species are predominant 3. The most commonly predisposing conditions involve immunodeficiency and include hematologic malignancies, poorly controlled diabetes mellitus, chemotherapy or immunosuppression due to hematopoietic stem cells or organ transplantation 5,6. Even though AIFR is a rare disease, its high mortality rate of approximately 50% 7 highlights the importance of an appropriate and early diagnosis followed by aggressive treatment utilizing a combination of surgical debridement, antifungal pharmacotherapy and restoration of the patient's immune system when possible 8. In many cases, AIFR is a manifestation of an overall poor prognosis with mortality attributed to the underlying medical condition 3. Early diagnosis and treatment of AIFR is of paramount importance to reduce patient morbidity and mortality. Effective treatment consists of an early and aggressive debridement of the necrotic tissue to decrease the fungal load and reduce im...

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Section: Discussionsupporting

confidence: 84%

A model for classification of invasive fungal rhinosinusitis by computed tomography

Slonimsky

McGinn

Goyal

et al. 2020

Sci Rep

Self Cite

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“…Actually, as we observed in our current cohort, a significant percentage of patients with confirmed AIFRS (39.5%) had CT scans with few or even normal findings. Our data reinforce that nasal endoscopy must be elected as the preferred choice to evaluate patients at risk because it can reveal subtle changes in the nasal mucosa [6, 14, 15] that are not detected by imaging exams [6, 15]. Taking into consideration only CT scans findings, these patients would have experienced a delayed treatment, and this could negatively impact on their outcome.…”

Section: Discussionsupporting

confidence: 56%

“…The early diagnosis of AIFRS is challenging and demands accurate and fast tests [14]. With this aim, we have established a protocol to maximize the sensitivity to diagnose AIFRS, in such a way that patients under risk, with subtle or even with non-specific symptoms, are immediately referred by hematologists to ENT evaluation.…”

Section: Discussionmentioning

confidence: 99%

Impact of early detection of acute invasive fungal rhinosinusitis in immunocompromised patients

et al. 2019

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Background Early diagnosis of acute invasive fungal rhinosinusitis (AIFRS) is vital to improving outcomes in immunocompromised patients. This study evaluated the impact of a systematic protocol with nasal endoscopy and biopsies to early detect AIFRS in immunocompromised patients. Additionally, we compared the accuracy of frozen-section biopsy and culture with formalin-fixed paraffin-embedded (FFPE) biopsy. Methods Retrospective cohort in a Tertiary Referral Hospital. Patients with the suspected diagnosis of AIFRS were evaluated following a standardized protocol, including serial nasal endoscopies and biopsies when necessary. The sensitivity and specificity of frozen-section biopsy and culture were also compared with FFPE. Results The mortality rate related to AIFRS of this standardized cohort (13/43) was 30.2%. Better outcomes were observed in patients with disease limited to the turbinates and in those with higher peripheral neutrophils count. Frozen-section biopsy positivity correlated with FFPE findings for fungi detection ( p-value < 0.0001), with a sensitivity of 90.6%, specificity of 72.7%, and accuracy of 86.0%. Conclusion Implementation of this standardized protocol was related to a considerably low mortality rate among patients with suspected AIFRS at our Institution. Frozen-section biopsy revealed high accuracy to diagnose AIFRS. The current protocol including frozen-tissue biopsy improved the evaluation and survival rates of immunocompromised patients with presumed AIFRS.

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“…In our review, the most commonly affected region was the paranasal sinuses (eight patients, 100%), followed by the orbit (three patients, 37.5%), brain (two patients, 25%), and lung (two patients, 25%). Payne et al[20] studied 41 cases of acute invasive fungal sinusitis and found that mucosal abnormalities of the middle turbinate and septum, specifically necrosis of the middle turbinate, could be important predictors of disease. Among eight patients, there were six with Cunninghamella infection confirmed by culture/biopsy from the nasal cavity, one with Cunninghamella infection confirmed by culture of the sputum, and one (our patient) with Cunninghamella infection confirmed by culture of the eye canthus secretions.…”

Section: Discussionmentioning

confidence: 99%

Successful treatment of invasive fungal rhinosinusitis caused by Cunninghamella: A case report and review of the literature

Liu

Zhou

Cheng

et al. 2019

WJCC

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BACKGROUNDInvasive fungal rhinosinusitis (IFR) caused by Cunninghamella is very rare but has an extremely high fatality rate. There have been only seven cases of IFR caused by Cunninghamella reported in English and, of these, only three patients survived. In this article, we present another case of IFR caused by Cunninghamella, in which the patient was initially treated successfully but then deteriorated due to a relapse of leukemia 2 mo later.CASE SUMMARYA 50-year-old woman presented with a 2-mo history of right ocular proptosis, blurred vision, rhinorrhea and nasal obstruction. Nasal endoscopic examination showed that the middle turbinate had become necrotic and fragile. Endoscopic sinus surgery and enucleation of the right orbital contents were performed successively. Additionally, the patient was treated with amphotericin B both systematically and topically. Secretion cultivation of the right eye canthus showed infection with Cunninghamella, while postoperative pathology also revealed fungal infection. The patient’s condition gradually stabilized after surgery. However, the patient underwent chemotherapy again due to a relapse of leukemia 2 mo later. Unfortunately, her leukocyte count decreased dramatically, leading to a fatal lung infection and hemoptysis.CONCLUSIONAggressive surgical debridements, followed by antifungal drug treatment both systematically and topically, are the most important fundamental treatments for IFR.

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Acute Invasive Fungal Rhinosinusitis

Cited by 74 publications

References 13 publications

A model for classification of invasive fungal rhinosinusitis by computed tomography

A model for classification of invasive fungal rhinosinusitis by computed tomography

Impact of early detection of acute invasive fungal rhinosinusitis in immunocompromised patients

Successful treatment of invasive fungal rhinosinusitis caused by Cunninghamella: A case report and review of the literature

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