Frequency of Granulomatous Invasive Fungal Sinusitis in Patients with Clinical Suspicion of Chronic Fungal Rhinosinusitis

Sharif, Muhammad; Ali, Salman; Nisar, Hasan

doi:10.7759/cureus.4757

Cited by 7 publications

(6 citation statements)

References 16 publications

(20 reference statements)

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“…In our study, the mean age of patients with FRS was 32.8±14 years. This is in concordance with the literature showing majority cases of FRS in the third and fourth decades of life [ 6 , 10 , 15 ]. Our study showed males, 84 (57.53%), to be predominantly affected by FRS.…”

Section: Discussionsupporting

confidence: 93%

Identification of a Unique Morphological Pattern for the Diagnosis of Fungal Rhinosinusitis

Maruf¹,

Loya²,

Mushtaq³

et al. 2023

Cureus

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Fungal rhinosinusitis (FRS) is a relatively common, but often misdiagnosed disease of paranasal sinuses. The FRS is classified into invasive and non-invasive forms. The non-invasive form includes fungal ball and allergic FRS, and invasive form includes acute invasive FRS, chronic invasive FRS, and granulomatous FRS. Invasive fungal infections are associated with high morbidity and mortality, hence requiring urgent medical and surgical intervention. The histomorphology can help identify certain fungal organisms that cannot be cultured or are rarely visible in exudates. The morphologic diagnosis of tissue invasive and non-invasive fungal infection is essential for appropriate treatment.We analyzed cases of rhinosinusitis from 2017 to 2019 in Pathology Department at a tertiary care cancer hospital, Lahore, Pakistan. All clinical information was retrieved from patient records. Paraffin-embedded tissue blocks were stained with hematoxylin and eosin (H&E), special Grocott methenamine silver stain (GMS), and periodic acid Schiff stain (PAS) according to standard protocol. They were reviewed by two pathologists blinded by fungus status.A total of 169 cases of rhinosinusitis were reviewed. FRS comprised 146 (86.4%) of them. The mean age of patients with FRS was 32.8±14 years. The male:female ratio was 1.4:1. Maxillary sinus was the main site of involvement in 39 (27%) FRS cases. Aspergillus was identified in 117 (80.1%) cases of FRS. The culture reports were available in 44/146 (30.14%) FRS cases. They were negative in 22/44 (50.0%), and Aspergillus species were isolated in 18/44 (40.9%) cases of FRS.There were 84 (57.5%) cases of non-invasive FRS and 59 (40.4%) cases of invasive FRS. Among invasive FRS, there were 56 (38.4%) chronic granulomatous FRS cases including mixed patterns. Majority cases, 54 (96.4%), of chronic granulomatous FRS showed a unique crowded giant cell pattern comprising of foreign body and Langhans type giant cells. These giant cells were arranged closely forming irregular non-caseating granulomas surrounded by lymphocytes and fibrosis. Interestingly, the giant cells were scattered haphazardly without forming a granuloma as well. Fungal organisms were identified in all 56 cases of chronic granulomatous FRS. Histologically, predominant organism was Aspergillus in 48 (85.7%) on GMS and PAS stain.Our study observed a unique crowded giant cell pattern, which is a hallmark of invasive fungal infection. If pathologists are familiar with this unique pattern, they can make a quick and accurate diagnosis on histology. The physician can start antifungal treatment timely for better prognosis.

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Section: Discussionsupporting

confidence: 93%

Identification of a Unique Morphological Pattern for the Diagnosis of Fungal Rhinosinusitis

Maruf¹,

Loya²,

Mushtaq³

et al. 2023

Cureus

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“…GCIFR is an uncommon disease mainly caused by Aspergillus flavus infection with geographic predilection towards Sudan, India, Pakistan, and Saudi Arabia, with few cases reported in North America and none reported in Mexico ( Table 1 ) [ 3 , 8 ]. Its prevalence among individuals with clinical suspicion of fungal rhinosinusitis has been reported in approximately 20% in subtropical populations, unlike North America, with a prevalence of 0.5% [ 8 , 9 ]. This distinction is attributable to tropical climate, which gives a microaerophilic sinus environment and promotes the growth of A. flavus [ 10 ].…”

Section: Discussionmentioning

confidence: 99%

“Chronic granulomatous invasive fungal rhinosinusitis associated with SARS-CoV-2 infection: A case report”

Treviño‐González

Santos-Santillana

Maldonado-Chapa

et al. 2021

Annals of Medicine and Surgery

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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 .…”

Section: Discussionmentioning

confidence: 99%

“…Importantly, CIFS also differs from chronic granulomatous invasive fungal sinusitis (CGIFS) in that there are no granulomas seen on histopathology. Further, most cases of CGIFS have been described in immunocompetent patients from the Sudan, Pakistan, and India, whereas this geographic bias has not been seen in CIFS 2,5 . However, as compared to AIFS in particular, the clinical outcomes of CIFS have been less well described.…”

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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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Frequency of Granulomatous Invasive Fungal Sinusitis in Patients with Clinical Suspicion of Chronic Fungal Rhinosinusitis

Cited by 7 publications

References 16 publications

Identification of a Unique Morphological Pattern for the Diagnosis of Fungal Rhinosinusitis

Identification of a Unique Morphological Pattern for the Diagnosis of Fungal Rhinosinusitis

“Chronic granulomatous invasive fungal rhinosinusitis associated with SARS-CoV-2 infection: A case report”

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

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