Invasive Fungal Adenoiditis

Adelson, Robert T.; Zito, Joseph; Romaguera, Rita L.

doi:10.1016/j.otohns.2005.12.018

Cited by 6 publications

(11 citation statements)

References 4 publications

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“…5,11 There have been reports that the diagnostic rate of mucormycosis is lower in frozen sections than aspergillus. 5,6 This was in accord with our results showing that frozen biopsy was more sensitive in Aspergillus than Mucor. Aspergillus is more organized and tends to form fungal "balls", making them more easily identifiable, while Mucor has a wider, looser, less organized structure that is more difficult to visualize in frozen sections without staining.…”

Section: Discussionsupporting

confidence: 90%

“…1,4,5 The accuracy of diagnoses based on frozen sections has been questioned, given the pathological changes seen in AIFRS tissues and the challenges associated with identifying fungi in frozen sections. 6,7 Although several studies have evaluated whether frozen biopsies are useful for AIFRS diagnosis, a formal meta-analysis has not yet been conducted. Therefore, we performed a meta-analysis to evaluate the utility of intraoperative frozen section biopsies for diagnosing AIFRS.…”

Section: Introductionmentioning

confidence: 99%

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Usefulness of intraoperative frozen section for diagnosing acute invasive fungal rhinosinusitis: A systematic review and meta‐analysis

Kim

Hwang

2021

Int Forum Allergy Rhinol

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Background:The accuracy of diagnoses of acute invasive fungal rhinosinusitis (AIFRS) based on frozen sections has been questioned.Methods: PubMed, the Cochrane Central Register of Controlled Trials, Embase, Web of Science, SCOPUS, and Google Scholar were used for data sources. Truepositive, true-negative, false-positive, and false-negative data were extracted for each study. Methodological quality was evaluated using the Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2) Tool.Results: Nine prospective and retrospective studies were included. The diagnostic odds ratio of intraoperative frozen section in AIFRS was 124.4717 (95% confidence interval [CI], 75.5168-205.1623). The area under the summary receiver operating characteristic curve was 0.906. The sensitivity, specificity, and positive predictive value were 0.8337 (95% CI, 0.7962-0.8655), 0.9858 (95% CI, 0.9330-0.9971), and 0.9822 (95% CI, 0.8905-0.9973), respectively. The correlation between sensitivity and the false-positive rate was 0.437, indicating a lack of heterogeneity.In subgroup analysis, the "per patient" subgroup tended to show higher diagnostic accuracy than the "per specimen" subgroup. Regarding fungal species, the frozen biopsy of aspergillus showed higher sensitivity than that of mucor (0.8103 vs. 0.7544). Conclusion:Positive frozen sections are reliable and facilitate early intervention in AIFRS. Collecting multiple specimens during surgery will decrease the rate of false-negative results.

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Section: Discussionsupporting

confidence: 90%

Section: Introductionmentioning

confidence: 99%

Usefulness of intraoperative frozen section for diagnosing acute invasive fungal rhinosinusitis: A systematic review and meta‐analysis

Kim

Hwang

2021

Int Forum Allergy Rhinol

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“…reported that 4 of 5 false negatives in their study were Mucor on final pathology. Further, a case study by Adelson et al . reported all frozen sections sent for a patient with AIFRS were negative but were later found to be positive for Mucor on final pathology.…”

Section: Discussionmentioning

confidence: 99%

Utility of intraoperative frozen sections in surgical decision making for acute invasive fungal rhinosinusitis

Papagiannopoulos

Lin

Al‐Khudari

et al. 2017

Int Forum Allergy Rhinol

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This study represents the largest series assessing the diagnostic accuracy of frozen section analysis in AIFRS. Frozen section analysis is an effective tool for guiding intraoperative decision making in patients with AIFRS with a high PPV. A Low NPV underscores the importance of clinical suspicion and intraoperative decision making based on endoscopic findings when negative frozen section results are encountered. Further, frozen section analysis appears to be equally effective in detecting either Mucor or Aspergillus.

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“…Invasive fungal disease is a feared complication in patients with compromised immune systems. The most studied site of invasive fungal infection remains sinonasal, but other sites have also been described, including the larynx, tracheobronchial tree, 2,3 thyroid, periorbital region, and adenoids 4,5 . To our knowledge, this is the first description of invasive fungal pharyngitis in a pediatric patient, and the second report of a patient with invasive fungal pharyngitis 6 …”

Section: Discussionmentioning

confidence: 80%

“…It is characterized by angioinvasion and necrosis on pathology. Diagnosis of IFD is often delayed, notably in non‐sinonasal disease, given the few reported cases and higher likelihood of bacterial or viral infection at other sites 2‐5 . To our knowledge, we present here the first reported pediatric case of invasive fungal disease of the pharynx in a 10‐year‐old immunosuppressed patient.…”

Section: Introductionmentioning

confidence: 90%

Invasive fungal pharyngitis in a pediatric bone marrow transplant patient

Redmann

Myer

Khandelwal

et al. 2021

Pediatric Transplantation

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Invasive fungal disease of the head and neck is a potentially fatal infection most commonly seen in immunocompromised patients. Even in the setting of combined surgical and medical treatment, prognosis is generally poor. We report the first pediatric case of invasive fungal pharyngitis and summarize a review of the literature. A 10-year-old female patientwith aplastic anemia status post-bone marrow transplant and accompanying immunosuppression initially presented with a diagnosis of a peritonsillar abscess. Incision and drainage did not show purulence, but culture grew out Rhizopus species. Immediately after diagnosis, the patient was treated successfully with aggressive staged surgical debridement and antifungal medications and had an excellent functional outcome 2 years after initial presentation. Invasive fungal disease is most common in the sinonasal region, but alternative sites of disease must be considered in immunocompromised patients who present with atypical symptoms.

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Invasive Fungal Adenoiditis

Cited by 6 publications

References 4 publications

Usefulness of intraoperative frozen section for diagnosing acute invasive fungal rhinosinusitis: A systematic review and meta‐analysis

Usefulness of intraoperative frozen section for diagnosing acute invasive fungal rhinosinusitis: A systematic review and meta‐analysis

Utility of intraoperative frozen sections in surgical decision making for acute invasive fungal rhinosinusitis

Invasive fungal pharyngitis in a pediatric bone marrow transplant patient

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