Invasive mould sinusitis in patients with haematological malignancies: a 10 year single-centre study

Abstract

Despite combined medical and surgical therapy, IMS had high mortality. Mortality risk factors were relapsed and/or refractory malignancy, cytopenia and Aspergillus infection in this study.

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

“…Similar to our results, Davoudi et al observed that hematologic malignancy is associated with increased risk of death at 3 months . In accordance with previous studies, diabetes correlated with improved survival on univariate analysis .…”

“…Acute invasive fungal sinusitis (AIFS) is a rare infection that typically occurs in immunocompromised patients when fungi, usually Aspergillus or Mucor , invade the mucosa of the paranasal sinuses and destroy adjacent structures through angioinvasion . Its mortality is high even with timely diagnosis and treatment: ∽50% in the largest meta‐analysis to date .…”

“…Its mortality is high even with timely diagnosis and treatment: ∽50% in the largest meta‐analysis to date . Risk factors for AIFS are related to functional and quantitative neutropenia, such as in cases of uncontrolled diabetes mellitus, hematologic malignancy (especially acute myeloid leukemia), chemotherapy, corticosteroid use, renal/liver failure, bone marrow transplantation (BMT), HIV/AIDS, or autoimmune disease …”

“…Early debridement may be key, as it provides histologic confirmation, fungal speciation, and directs antifungal therapy. Further, as absolute neutrophil count (ANC) recovery is correlated with improved survival, immune‐stimulating therapies (ISTs) are used with unknown efficacy . IST includes such therapies as granulocyte colony‐stimulating factor (G‐CSF), granulocyte macrophage colony‐stimulating factor (GM‐CSF), and granulocyte transfusions.…”

“…The cause of immunosuppression may play a role: acute mylogenous leukemia, renal failure, and diabetes have been associated with worse outcomes. Some studies reported that Mucor infections portend worse outcomes . Involvement of the hard palate, septum, ethmoid sinus, orbit, and brain may increase mortality.…”