Managing acute invasive fungal sinusitis

Dwyhalo, Kristina M.; Donald, Carrlene B.; Mendez, Anthony P.; Hoxworth, Joseph M.

doi:10.1097/01.jaa.0000473374.55372.8f

Cited by 11 publications

(15 citation statements)

References 22 publications

(22 reference statements)

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“…Imaging workup is essential to evaluate extra-sinonasal extensiveness of the disease and for surgical planning. CT scans and MRI are necessary to evaluate bone and soft tissue involvements (i.e., orbit/brain), respectively [2, 8], although their findings in early stages are usually non-specific [7]. Unilateral disease and bone thickening on CT scans are highly suggestive of AIFRS [6].…”

Section: Introductionmentioning

confidence: 99%

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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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Section: Introductionmentioning

confidence: 99%

“…Formalin-fixed paraffin-embedded (FFPE) histopathological exam, including hematoxylin-eosin (HE) and Gomori methenamine-silver (GMS) staining, is the most reliable test to confirm fungi invasion into the tissue [3, 8, 9]. However, processing for FFPE is time-consuming, which contrasts with the urgency to diagnose AIFRS.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2019

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“…Chen et al[24] studied 46 patients with invasive fungal sinusitis and suggested that early introduction of an anti-fungal agent and aggressive surgical debridement potentially decrease morbidity and mortality in high-risk patients. Other accompanying treatments should include tight regulation of blood glucose, management of diabetic ketoacidosis, and reversal of the underlying immunocompromised state when possible[25].…”

Section: Discussionmentioning

confidence: 99%

“…Schwartz et al[27] studied 54 consecutive patients with acute myelogenous leukemia and reported that major factors associated with cases ultimately developing IFD included the duration of chemotherapy, the number of sites colonized with fungi, and the number of fungal species isolated on certain surveillance cultures. According to the study of Dwyhalo et al[25], patients who are diagnosed and treated early, i.e ., when the fungal load is low, have the best outcomes. In our case, the patient’s condition gradually stabilized after surgical debridement and antifungal drug treatment.…”

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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“…However, there is controversy regarding the best methods for the prevention, diagnosis and treatment of IFS. Early diagnosis and intervention are critical and could be lifesaving (4). The identification of species of the fungi is a key to anti-fungal therapy and also surgical intervention.…”

Section: Introductionmentioning

confidence: 99%

Clinical Manifestation and Diagnosis of Invasive Fungal Sinusitis in Patients with Hematological Malignancy

Mardani

Faghani

Tabarraee

et al. 2016

Arch Clin Infect Dis

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Background: Invasive fungal sinusitis (IFS) is a potentially deadly infection especially in patients with immunocompromising conditions. Objectives: The current study aimed to evaluate the clinical manifestations, outcomes and factors that may affect survival of patients with IFS. Methods: A cross sectional descriptive study was performed on hospitalized patients admitted to Taleghani hospital affiliated to Shahid Beheshti University of Medical Sciences, Tehran, Iran, from October 2012 to October 2013. The clinical data of 24 patients with IFS were reviewed. All patients had hematologic malignancies, and received broad spectrum chemotherapy. Demographic data, clinical characteristics, presented symptoms and signs, underlying diseases and outcomes of the patients were studied. Results: The age range of patients was 15 -60 years. The IFS was proven, probable and possible in 25%, 66.7% and 8.3% of the cases, respectively. Serum galactomannan antigen was positive in 41.6% of the cases; 15 out of 24 cases with IFS had received antifungal chemoprophylaxis before diagnosis, 54% fluconazole and 8.3% itraconazole. Aspergillus flavus (33%), Aspergillus fumigatus (20.8%), Aspergillus niger (16.7%) and Mucor spp. (16.7%) were responsible for incidence of IFS; 54% of IFS cases occurred in summer and 91.6% of occurred during hospital construction; a risk factor in 91.6% of the cases. Conclusions: Current study revealed that A. flavus was the most common isolated pathogen. Moreover, A. fumigatus was the second common isolated pathogen in patients with IFS. Additionally, the hospital construction was an important environmental risk factor for acquisition of infection in patients with hematological malignancy. The most common season for IFS incidence was summer. Additionally, the common causes of death in patients with IFS were primary disease and also resistance to chemotherapy (37.5%).

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Managing acute invasive fungal sinusitis

Cited by 11 publications

References 22 publications

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

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

Clinical Manifestation and Diagnosis of Invasive Fungal Sinusitis in Patients with Hematological Malignancy

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