Validate the classification of fungal rhinosinusitis: A retrospective analysis of 162 patients at a single institution

Hua, Man‐Wei; Wu, Chih-Ying; Jiang, Rong–San; Chang, Ching-Yun; Liang, Kai‐Li

doi:10.1111/coa.13413

Cited by 4 publications

(12 citation statements)

References 10 publications

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“…Presentation can be grouped into general categories of constitutional, sinonasal, otolaryngologic, cranial nerve, and ophthalmologic manifestations. Constitutional symptoms included fever (ranging from 9% to 100% of patients in identified studies), 4,6,15,19,31,48–49,52 headache (25% to 100%), 33–34,43,53 and altered mental status (11% to 27%) 17,45,51 . Sinonasal signs and symptoms reported include nasal congestion (14% to 100%), 4,22,48–49,52 nasal crusting/eschar (8% to 90%), 20,36,44,56 rhinorrhea (21% to 66%), 6,19,20 necrotic mucosa (21% to 100%), 28,29,53 and septal perforation/ulceration (9% to 38%) 35,46,51 .…”

Section: Signs and Symptomsmentioning

confidence: 99%

“…Cranial nerve symptoms (25% to 49%), 30,33,39,57 including facial anesthesia (8% to 55%), 5,7,15,31,37–38,56,58 palatal anesthesia (up to 8%), 15 and facial paralysis (25% to 44%), 33,47 as well as ophthalmologic symptoms/symptoms, which include loss of visual acuity (26% to 87%), 17,26,30,38 proptosis (16% to 100%), 35,45,47 ophthalmoplegia (17% to 60%), 28,38,42,58 diplopia/extraocular muscle weakness (9% to 50%), 7,24,46,55 and ptosis (up to 100% in some series) 26,35,45 frequently develop if the disease extends outside the sinonasal cavity.…”

Section: Signs and Symptomsmentioning

confidence: 99%

“…Tissue fungal culture is an important component of AIFS diagnosis and treatment 7,17,28,31,33,60,61 . Intraoperatively collected tissue or aspirates, not swabs, maximize yield 62 .…”

Section: Laboratory and Microbiology Diagnosticsmentioning

confidence: 99%

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Diagnosis, Prognosticators, and Management of Acute Invasive Fungal Rhinosinusitis: Multidisciplinary Consensus Statement and Evidence‐Based Review with Recommendations

Roland

Humphreys

et al. 2023

Int Forum Allergy Rhinol

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BackgroundAcute invasive fungal sinusitis (AIFS) is an aggressive disease that requires prompt diagnosis and multidisciplinary treatment given its rapid progression. However, there is currently no consensus on diagnosis, prognosis, and management strategies for AIFS, with multiple modalities routinely employed. The purpose of this multi‐institutional and multidisciplinary evidence‐based review with recommendations (EBRR) is to thoroughly review the literature on AIFS, summarize the existing evidence, and provide recommendations on the management of AIFS.MethodsThe PubMed, EMBASE, and Cochrane databases were systematically reviewed from inception through January 2022. Studies evaluating management for orbital, non‐sinonasal head and neck, and intracranial manifestations of AIFS were included. An iterative review process was utilized in accordance with EBRR guidelines. Levels of evidence and recommendations on management principles for AIFS were generated.ResultsA review and evaluation of published literature was performed on 12 topics surrounding AIFS (signs and symptoms, laboratory and microbiology diagnostics, endoscopy, imaging, pathology, surgery, medical therapy, management of extrasinus extension, reversing immunosuppression, and outcomes and survival). The aggregate quality of evidence was varied across reviewed domains.ConclusionBased on the currently available evidence, judicious utilization of a combination of history and physical examination, laboratory and histopathologic techniques, and endoscopy provide the cornerstone for accurate diagnosis of AIFS. In addition, AIFS is optimally managed by a multidisciplinary team via a combination of surgery (including resection whenever possible), antifungal therapy, and correcting sources of immunosuppression. Higher quality (i.e., prospective) studies are needed to better define the roles of each modality and determine diagnosis and treatment algorithms.

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Section: Signs and Symptomsmentioning

confidence: 99%

Section: Signs and Symptomsmentioning

confidence: 99%

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Diagnosis, Prognosticators, and Management of Acute Invasive Fungal Rhinosinusitis: Multidisciplinary Consensus Statement and Evidence‐Based Review with Recommendations

Roland

Humphreys

et al. 2023

Int Forum Allergy Rhinol

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“…Nevertheless, this criteria does not fit into IFS well, as IFS can occur in immunocompetent patients. Liang et al observed sinonasal fungal infection demonstrating transitional changes between each classification [42], which corresponds to Kosmidis's proposal that different forms of pulmonary aspergillosis should be viewed as a semicontinuous spectrum of disease and one form may evolve into another [43]. Therefore, we proposed that although there was no histopathologic evidence of invasive fungal disease, if the patient suffered a fungal rhinosinusitis with clinically apparent neuro-orbital complications, the patient still would benefit from aggressive treatment with early surgical debridement followed by systemic anti-fungal medications.…”

Section: Discussionmentioning

confidence: 99%

Invasive Fungal Rhinosinusitis with and without Orbital Complications: Clinical and Laboratory Differences

Twu

Kuo

et al. 2021

JoF

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Background: Invasive fungal rhinosinusitis (IFS) is a rare but often fatal disease. There are limited studies regarding IFS with orbital complications (IFSwOC). The present study aimed to identify the clinical signs associated with IFSwOC and prognosticators of the disease. Methods: A retrospective case series was conducted of patients histopathologically confirmed IFS or fungal rhinosinusitis with clinically apparent neuro-orbital complications who underwent surgery between 2008 and 2018. Demographic data, presenting symptoms and signs, culture data, laboratory results, and patient outcomes were obtained from medical records. Results: A total of 38 patients were identified, including 9 patients with IFSwOC, and 29 patients with IFS without orbital complications (IFSsOC). The clinical signs associated with developing orbital complications include headache, fever, sphenoid sinus, or posterior ethmoid sinus involvement, CRP level ≥ 1.025 mg/dL, or ESR level ≥ 46.5 mm/h. In IFSwOC group, male, posterior ethmoid sinus involvement, WBC count ≥ 9000 μL, CRP level ≥ 6.91 mg/dL, or ESR level ≥ 69 mm/h were correlated with a significantly poorer prognosis. Conclusion: IFS patients with sphenoid or posterior ethmoid sinus involvement, headache or fever as presenting symptoms, elevated CRP, and ESR level were at risk of developing orbital complications. Timely surgical debridement followed by systemic antifungal treatment may improve treatment outcomes.

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“…Acute invasive fungal rhinosinusitis (AIFRS) is a rare but life-threatening infectious disease. It demonstrates both a fulminant clinical course, as well as provides pathological evidence of angioinvasion by fungal hyphae or acute tissue necrosis [ 1 – 3 ]. AIFRS is an opportunistic disease seen mostly in immunocompromised patients.…”

Section: Introductionmentioning

confidence: 99%

Acute Invasive Fungal Rhinosinusitis-Related Orbital Infection: A Single Medical Center Experience

Huang

Liang

et al. 2021

Journal of Ophthalmology

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Backgrounds. Acute invasive fungal rhinosinusitis (AIFRS) is a hazardous infectious disease with rapid progression and high mortality and morbidities. Further orbital involvement is commonly seen. This study aims to analyze risk factors, clinical characteristics, and outcomes between patients with or without orbital involvement. Methods. A retrospective review was performed in a single tertiary medical center over a span of 13 years (2005–2018). A total of 21 patients with diagnosis of AIFRS were enrolled. We reviewed the patients’ basic characteristics, comorbidities, clinical presentations, image study findings, culture pathogens, and treatment outcomes and analyzed the differences between orbital-involved and orbital sparing disease. Results. The most common comorbidities in AIFRS were diabetes mellitus (DM) and hematological malignancy. Nine the 21 AIFRS patients had orbital-involved disease. Patients with orbital involvement had a higher prevalence of DM ( p < 0.05 ). Image studies revealed significant infection of the ethmoid sinus, sphenoid sinus, and frontal sinus in the group with orbital complication ( p < 0.05 ). Mucor, Rhizopus, and Aspergillus were cultured in both groups. Five patients in the orbital involvement group expired, with all of them having an initial presentation of conscious disturbance ( p < 0.01 ). Rhino-orbital-cerebral fungal infection was noticed in 3 of the 5 expired patients. Conclusion. In AIFRS patients, DM other than hematological malignancy was the main risk factor for orbital-involved disease. Patients with ethmoid, sphenoid, or frontal sinusitis had a higher possibility of orbital complication. Poor consciousness at initial presentation revealed highest possibility of rhino-orbital-cerebral fungal infection and led to death.

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Validate the classification of fungal rhinosinusitis: A retrospective analysis of 162 patients at a single institution

Cited by 4 publications

References 10 publications

Diagnosis, Prognosticators, and Management of Acute Invasive Fungal Rhinosinusitis: Multidisciplinary Consensus Statement and Evidence‐Based Review with Recommendations

Diagnosis, Prognosticators, and Management of Acute Invasive Fungal Rhinosinusitis: Multidisciplinary Consensus Statement and Evidence‐Based Review with Recommendations

Invasive Fungal Rhinosinusitis with and without Orbital Complications: Clinical and Laboratory Differences

Acute Invasive Fungal Rhinosinusitis-Related Orbital Infection: A Single Medical Center Experience

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