Fungal Rhinosinusitis: A Retrospective Microbiologic and Pathologic Review of 400 Patients at a Single University Medical Center

Fungal Rhinosinusitis (FRS) is a well known entity, but only in more recent times have the types of FRS been more fully defined. In this study, we evaluate the diagnosis of FRS in a single medical center. Cases were divided into 2 main categories, non-invasive and invasive. Non-invasive FRS included fungus ball (FB) and allergic fungal rhinosinusitis (AFRS). Invasive FRS included acute invasive fungal rhinosinusitis (AIFRS), chronic invasive fungal rhinosinusitis (CIFRS), and chronic invasive granulomatous fungal rhinosinusitis (CGFRS). Fungal culture data, if available was reviewed. 400 patients with FRS were identified. 87.25% were non-invasive (45% AFRS, 40% FB, and 2% combined AFRS and FB and 12.5% were invasive 11% AIFRS 1.2% CIFRS 0.5% CGFRS. One patient (0.25%) had combined FB/CGFRS.Aspergillus sp.or dematiaceous species were the most common fungi isolated in AFS whileAspergillus sp.was most common in FB and AIFRS. In our experience, most FRS is non-invasive. In our patient population, invasive FRS is rare with AIFRS representing >90% of cases. Culture data supports that a variety of fungal agents are responsible for FRS, butAspergillus sp.appears to be one of the most common organisms in patients with FRS.

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Fungal diseases of the ear, nose, and throat

10.1093/med/9780198755388.003.0024 ◽

2017 ◽

Author(s):

Arunaloke Chakrabarti

Keyword(s):

Invasive Disease ◽

Sinus Disease ◽

Laryngeal Diseases ◽

Non Invasive ◽

Fungal Rhinosinusitis ◽

Acute Invasive Fungal Rhinosinusitis ◽

Invasive Infections ◽

Invasive Fungal Rhinosinusitis ◽

Chronic Invasive ◽

Nose And Throat

Fungal infection of the ear (otomycosis), nose (fungal rhinosinusitis), and throat (oropharyngeal candidiasis) are common diseases. Fungal laryngeal diseases and invasive otomycosis & acute fungal rhinosinusitis are much less common and occur in immunosuppressed hosts, including those with diabetes. Aspergillus and Candida spp. are the commonest causes of otomycosis, whilst Aspergillus spp. predominate in sinus disease, with members of the Mucorales also causing serious invasive infections. Management of the non-invasive conditions can be difficult, and otomycosis and rhinosinusitis often become chronic. Invasive disease usually requires surgical intervention along with appropriate antifungal therapy. Acute invasive fungal rhinosinusitis has a mortality of approximately 50%.

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NON-INVASIVE FUNGAL RHINOSINUSITIS. ALLERGIC FUNGAL RHINOSINUSITIS

10.33848/foliorl23103825-2019-25-2-59-66 ◽

2019 ◽

Vol 25 (2) ◽

pp. 59-66

Author(s):

L. Gariuc ◽

Keyword(s):

Non Invasive ◽

Fungal Rhinosinusitis ◽

Allergic Fungal Rhinosinusitis ◽

Invasive Fungal Rhinosinusitis

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Allergen Immunotherapy in an HIV+ Patient with Allergic Fungal Rhinosinusitis

Case Reports in Immunology ◽

10.1155/2015/875260 ◽

2015 ◽

Vol 2015 ◽

pp. 1-5 ◽

Cited By ~ 2

Author(s):

Ian A. Myles ◽

Satyen Gada

Keyword(s):

Allergen Immunotherapy ◽

Severe Infection ◽

Invasive Fungal Disease ◽

Fungal Disease ◽

Fungal Sinusitis ◽

Opportunistic Pathogens ◽

Fungal Rhinosinusitis ◽

Allergic Fungal Rhinosinusitis ◽

Invasive Fungal Rhinosinusitis ◽

Chronic Invasive

Patients with HIV/AIDS can present with multiple types of fungal rhinosinusitis, fungal balls, granulomatous invasive fungal rhinosinusitis, acute or chronic invasive fungal rhinosinusitis, or allergic fungal rhinosinusitis (AFRS). Given the variable spectrum of immune status and susceptibility to severe infection from opportunistic pathogens it is extremely important that clinicians distinguish aggressive fungal invasive fungal disease from the much milder forms such as AFRS. Here we describe a patient with HIV and AFRS to both remind providers of the importance of ruling out invasive fungal disease and outline the other unique features of fungal sinusitis treatment in the HIV-positive population. Additionally we discuss the evidence for and against use of allergen immunotherapy (AIT) for fungal disease in general, as well as the evidence for AIT in the HIV population.

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Retrospective Analysis of Patients With Acute Invasive Fungal Rhinosinusitis in a Single Tertiary Academic Medical Center: A 10-Year Experience

American Journal of Rhinology and Allergy ◽

10.1177/1945892419896233 ◽

2019 ◽

Vol 34 (3) ◽

pp. 324-330

Author(s):

Gennadiy Vengerovich ◽

Kristen A. Echanique ◽

Ki Wan Park ◽

Christine Wells ◽

Jeffrey D. Suh ◽

...

Keyword(s):

Medical Management ◽

Medical Center ◽

Academic Medical Center ◽

Sinus Surgery ◽

Open Approach ◽

Presenting Symptoms ◽

Fungal Rhinosinusitis ◽

Acute Invasive Fungal Rhinosinusitis ◽

Academic Medical ◽

Invasive Fungal Rhinosinusitis

Background Acute invasive fungal rhinosinusitis (AIFRS) is an aggressive, potentially fatal disease that can spread rapidly to the orbit and intracranial structures causing significant mortality and morbidity. Objective In this study, we present a 10-year experience from a tertiary academic medical center of patients presenting with AIFRS. Data on presentation, mortality rate, comorbidities, surgical, and medical management were analyzed. Methods A retrospective chart review was performed in a tertiary academic medical center of patients with AIFRS from January 2009 through February 2019. Data collected included demographics, presenting symptoms, comorbidities, immunosuppression status, endoscopic and imaging findings, orbital and intracranial complications, surgical and medical management, as well as outcomes and mortality. Results A total of 34 patients were identified. In our series, mortality was noted to be 61.8%, excluding patients who were lost to follow-up. The most common presenting symptoms included facial pain, ophthalmologic complaints, headaches, and proptosis. Only 4 of the 34 patients did not undergo surgical intervention, as they were not deemed surgical candidates; they all succumbed to their disease. Twenty-six of the 30 surgical patients (86.7%) underwent endoscopic sinus surgery, 8 underwent an open approach (26.7%), while 7 patients underwent orbital exenteration (23.3%). All patients had surgical pathology consistent with AIFRS. Fungal species isolated from culture included Aspergillus, Mucor/ Rhizopus, Candida, Cunninghamella Scedosporium boydii, Paecilomyces, and Scopulariopsis. Medical therapies included intravenous amphotericin B, caspofungin, posaconazole, voriconazole, isavuconazole, and micafungin. Conclusion AIFRS was associated with 61.8% mortality in our series of 34 patients over the past 10 years. Early diagnosis, as well as rapid and aggressive surgical and medical management, is necessary for optimal outcomes in this devastating disease.

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

Journal of Ophthalmology ◽

10.1155/2021/9987871 ◽

2021 ◽

Vol 2021 ◽

pp. 1-8

Author(s):

Yu-Fang Huang ◽

Kai-Li Liang ◽

Chiao-Ying Liang ◽

Po-Chin Yang ◽

Jun-Peng Chen ◽

...

Keyword(s):

Fungal Infection ◽

Hematological Malignancy ◽

Medical Center ◽

Initial Presentation ◽

Rapid Progression ◽

Orbital Involvement ◽

Fungal Rhinosinusitis ◽

Acute Invasive Fungal Rhinosinusitis ◽

Orbital Complication ◽

Invasive Fungal Rhinosinusitis

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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Invasive fungal rhinosinusitis

Romanian Journal of Rhinology ◽

10.2478/rjr-2019-0001 ◽

2019 ◽

Vol 9 (33) ◽

pp. 13-19

Author(s):

Lucia Gariuc ◽

Alexandru Sandul ◽

Lupoi Daniel

Keyword(s):

Risk Factors ◽

Early Treatment ◽

Imaging Techniques ◽

Diagnostic Information ◽

Immunocompromised Patients ◽

Fungal Rhinosinusitis ◽

Acute Invasive Fungal Rhinosinusitis ◽

Invasive Fungal Rhinosinusitis ◽

Chronic Invasive ◽

Systemic Antifungal Therapy

Abstract Invasive fungal rhinosinusitides are a group of disorders with three subtypes (acute invasive fungal rhinosinusitis, chronic invasive fungal rhinosinusitis and granulomatous invasive fungal rhinosinusitis), requiring urgent diagnosis and early treatment due to the reserved vital and functional prognosis. This disorder occurs in immunocompromised patients, but it can also occur in immunocompetent people. Aspergillus and Mucormicosis species are the most common microorganisms found in invasive fungal rhinosinusites. The otorhinolaryngologic clinical examination and imaging techniques provide important diagnostic information in patients with risk factors for invasive fungal rhinosinusitis, including intracranial or orbital extension identification. The treatment of invasive fungal rhinosinusites (acute or chronic) consists of reversing immunosuppression, appropriate systemic antifungal therapy and aggressive and prompt surgical debridement of the affected tissues.

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Frozen Section as a Rapid and Accurate Method for Diagnosing Acute Invasive Fungal Rhinosinusitis

Otolaryngology ◽

10.1177/0194599818770615 ◽

2018 ◽

Vol 159 (3) ◽

pp. 576-580 ◽

Cited By ~ 7

Author(s):

Max Hennessy ◽

Johnathan McGinn ◽

Bartholomew White ◽

Sakeena Payne ◽

Joshua I. Warrick ◽

...

Keyword(s):

Failure Rate ◽

Frozen Section ◽

Medical Center ◽

Periodic Acid ◽

Accurate Method ◽

Frozen Sections ◽

Periodic Acid Schiff ◽

Fungal Rhinosinusitis ◽

Acute Invasive Fungal Rhinosinusitis ◽

Invasive Fungal Rhinosinusitis

Objective Identify methods to improve the frozen-section diagnosis of acute invasive fungal rhinosinusitis. Study Design Biopsies with frozen section for suspected acute invasive fungal rhinosinusitis were reviewed to identify causes for missed diagnoses and evaluate methods for potential improvement. Setting All aspects of the study were performed at the Penn State Milton S. Hershey Medical Center. Subjects and Methods All frozen sections performed for suspected acute invasive fungal rhinosinusitis between 2006 through 2017 were reviewed with their diagnoses compared to the final diagnoses. Sensitivity and specificity were determined for each biopsy specimen to evaluate the diagnostic method and for each patient for its effectiveness on outcome. Causes for frozen-section failures in diagnosis were identified. A periodic acid–Schiff stain for fungus (PASF) was modified for use on frozen tissue (PASF-fs) and applied both retrospectively and prospectively to frozen sections to determine its ability to identify undetected fungus and improve diagnostic sensitivity. Results Of 63 biopsies positive for acute invasive fungal rhinosinusitis, 51 were diagnosed on frozen section, while 61 were identified by including the novel PASF-fs stain, reducing the failure rate from 19% to 3%. Of 41 cases that were positive, 34 were diagnosed on frozen section. Of the 7 that were not, 5 were identified by including the PASF-fs, reducing the failure rate from 17% to 5%. Conclusions Frozen section interpretation of biopsies for suspected acute invasive fungal rhinosinusitis using a PASF-fs stain should enable a rapid and accurate diagnosis with improved outcomes by shortening the time to surgery.

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Accuracy of Intraoperative Frozen Section in Detection of Acute Invasive Fungal Rhinosinusitis

Archives of Pathology & Laboratory Medicine ◽

10.5858/arpa.2019-0696-oa ◽

2020 ◽

Author(s):

Rahaf Alkhateb ◽

Preethi Dileep Menon ◽

Hamza Tariq ◽

Sarah Hackman ◽

Alia Nazarullah ◽

...

Keyword(s):

Predictive Value ◽

Frozen Section ◽

Fungal Culture ◽

Fungal Sinusitis ◽

Fungal Rhinosinusitis ◽

Acute Invasive Fungal Rhinosinusitis ◽

Frozen Section Analysis ◽

Early Surgical Intervention ◽

Invasive Fungal Rhinosinusitis ◽

Section Analysis

Context.— Acute invasive fungal rhinosinusitis (AIFRS) is an aggressive form of fungal sinusitis, which remains a significant cause of morbidity and mortality. Early diagnosis and intervention are keys to improving patient outcomes. Intraoperative consultation has shown promise in facilitating early surgical intervention, but the accuracy of frozen section has not been clarified in this setting. Objectives.— To assess the accuracy of frozen-section diagnosis in patients with clinically suspected AIFRS. Design.— All cases of clinically suspected AIFRS during a 10-year period (2009–2019) were retrospectively reviewed. The frozen-section results were compared with the final permanent sections as well as the tissue fungal culture results, following which the accuracy of frozen section was determined. Results.— Forty-eight patients with 133 frozen-section evaluations for AIFRS were included in the study. Thirty of 48 patients and 61 of 133 specimens were positive for AIFRS on final pathology. Of 30 positive patients, 27 (90%) had at least 1 specimen diagnosed as positive during intraoperative consultation, among the 61 positive specimens, 54 (88.5%) were diagnosed as positive during intraoperative consultation. Of 72 negative specimens, all were interpreted as negative on frozen section. Thus, frozen sections had a sensitivity of 88.5% (95% CI, 0.78–0.97), specificity of 100% (95% CI, 0.94–1), positive predictive value of 100% (95% CI, 0.92–1), and negative predictive value of 90.6% (95% CI, 0.82–0.97). Conclusions.— This study represents the largest series assessing the diagnostic accuracy of frozen section analysis in AIFRS. These findings are useful in frozen section–informed intraoperative decision making.

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