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

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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Medical Management Of Sexual Assault Survivors At An Academic Medical Center

Journal of Woman s Reproductive Health ◽

10.14302/issn.2381-862x.jwrh-15-846 ◽

2016 ◽

Vol 1 (3) ◽

pp. 31-37

Author(s):

Sadaf Rowshanrad ◽

Jamie Kneebusch ◽

Sally Rafie

Keyword(s):

Sexual Assault ◽

Medical Management ◽

Medical Center ◽

Academic Medical Center ◽

Sexual Assault Survivors ◽

Academic Medical ◽

Assault Survivors

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

International Journal of Otolaryngology ◽

10.1155/2012/684835 ◽

2012 ◽

Vol 2012 ◽

pp. 1-9 ◽

Cited By ~ 52

Author(s):

Kathleen T. Montone ◽

Virginia A. Livolsi ◽

Michael D. Feldman ◽

James Palmer ◽

Alexander G. Chiu ◽

...

Keyword(s):

Medical Center ◽

Fungus Ball ◽

Fungal Culture ◽

Non Invasive ◽

Fungal Rhinosinusitis ◽

Allergic Fungal Rhinosinusitis ◽

Acute Invasive Fungal Rhinosinusitis ◽

Aspergillus Sp ◽

Invasive Fungal Rhinosinusitis ◽

Chronic Invasive

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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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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Bioabsorbable Steroid Eluting Stents in the Treatment of Recurrent Rathke's Cleft Cyst

Journal of Neurological Surgery Part B Skull Base ◽

10.1055/s-0038-1675558 ◽

2018 ◽

Vol 80 (05) ◽

pp. 505-510 ◽

Cited By ~ 1

Author(s):

Elisabeth H. Ference ◽

Karam W. Badran ◽

Edward C. Kuan ◽

Marvin Bergsneider ◽

Anthony P. Heaney ◽

...

Keyword(s):

Stent Placement ◽

Medical Center ◽

Academic Medical Center ◽

Cerebrospinal Fluid Leak ◽

Sinus Surgery ◽

Recurrence Rates ◽

Academic Medical ◽

Surgical History ◽

Rathke's Cleft Cysts ◽

Rathke's Cleft

Abstract Objectives Bioabsorbable steroid eluting stents may prevent the stenosis of ostia after sinus surgery. We describe a technique utilizing this technology to prevent the reformation of Rathke's cleft cysts (RCC) after transnasal transsphenoidal surgical drainage. Design This study is based on retrospective review. Setting The research took place at Tertiary academic medical center. Participants Patients who underwent endoscopic marsupialization of RCC with stent placement were participated in this study. Main Outcome Measures Demographics, surgical history, outcomes, and complications were primary measures of this study. Results Four patients underwent drainage of a recurrent RCC with subsequent stent placement. All patients consented to off-label use of the stent. The mean age of patients was 42 years old and the number of prior drainage procedures ranged from 1 to 3. The stent was placed directly into the opening of the cyst after drainage with no other tissue placed into the cyst cavity or opening. The stents are bioabsorbable and were not removed after surgery but were evaluated endoscopically at 2 and 6 weeks after surgery. The patients have been followed for a mean of 14 months after surgery with no evidence of recurrence on endoscopic exam or imaging. No patient had cerebrospinal fluid leak during or after the operation or permanent endocrinopathy. Conclusion The use of a bioabsorbable steroid eluting stent had no unanticipated consequences and all drainage pathways of all the RCCs remain patent. The use of this technology may decrease recurrence rates in revision or complex cases where patients have extensive scarring of the operative field from prior drainage procedures. Further follow-up of the current cases and study in a larger cohort are warranted.

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Image-Guided Sinus Surgery: Lessons Learned from the First 1000 Cases

Otolaryngology ◽

10.1067/mhn.2003.40 ◽

2003 ◽

Vol 128 (1) ◽

pp. 8-13 ◽

Cited By ~ 52

Author(s):

Ralph Metson

Keyword(s):

Image Guidance ◽

Medical Center ◽

New Technology ◽

Academic Medical Center ◽

Lessons Learned ◽

Sinus Surgery ◽

Image Guided ◽

Academic Medical ◽

Potential Benefits ◽

Guidance Systems

OBJECTIVE: To study physician utilization and experience with image-guidance technology for sinus surgery. STUDY DESIGN AND SETTING: Retrospective review of the first 1000 image-guided sinus operations performed by 42 surgeons at an academic medical center. RESULTS: Utilization of image-guidance systems showed a dramatic increase in both number of cases performed and surgeons who used this equipment (70.6% and 92.8%, respectively) during the first 2 years of its availability. Surgical volume subsequently decreased by a mean of 9.3% per year, whereas the number of surgeons using this technology plateaued. The majority of surgeons continued to perform image-guided surgery throughout the study period for selected cases. The knowledge base gained from this experience can best be summarized as a series of lessons learned. CONCLUSION: It is likely that the availability and utilization of image-guidance systems for sinus surgery will continue to increase in the future. Physicians who learn to use this new technology must do so with an appreciation for both its potential benefits and pitfalls.

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