Invasive Fungal Rhinosinusitis: What is the Appropriate Follow-Up?

2006 ◽  
Vol 20 (6) ◽  
pp. 582-585 ◽  
Author(s):  
Kristen J. Otto ◽  
John M. DelGaudio
Keyword(s):  
Fungal Rhinosinusitis ◽  
Invasive Fungal Rhinosinusitis

scholarly journals Invasive fungal rhinosinusitis associated with COVID-19: An observational study

2021 ◽  
Vol 7 (4) ◽  
pp. 237-241
Author(s):  
Bhagyashri Jadhav ◽  
Neeta Patwardhan
Keyword(s):  
Observational Study ◽  
Viral Infections ◽  
Respiratory Infections ◽  
Fungal Infections ◽  
Fungal Rhinosinusitis ◽  
Acute Invasive Fungal Rhinosinusitis ◽  
History Of ◽  
Lost To Follow Up ◽  
Invasive Fungal Rhinosinusitis

Respiratory Viral infections predispose patients to various coinfections and this may lead to enhanced disease severity and mortality. Despite the proven importance of co-infections, these are understudied during the large outbreaks of respiratory infections. Occurrence of invasive fungal respiratory superinfections in patients with COVID-19 has gained increasing attention recently. This study aims to assess Clinical & Microbiological profile of patients with invasive sinusitis in setting of COVID-19 disease at our institute Study Design: A retrospective observational study. Study included patients diagnosed with acute invasive fungal rhinosinusitis (AIFR) suffering from or having a history of coronavirus disease infection over the period of three months.(April 21 – June 21). The patients’ presentation details, imaging findings, co-morbidities, management details, and follow-up information were obtained, recorded and analysed. A total of 32 patients with AIFR with a mean age of 54.46±13.13 years old were included. Most common associated disease was diabetes mellitus (62.5%). Mycological analysis revealed most common fungi isolated from these patients were Mucor species.(56.25%) followed by Aspergillus species(15.62%) while coinfection with both of these species was seen in 5 patients.(15.62%) Candida species was isolated from samples of 4 patients (12.5%). Radiological studies of nose and paranasal sinuses showed that ethmoid (62.5%) and maxillary (46.87%) sinuses being the most commonly affected sinuses followed by Frontal (31.25%) and sphenoid (21.87%) sinuses. Peri-orbital invasion was seen in 5 (15.62%) cases whereas intracranial involvement was seen in 1 patient.(3.12%) In 8 (25%) patients only medical line of treatment was sufficient whereas 20 (62.5%) patients required surgical debridement during the treatment. 4 patients were lost to follow up. Overall survival was 90.62% (29/32) at the conclusion of the study. We are still learning the new and long-term complications of COVID- 19.The puzzle still remains unsolved about the cause and increased prevalence of invasive fungal infections in post-covid-19 population. High clinical suspicion and early and accurate diagnosis of AIFR in COVID-19 patients are essential for better prognosis.

scholarly journals Microinvasive Fungal Rhinosinusitis: Proposal of a New Subtype in the Classification

2020 ◽  
Vol 9 (2) ◽  
pp. 600
Author(s):  
Min Young Seo ◽  
Hyeri Seok ◽  
Seung Hoon Lee ◽  
Ji Eun Choi ◽  
Sang Duk Hong ◽  
...  
Keyword(s):  
Hematologic Malignancy ◽  
Antifungal Treatment ◽  
Fungal Ball ◽  
Fungal Rhinosinusitis ◽  
Key Points ◽  
Ethmoid Sinuses ◽  
Histopathologic Findings ◽  
Classification Category ◽  
Invasive Fungal Rhinosinusitis

Background: Fungal rhinosinusitis (FRS) with mucosal invasion is not classified by the current criteria, and clinical reports on the topic are limited. The aim of this study was to present our 25-year experience on fungal balls with mucosal invasion that do not appear in the FRS classification. Methods: Of 1318 patients who underwent endoscopic surgery with paranasal FRS between November 1994 and July 2019, 372 underwent mucosal biopsies. Medical chart and pathology review were performed on 13 patients diagnosed as having fungal balls with mucosal invasion without accompanying tissue invasion. Results: Histopathologic findings identified all fungi as belonging to the Aspergillus species. In 13 patients, 7 fungal balls were located in the maxillary sinus, 3 in the sphenoid sinus, and 3 in both the maxillary and ethmoid sinuses. The median age at diagnosis was 67 years (interquartile range (IQR): 62–72), and the sex ratio was 1:2 (4 men and 9 women). Five patients had comorbidities—three with diabetes mellitus and two with hematologic malignancy—all of whom received postoperative antifungal therapy. The median duration of antifungal treatment was 13 weeks (IQR: 8–17). No recurrences occurred during the median follow-up period of 30 months (IQR: 22–43). Conclusions: Patients who have been clinically diagnosed with a fungal ball and showed mucosal invasion but no vascular invasion, based on pathologic findings after surgery, may need a new FRS classification category, such as microinvasive FRS, and adjuvant antifungal treatment may be needed for immunocompromised patients with microinvasive FRS. Key points: Fungal rhinosinusitis with mucosal invasion is different from fungal ball and invasive fungal rhinosinusitis and may be classified in a separate category as microinvasive FRS.

scholarly journals Surgical Management of Fungal Rhinosinusitis

2009 ◽  
Vol 1 (1) ◽  
pp. 69-75
Keyword(s):  
Surgical Management ◽  
Current Treatment ◽  
Sinus Surgery ◽  
Surgical Approaches ◽  
Treatment Protocols ◽  
Fungal Rhinosinusitis ◽  
Intracranial Involvement ◽  
Invasive Fungal Rhinosinusitis ◽  
Orbital Soft Tissue

Abstract Fungal rhinosinusitis is on the rise. Most current treatment protocols for fungal rhinosinusitis include surgery combined with medical therapy. Endoscopic sinus surgery has revolutionized the management of this disease limiting the use of the open surgical approaches to very extensive cases with orbital, soft tissue or intracranial involvement by invasive fungal rhinosinusitis. A regular and thorough follow-up is mandatory in all cases to check for recurrences. This article discusses the various forms of fungal rhinosinusitis and their surgical management.

scholarly journals The impact of COVID-19 outbreak on the incidence of acute invasive fungal rhinosinusitis

2021 ◽  
pp. 103080
Author(s):  
Wael F. Ismaiel ◽  
Mohamed H. Abdelazim ◽  
Ibrahim Eldsoky ◽  
Ahmed A. Ibrahim ◽  
Mahmoud E. Alsobky ◽  
...  
Keyword(s):  
Fungal Rhinosinusitis ◽  
Acute Invasive Fungal Rhinosinusitis ◽  
The Impact ◽  
Invasive Fungal Rhinosinusitis

Pediatric invasive fungal rhinosinusitis: An investigation of 17 patients

2017 ◽  
Vol 99 ◽  
pp. 111-116 ◽  
Author(s):  
Daniel Vinh ◽  
Michael Yim ◽  
Ankhi Dutta ◽  
John K. Jones ◽  
Wei Zhang ◽  
...  
Keyword(s):  
Fungal Rhinosinusitis ◽  
Invasive Fungal Rhinosinusitis

scholarly journals Allergen Immunotherapy in an HIV+ Patient with Allergic Fungal Rhinosinusitis

2015 ◽  
Vol 2015 ◽  
pp. 1-5 ◽  
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.

Usefulness of Computed Tomography and Magnetic Resonance in Fulminant Invasive Fungal Rhinosinusitis

2001 ◽  
Vol 15 (4) ◽  
pp. 255-261 ◽  
Author(s):  
R. Charles Howells ◽  
Hassan H. Ramadan
Keyword(s):  
Computed Tomography ◽  
Magnetic Resonance ◽  
Early Recognition ◽  
Bone Destruction ◽  
Immunocompromised Host ◽  
Intracranial Extension ◽  
Tissue Ischemia ◽  
Fungal Rhinosinusitis ◽  
Ct Findings ◽  
Invasive Fungal Rhinosinusitis

Fulminant invasive fungal rhinosinusitis is an aggressive, destructive process most commonly affecting the immunocompromised host. Although frequently fatal, prognosis is related directly to early recognition and aggressive treatment. Various reports advocate computed tomography (CT) scanning as the study of choice in evaluating suspected invasive fungal disease, reserving magnetic resonance imaging (MRI) for select cases. Others report lack of correlation between CT and surgical or pathological findings. Our aim was to investigate the usefulness of CT and MR in the diagnosis of invasive fungal rhinosinusitis. We retrospectively reviewed four cases of biopsyproven invasive disease. Correlations between radiographic, endoscopic, and surgical findings were investigated. Rhizopus species were detected in three cases and mixed Mucor and Aspergillus species in another. Superimposed bacterial sinusitis was confirmed in all cases. CT findings were nonspecific, revealing pansinusitis; no bone destruction or intracranial extension was noted. Mild orbital cellulitis was noted in one case. Anterior rhinoscopy revealed nonviable tissue in two patients. Nasal endoscopy later confirmed tissue ischemia in a third patient, whereas a final patient had normal findings on both exams. Nonspecific findings resulted in delay of diagnosis by 48–72 hours in two patients with presumed bacterial sinusitis. MR revealed intracranial extension in two patients and better represented intraoperative findings. In conclusion, CT findings in invasive fungal rhinosinusitis may be nonspecific and underestimate extent of disease. A high index of suspicion and early endoscopic examination with biopsy are mandatory for evaluation. MRI may better represent disease progression and should be considered early.

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