TO DETERMINE THE VARIOUS CLINICAL PRESENTATIONS, UNDERLYING IMMUNOCOMPROMISED CONDITION, COMPLICATION OF ACUTE INVASIVE FUNGAL RHINOSINUSITIS (AIFRS): AN OBSERVATIONAL STUDY.

Aim: to determine the various clinical presentations, underlying immune-compromised condition, complication of acute invasive fungal rhinosinusitis (AIFRS). Materials and Methods: The present prospective observational study was conducted in the Department of ENT, Sri Krishna Medical College and Hospital, Muzaffarpur, Bihar, India. Among 40 patients of acute invasive fungal sinusitis that underwent treatment as inpatient basis. Nasal swabs from the middle meatus were subjected to potassium hydroxide mount and if fungal elements were identified, then fungal culture was done. Post-operatively, tissue removed from the sinuses was sent for histopathological examinations. Results: majority of the patients were male 57.5% and rest 42.5% were female. Patients having Diabetes Mellitus were found to be more susceptible to acute and invasive fungal sinusitis. The common presenting symptoms were nasal obstruction followed by rhinorrhea, epistaxis, headache, fever, facial swelling. Most common complication reported in this study was Cavernous sinus thrombosis 11 (27.5%). Conclusion: acute invasive fungal sinusitis is most common in immunocompromised patients, with the highest incidence in patients with uncontrolled diabetes mellitus. The most consistent finding of acute invasive fungal sinusitis was mucosal necrosis and black crust/debris. Keywords: acute invasive fungal sinusitis, diabetes mellitus, cavernous sinus thrombosis

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

IP International Journal of Medical Microbiology and Tropical Diseases ◽

10.18231/j.ijmmtd.2021.049 ◽

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.

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Invasive Fungal Rhinosinusitis: Our Experience

Clinical Rhinology An International Journal ◽

10.5005/jp-journals-10013-1005 ◽

2009 ◽

Vol 2 (3) ◽

pp. 21-26

Author(s):

Kapil Dua ◽

H Chopra ◽

Neha Chopra ◽

Sanjeev Puri ◽

Vikrant Mittal

Keyword(s):

Facial Pain ◽

Antifungal Agents ◽

Fungal Infections ◽

Immunocompromised Patient ◽

Fungal Sinusitis ◽

Adequate Treatment ◽

Invasive Fungal Sinusitis ◽

Fungal Rhinosinusitis ◽

Endemic Mycoses ◽

Invasive Fungal Rhinosinusitis

Abstract Opportunistic fungal infections in immunocompromised patients are associated with a high mortality rate. Endemic mycoses are often asymptomatic, but in appropriate hosts, fungi can cause severe and even fatal infection. Facial pain in an immunocompromised patient may signify invasive fungal sinusitis. Treatment with antifungal agents needs to be individualized according to factors such as the type of fungus, presence of renal failure, or pregnancy. Combining antifungal agents or addition of other approaches, such as surgical debridement or steps to control intracranial pressure, may be needed for adequate treatment of certain types of fungal infections.

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Invasive fungal rhinosinusitis in patients with diabetes

The Journal of Infection in Developing Countries ◽

10.3855/jidc.9699 ◽

2018 ◽

Vol 12 (09) ◽

pp. 787-793

Author(s):

Nishant Raizada ◽

Viveka P Jyotsna ◽

Devasenathipathy Kandasamy ◽

Immaculata Xess ◽

Alok Thakar ◽

...

Keyword(s):

Hospital Stay ◽

Care Center ◽

Tertiary Care ◽

North India ◽

Treatment Modalities ◽

Fungal Sinusitis ◽

Invasive Fungal Sinusitis ◽

Fungal Rhinosinusitis ◽

Patients With Diabetes ◽

Invasive Fungal Rhinosinusitis

Introduction: We report the clinical and radiological features as well as outcomes of invasive fungal rhinosinusitis in patients with diabetes from a tertiary care center in North India. Methodology: All patients admitted with a diagnosis of invasive fungal rhinosinusitis with pre-existing or newly diagnosed diabetes from 1st January 2008 to 31st December 2015 were included. Hospital records were used to identify clinical features, biochemical investigations and treatment modalities used. The imaging findings were reported at baseline, 30, 60,90 and 120 days of admission and progression of disease was reported as static, worse or improved. The outcomes were sight loss and survival at end of hospital stay. Results: 22 patients of invasive fungal sinusitis and diabetes were identified. At presentation, 5 had ketoacidosis, all of whom died at the end of hospital stay. Loss of vision in one eye was seen in 70% cases. The survival at end of hospital stay was 72.7% and at six months after end of study period was 57.8%. No patients had radiological improvement at day 30 imaging (including those who subsequently improved). Conclusion: Radiological improvement is not apparent before two months of therapy. Ketoacidosis is a predictor of mortality in invasive fungal sinusitis with diabetes.

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Clinicoepidemiological study of acute invasive fungal rhinosinusitis in a tertiary care centre

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20214229 ◽

2021 ◽

Vol 7 (11) ◽

pp. 1772

Author(s):

Rajeshree Chaurpagar ◽

Priyanka Garud ◽

Apurva Pawde ◽

Parag Doifode ◽

Bhagyashree Chiplunkar ◽

...

Keyword(s):

Diabetes Mellitus ◽

Tertiary Care ◽

World Health ◽

High Morbidity ◽

Care Hospital ◽

Tertiary Care Centre ◽

Fungal Rhinosinusitis ◽

Acute Invasive Fungal Rhinosinusitis ◽

History Of ◽

Invasive Fungal Rhinosinusitis

Background: Coronavirus disease 2019 (COVID-19) accounted for severe acute respiratory syndrome corona virus 2 (SARS-CoV-2), which was declared a global pandemic by World health organization (WHO) in March 2020. In second wave of COVID there was notable surge in Acute invasive fungal rhinosinusitis (AIFRS). We observed that use of systemic corticosteroids in treatment of COVID 19 especially among patients with poorly controlled diabetes mellitus increased the incidence of AIFRS.Methods: This is retrospective observational study carried out in a Tertiary care Hospital GMC Akola from period of February 2021 to august 2021 were patients with the suspected diagnosis of AIFRS were admitted and evaluated following a standardized protocol, including clinical examination diagnostic nasal endoscopy, radiological evaluation. Diagnosis of AIFRS was confirmed on histopathology.Results: Study was conducted in GMC, Akola of 136 patients out of which 97 were males and 39 were females. In our study 78.67% patients had history of covid infection, followed by diabetes mellitus in 54.41%, history of steroid treatment found in 64.70% patients. On HPE 69.85% were positive for mucor and mixed infection (mucor and aspergillus) were found in 6.61%. Most common presenting feature was facial pain and swelling in 66.91%, palatal changes with dental pain in 45.58%, diminution of vision 17.64%, headache in 27.94% patients.Conclusions: Early and prompt diagnosis in high level of clinical suspicion in suspicious patient of AIFRS is vital to improve outcomes as it is known to have high morbidity and mortality (18-80%).

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Chronic Invasive Fungal Rhinosinusitis in Immunocompetent Patients: A Retrospective Chart Review

Frontiers in Surgery ◽

10.3389/fsurg.2020.608342 ◽

2020 ◽

Vol 7 ◽

Author(s):

Naif H. Alotaibi ◽

Omar Abu Omar ◽

Mays Altahan ◽

Haifa Alsheikh ◽

Fawziah Al Mana ◽

...

Keyword(s):

Chart Review ◽

Tertiary Care ◽

Retrospective Chart Review ◽

Csf Leak ◽

Fungal Sinusitis ◽

Invasive Fungal Sinusitis ◽

Fungal Rhinosinusitis ◽

Invasive Fungal Rhinosinusitis ◽

Chronic Invasive ◽

Immunocompetent Patients

Objective: We report cases of Chronic Invasive Fungal Sinusitis (CIFS) in patients considered as immunocompetent at tertiary care center (King Faisal Specialist Hospital), to analyze their clinical, biological, radiological features, and management.Material and methods: A retrospective chart review of CIFS in immunocompetent patients. The inclusion criteria as the following: immunocompetent patients of any age with histopathological findings of CIFS. Immunocompromised patients, acute Invasive Fungal Sinusitis (IFS), non-invasive fungal rhinosinusitis, and no positive histological findings were excluded.Results: Seventeen (17) patients were included. The species isolated included: Aspergillus (most frequent) & Mucor. Surgical treatment approaches were described. Complications reported include CSF leak, blindness, recurrence, and death.Conclusions: Early diagnosis and management of CIFS improve clinical outcomes.

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A rare case of invasive fungal sinusitis by co-infection of two fungi in a post COVID-19 patient: a case report

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20212906 ◽

2021 ◽

Vol 7 (8) ◽

pp. 1361

Author(s):

Timna Chungath ◽

Deepak Dileep Kumar ◽

Shalu Susan Mathew ◽

Jijo Paul

Keyword(s):

Case Report ◽

Nasal Cavity ◽

Liposomal Amphotericin ◽

Rare Case ◽

Patient Survival ◽

Severe Headache ◽

Fungal Sinusitis ◽

Invasive Fungal Sinusitis ◽

Fungal Rhinosinusitis ◽

Invasive Fungal Rhinosinusitis

Invasive fungal rhinosinusitis is a disease of the paranasal sinuses and nasal cavity that typically affects immunocompromised patients in acute fulminant form. Early symptoms can often mimic rhino sinusitis while late symptoms can cause significant morbidity and mortality. With early diagnosis and treatment can increase the patient survival. This case report is of 73 years old diabetic post COVID-19 patients. The patient presented to us was having severe headache and facial pain confined to left side cheek area with loosening of teeth. The patient underwent nasal cavity and biopsy from the maxillary sinus (left side) under local anaesthesia, which confirmed the diagnosis of invasive fungal sinusitis suggestive of co-infection by 2 fungi, aspergillus flavus and mucor. Further, the patient underwent surgical debridement and started on liposomal amphotericin B and patient improved significantly.

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

American Journal of Otolaryngology ◽

10.1016/j.amjoto.2021.103080 ◽

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

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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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