Prognosis of acute invasive fungal rhinosinusitis related to underlying disease

Abstract

Background: Acute invasive fungal rhinosinusitis (AIFRS) is a rare disease with high morbidity and mortality rates. The objective of this study was to correlate the initial clinical features of AIFRS to the prognosis after surgery.

Methods: Thirty-two patients with AIFRS were evaluated retrospectively. The correlation of underlying disease, fungus isolated, and extent of the disease to the clinical outcome of AIFRS was also evaluated.

Results: The most common underlying disease was hematological malignancy and aplasia (n=20). Aspergillus (n=13) and Mucoraceae (n=11) were the main fungi found in AIFRS. Mucosal biopsy confirmed fungal invasion to the nasal mucosa in all cases. Computed tomography and endoscopic findings showed a predominance of unilateral disease, with various stages of nasal involvement. All patients underwent surgical debridement and systemic antifungal therapy immediately after diagnosis. Sixteen patients died (50%) due to AIFRS. A poor prognosis was related to the extensiveness of AIFRS and to the underlying disease (patients with aplastic anemia and diabetes had the worst outcomes), but not to the fungus isolated.

Conclusions: Early medical and surgical treatment is essential to improve the prognosis of AIFRS patients. A poorer prognosis was associated with underlying disease and extensiveness of AIFRS, but not to the fungus isolated.