A prospective analytic study of invasive fungal rhinosinsitis
Keywords:Fungal rhino-sinusitis, Diabetic mellitus, HIV
Background: Fungal sinusitis is more commonly found in immunocompromised patients with systemic illnesses, e.g., uncontrolled diabetes mellitus, chronic renal failure, patient on prolonged systemic steroid therapy, hematological malignancies, HIV/AIDS, etc. Invasive fungal sinusitis is subdivided into acute and chronic. Less than 4 weeks duration separates the acute stage from the chronic stage of the disease. Management of invasive fungal sinusitis consists of sinonasal debridement with or without Caldwell-Luc surgery followed by antifungal therapy.
Methods: Total 30 cases of both types of invasive fungal sinusitis were included in this study. The demographic profile, clinical presentation, underlying immunocompromised status, complication, mortality and management of all these 30 patients were analyzed.
Results: Invasive fungal sinusitis was most commonly observed in 3rd and 4th decade of life with male predominance. Prolonged uncontrolled diabetic mellitus was the most common underlying immunocompromised status. Mucor was the most common isolated fungal species. Preseptal cellulitis was the most common complication.
Conclusions: For early detection of mucosal changes one has to do endoscopic examination in all immunocompromised patients with symptoms like headache, facial or periorbital pain and swelling, purulent nasal discharge, etc. All clinician should think vigilantly in immunocompromised patients with above symptoms or in pyrexia of unknown origin not responding to antibiotics. To reduce mortality, one has to go for immediate sinonasal debridement even in local anaesthesia also if patient is not fit for general anaesthesia.
deShazo D, O’Brien M, Chapin K, Soto-Aguilar M, Gardner L, Swain R. A new classification and diagnostic criteria for invasive fungal sinusitis. Arch Otolaryngol Head Neck Surg. 1997;123(11):1181-8.
deShazo R, O'Brien M, Chapin K, Soto-Aguilar M, Swain R, Lyons M, et al. Criteria for the diagnosis of sinus mycetoma. J Allergy Clin Immunol. 1997;99(4):475-85.
Ferguson J. Definitions of fungal rhinosinusitis. Otolaryngol Clin North Am. 2000;33(2):227-35.
Parikh L, Venkatraman G, DelGaudio M. Invasive fungal sinusitis: a 15-year review from a single institution. Am J Rhinol. 2004;18(2):75-81.
Chien-Yuan C, Wang-Huei S, Aristine C, Yee-Chun C, Woei T, Jih-Luh T, et al. Invasive fungal sinusitis in patients with hematological malignancy: 15 years’ experience in a single university hospital in Taiwan. BMC Infect Dis. 2011;11:250.
Lee Y, Yeo L, Lee H, Kwa L, Koh P, Hsu Y. Prevalence of invasive fungal disease in hematological patients at a tertiary university hospital in Singapore. BMC Res Notes. 2011;4:42.
Herbrecht R, Denning D, Patterson T, Bennett J, Greene R, Oestmann J, et al. Voriconazole versus amphotericin B for primary therapy of invasive aspergillosis. N Engl J Med. 2002;347(6):408-15.
Milosev B, el-Mahgoub S, Aal A, and el-Hassan M. Primary aspergilloma of the paranasal sinuses in Sudan. A review of seventeen cases. Br J Surg. 1969;56:132-7.
Stammberger H. Endoscopic surgery for mycotic and chronic recurring sinusitis. Ann Otol Rhinol Laryngol Suppl. 1985;119:1-11.
Hazarika P, Ravikumar V, Nayak R, Rao P, Shivananda P. Rhinocerebral mycosis. Ear Nose Throat J. 1984;63:464-8.
Chakrabarti A, Sharma C, Chandler J. Epidemiology of pathogenesis of paranasal sinus mycoses. Otolaryngol Head Neck Surg. 1992;107:745-50.
Patorn P, Sanguansak T. Acute Versus Chronic Invasive Fungal Rhinosinusitis: A Case-Control Study. Infect Dis: Res Treat. 2012;5:43-8.
Suslu A, Ogretmenoglu O, Suslu N, Yucel O, Onerci T. Acute Invasive Fungal Rhinosinusitis: Our Experience with 19 Patients. Euro Arch Otorhinolaryngol. 2009;266:77-82.
Mohsen M, Hossein R, Parisa B, Abolhassan F, Payam P, Kamran L. Invasive Fungal Sinusitis in Immunocompromised Patients: A Multicentre, University Hospital Experience in Shiraz. Adv Infect Dis. 2013;3:263-8.