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Acute invasive fungal rhinosinusitis: our 2 year experience and outcome analysis

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Abstract

Purpose

The incidence of Acute invasive fungal rhinosinusitis (AIFRS) is on the rise considering the multitude of comorbidities present in a single patient.The delay in suspecting the fungal etiology, presentation of the patient for an Otorhinolaryngology consult and lack of defined protocols affects outcome.This study looks in to the various aspects of treatment of AIFRS including sample collection, diagnosis and medicosurgical treatment. We propose a protocol for the management of these patients crafted from our outcome.

Methods

Between September 2015–September 2017, 14 patients presented with AIFRS. Targeted samples were taken for Potassium hydroxide mount, histopathological studies and fungal culture. Management was initiated with antifungals and multi-approach surgical debridement.

Results

Six of these patients had multiple comorbidities and most were uncontrolled diabetics. The average delay in presentation was 9 days. Potassium hydroxide mount was the screening test of choice. A minimum of two sittings of debridement was essential. In an average follow-up period of 15.12 months, all the patients are alive and disease free.

Conclusion

A high index of suspicion, awareness among medical fraternity and precise sample collection aids a firm diagnosis. Simultaneous initiation of surgical debridement and anti-fungals is fundamental.

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Abbreviations

AIFRS:

Acute invasive fungal rhinosinusitis

AmB:

Amphotericin B

AE:

Anterior ethmoidotomy

BA:

Bronchial asthma

CKD:

Chronic kidney disease

CT:

Computerized tomography

DKA:

Diabetic ketoacidosis

DNE:

Diagnostic nasal endoscopy

FS:

Frontal sinus

FESS:

Functional endoscopic sinus surgery

HPE:

Histopathological examination

HTN:

Hypertension

IT:

Inferior turbinate

IHD:

Ischemic heart disease

LP:

Lamina papyracea

Lip AmB:

Liposomal amphotericin B

MS:

Maxillary sinus

MMA:

Middle meatal antrostomy

MT:

Middle turbinate

MPGN:

Membranoproliferative glomerulonephritis

NLD:

Nasolacrimal duct

Pin :

Posaconazole

PE:

Posterior ethmoidotomy

KOH mount:

Potassium hydroxide mount

T1DM:

Type 1 diabetes mellitus

T2DM:

Type 2 diabetes mellitus

ST:

Superior turbinate

V:

Voricanazole

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Authors and Affiliations

  1. Department of ENT, SDM College of Medical Sciences, Hubli-Dharwad, Karnataka, 680009, India

    Raghunath Shanbag, Nita Rachel Rajan & Arun Kumar

Authors
  1. Raghunath Shanbag
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  2. Nita Rachel Rajan
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  3. Arun Kumar
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Corresponding author

Correspondence to Nita Rachel Rajan.

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Conflict of interest

We have no conflicts of interest to declare.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and or national research committee and with 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

This was a retrospective chart review and thus informed consent was not required by our human ethics board.

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Shanbag, R., Rajan, N.R. & Kumar, A. Acute invasive fungal rhinosinusitis: our 2 year experience and outcome analysis. Eur Arch Otorhinolaryngol 276, 1081–1087 (2019). https://doi.org/10.1007/s00405-019-05288-w

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  • DOI: https://doi.org/10.1007/s00405-019-05288-w

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