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Fourteen cases of acute invasive fungal rhinosinusitis: is there a place for less aggressive surgical treatment?

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Abstract

Purpose

Acute invasive fungal rhinosinusitis (AIFRS) is a rare, fulminant, angio-invasive infection with high mortality rate. Treatment of AIFRS includes aggressive surgical debridement combined with antifungal agents and treatment of the underlying disease. The aim of this study is to report our experience with this often fatal disease and estimate the long-term survival of AIFRS patients with more conservative surgery.

Methods

A retrospective study was performed on immunocompromised adults with AIFRS from January 2011 to December 2020. The diagnosis was histologically confirmed by tissue fungus invasion. We analyze epidemiological and microbiological findings, the underlying disease and discuss our patients’ treatment plan and long-term survival.

Results

Fourteen patients were included in the study. Mean age was 53.8 ± 18.9 years. The underlying disease was hematologic malignancy in nine patients, diabetes mellitus in three, aplastic anemia in one, and renal/liver failure in one. Leukopenia was not significantly correlated with outcome or survival. Histological and culture findings revealed that Mucor/Rhizopus were the causative organisms in nine cases. All patients received systemic antifungal therapy. Surgery was performed in nine patients (endoscopic for all patients, combined in three with an external approach). Overall survival was 35.7% as five patients survived, two who underwent surgery, and three who were treated non-surgically. Nine patients died, two from AIFRS after central nervous system involvement and seven from their primary disease, free of fungi. Older individuals and patients with hematologic malignancies had a worse outcome.

Conclusion

Early surgical debridement, antifungal agents, and treatment of the underlying disease remain the cornerstones of AIFRS management. Prognosis is overall defined by the underlying disease and in some selected cases, medical treatment alone could be a reasonable option.

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Data availability

The datasets used or analyzed during the current study are available from the corresponding author on reasonable request.

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Acknowledgements

We would like to acknowledge M.Drogari-Apiranthitou, MD, PhD, Medical Microbiologist, Infectious Diseases Research Laboratory, 4th Dept. of Internal Medicine, School of Medicine National and Kapodistrian University of Athens, “ATTIKON” Hospital, for her contribution.

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Authors and Affiliations

  1. 2nd Otolaryngology Department, School of Medicine, National & Kapodistrian University of Athens, Attikon” University Hospital, Rimini 1, 124 62, Chaidari, Athens, Greece

    Giorgos Sideris, Antonia Arvaniti, Pavlos Maragoudakis & Alexander Delides

  2. 1st Otolaryngology Department, School of Medicine, National & Kapodistrian University of Athens, “Ippokrateion” General Hospital, Athens, Greece

    Evaggelos Giotakis

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  1. Giorgos Sideris
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Contributions

G.S, A.D., and A.A. wrote the main manuscript text. E.G. and A.D performed the surgical procedures. P.M participated in the direction of the team and protocol design. All authors reviewed the manuscript.

Corresponding author

Correspondence to Giorgos Sideris.

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

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The patient’s written informed consent to participate was obtained.

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The authors affirm that the patient provided informed consent for publication of the images in Fig. 1.

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The authors declare no competing interests.

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Sideris, G., Arvaniti, A., Giotakis, E. et al. Fourteen cases of acute invasive fungal rhinosinusitis: is there a place for less aggressive surgical treatment?. Oral Maxillofac Surg 28, 157–162 (2024). https://doi.org/10.1007/s10006-022-01120-8

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  • DOI: https://doi.org/10.1007/s10006-022-01120-8

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