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Bahethi R, Talmor G, Choudhry H, Lemdani M, Singh P, Patel R, Hsueh W. Chronic invasive fungal rhinosinusitis and granulomatous invasive fungal sinusitis: A systematic review of symptomatology and outcomes. Am J Otolaryngol 2024; 45:104064. [PMID: 37769504 DOI: 10.1016/j.amjoto.2023.104064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 09/18/2023] [Accepted: 09/20/2023] [Indexed: 10/03/2023]
Abstract
INTRODUCTION Chronic invasive fungal rhinosinusitis (CIFRS) and granulomatous invasive fungal sinusitis are two uncommon diseases differentiated primarily by the pathologic finding of non-caseating granulomas in GIFRS. Both share many similarities in presentation. We aim to characterize the symptomatology and outcomes of these diseases. METHODS A comprehensive search strategy was designed to identify studies in the Cochrane, EMBASE and PubMed databases from database inception to January 2022. Inclusion criteria included all patients with a diagnosis of either CIFRS or GIFRS. All studies were screened by two reviewers. Chi-square analyses were used where appropriate. RESULTS 51 studies were included totaling 513 patients. The majority were diagnosed with CIFRS (389, 75.8 %) compared to GIFRS (124, 24.4 %). CIFRS was more common in immunocompromised or diabetic patients (p < 0.0001; p = 0.02). Patients with CIFRS were more likely to exhibit nasal symptoms including discharge (p = 0.0001), obstruction (p = 0.03) and congestion (p = 0.001) as well as systemic symptoms including fever, which no GIFRS patient exhibited, facial pain (p = 0.007), headache (p = 0.004). Aspergillus was the most common organism identified in both groups with a slight predominance among GIFRS patients (p = 0.01). GIFRS patients were also more likely to present with no identifiable organisms (p = 0.0006). CIFRS patients were more likely to die of disease (p = 0.0008). CONCLUSIONS CIFRS generally presents with more symptoms and is associated with poorer outcomes primarily occurring in an immunocompromised population. GIFRS likely follows a more insidious course in immunocompetent patients. Understanding the key differences in symptomatology and outcomes for these two populations is critical for appropriate diagnosis and prognostication.
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Affiliation(s)
- Rohini Bahethi
- Department of Otolaryngology-Head and Neck Surgery at Rutgers New, Jersey Medical School, Newark, NJ, United States.
| | - Guy Talmor
- Department of Otolaryngology-Head and Neck Surgery at Rutgers New, Jersey Medical School, Newark, NJ, United States
| | - Hannaan Choudhry
- Department of Otolaryngology-Head and Neck Surgery at Rutgers New, Jersey Medical School, Newark, NJ, United States
| | - Mehdi Lemdani
- Department of Otolaryngology-Head and Neck Surgery at Rutgers New, Jersey Medical School, Newark, NJ, United States
| | - Priyanka Singh
- Department of Otolaryngology-Head and Neck Surgery at Rutgers New, Jersey Medical School, Newark, NJ, United States
| | - Rushi Patel
- Department of Otolaryngology-Head and Neck Surgery at Rutgers New, Jersey Medical School, Newark, NJ, United States
| | - Wayne Hsueh
- Department of Otolaryngology-Head and Neck Surgery at Rutgers New, Jersey Medical School, Newark, NJ, United States
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Rupa V, Peter J, Michael JS, Thomas M, Irodi A, Rajshekhar V. Chronic Granulomatous Invasive Fungal Sinusitis in Patients With Immunocompetence: A Review. Otolaryngol Head Neck Surg 2023; 168:669-680. [PMID: 35503655 DOI: 10.1177/01945998221097006] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Accepted: 04/05/2022] [Indexed: 11/16/2022]
Abstract
OBJECTIVE We aimed to study the literature on chronic granulomatous invasive fungal sinusitis to elucidate the changing trends in the management of the disease. DATA SOURCES Using specific keywords, we searched the PubMed, PubMed Central, and Scopus databases over the past 50 years, which yielded 938 articles in the English language. REVIEW METHODS Scrutiny of 147 relevant articles revealed 15 homogenous case series (255 cases of histologically proven chronic granulomatous fungal sinusitis alone) and 8 heterogeneous case series (patients with other types of fungal sinusitis included), which were analyzed in detail (all with >5 cases each). CONCLUSIONS The disease typically affected middle-aged adults with immunocompetence. Most reports were from Sudan, India, and Saudi Arabia. A slowly progressive orbital, cheek, or palatal mass with proptosis (88.2%) or sinonasal symptoms (39.2%) was typical. Ethmoid (57.2%) and maxillary (51.4%) sinuses were chiefly affected with intracranial extension in 35.1%. Aspergillus flavus (64%) was the most frequent isolate reported. Endoscopic excision (78.8%) followed by azole therapy was the preferred treatment in recent reports. Orbital exenteration and craniotomy were infrequently performed. Complete resolution or improvement was reported in 91.3% of patients. Mortality ranged from 5.9% to 22.2%. There is a trend in the literature toward less radical and disfiguring surgery and preferential use of azoles, with good outcomes even in advanced cases. IMPLICATIONS FOR PRACTICE Chronic granulomatous fungal sinusitis should be diagnosed on the basis of well-defined histopathologic features. A combination of endoscopic sinus surgery and azole therapy usually yields good outcomes.
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Affiliation(s)
- Vedantam Rupa
- Department of Otorhinolaryngology, Christian Medical College Hospital, Vellore, India
| | - Jayanthi Peter
- Department of Ophthalmology, Christian Medical College Hospital, Vellore, India
| | | | - Meera Thomas
- Department of Pathology, Christian Medical College Hospital, Vellore, India
| | - Aparna Irodi
- Department of Radiology, Christian Medical College Hospital, Vellore, India
| | - Vedantam Rajshekhar
- Department of Neurological Sciences, Christian Medical College Hospital, Vellore, India
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Samaddar A, Shrimali T, Tiwari S, Sharma A. First report of human infection caused by Curvularia warraberensis, manifesting as invasive sinusitis with intracranial involvement. J Mycol Med 2023; 33:101337. [PMID: 36274521 DOI: 10.1016/j.mycmed.2022.101337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 10/11/2022] [Accepted: 10/17/2022] [Indexed: 03/01/2023]
Abstract
Curvularia species are saprophytic dematiaceous fungi commonly isolated from environmental sources. Most often, they are responsible for allergic fungal rhinosinusitis, an intense, allergic inflammatory sinus disease in immunocompetent individuals. Though invasive infections are rare and more commonly observed in immunocompromised patients, recent reports indicate an increasing trend of invasive sinusitis caused by Curvularia species in immunocompetent hosts. Over the past few years, new species of the genus Curvularia are increasingly being recognized as human pathogens. Here, we report the first human infection caused by Curvularia warraberensis, a cryptic species of Curvularia primarily described as an endophyte in Australian grasses. The 33-year-old female presented with chronic invasive sinusitis of the sphenoid and ethmoid sinuses that progressed to involve the pituitary gland, mid-brain, the facial-vestibulocochlear nerve complex, and basilar artery. The patient underwent endoscopic sinus surgery. Histopathology, microscopic examination and culture of biopsy tissues revealed a dematiaceous fungus that was identified as C. warraberensis, based on sequencing the internal transcribed spacer (ITS) and large subunit (LSU) regions of ribosomal DNA. Antifungal susceptibility testing (AFST) showed low minimum inhibitory concentrations (MICs) for amphotericin B (1 µg/mL), itraconazole (0.25 µg/mL) and posaconazole (0.125 µg/mL). Accurate identification and AFST are crucial for making treatment decisions as some Curvularia species demonstrate variable susceptibility to antifungal agents. The patient died despite combined surgical and medical intervention owing to late presentation and delay in initiating antifungal therapy. A high index of suspicion together with an early diagnosis and aggressive treatment may improve the outcome in such cases.
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Affiliation(s)
- Arghadip Samaddar
- Department of Microbiology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India.
| | - Twishi Shrimali
- Department of Microbiology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Sarbesh Tiwari
- Department of Diagnostic and Interventional Radiology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Anuradha Sharma
- Department of Microbiology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
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Ma F, Xu L, Ai P. Treatment and Impacts of Chronic Sinusitis with the Confluence of Biyuan Tongqiao Granules and Saline Nasal Irrigation. JOURNAL OF HEALTHCARE ENGINEERING 2022; 2022:2916700. [PMID: 35368965 PMCID: PMC8970802 DOI: 10.1155/2022/2916700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 02/12/2022] [Accepted: 02/25/2022] [Indexed: 11/17/2022]
Abstract
In this research study, we will study the clinical effect of Biyuan Tongqiao granules with saline nasal irrigation for treatment of chronic sinusitis. It will also study its impacts on the computed tomography (CT) score of the nasal sinus and negative reactions in patients. For this purpose, ninety (90) patients with chronic sinusitis were admitted to the hospital (June 2019 to June 2020). They were selected as the research subjects and divided into experimental and control groups randomly with 45 cases in each group. Control group patients were treated with nasal irrigation with normal saline. While, Biyuan Tongqiao granules combined with nasal irrigation with normal saline was treated by the experimental group. The CT scores of nasal sinus, clinical effect, the incidence of adverse reactions, recurrence rate, duration of nasal mucosal epithelialization, and nasal ciliary transmission speed of both the groups were compared. The patients' pain was assessed by the visual analogue scale (VAS), and the symptoms of sinusitis were scored by the SNOT-20 scale. The experimental group showed significantly lower sinus CT scores and better clinical effects. Adverse reactions were not observed in both the groups' probability (P > 0.05). The experimental group presented a significantly lower recurrence rate, shorter duration of nasal mucosal epithelialization, faster nasal ciliary transmission, and sharply lowers VAS scores and SNOT-20 scores than in the control group (P < 0.05). This proves Biyuan Tongqiao granules and nasal irrigation with normal saline can effectually boost the clinical efficacy and lessen the computed tomography score of nasal sinus in chronic sinusitis patients. It has a worthy clinical application and promotion.
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Affiliation(s)
- Fei Ma
- Department of Otolaryngology, Renmin Hospital, Hubei University of Medicine, Shiyan, Hubei 442000, China
| | - Lian Xu
- Department of Otolaryngology, Renmin Hospital, Hubei University of Medicine, Shiyan, Hubei 442000, China
| | - Ping Ai
- Department of Otolaryngology, Renmin Hospital, Hubei University of Medicine, Shiyan, Hubei 442000, China
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Kim J, Makary CA, Roland LT, Kuruvilla M, Lam K, Smith KA, Magliocca KR, Wise SK, Toskala E, Fermin JM, Pashley CH, Levy JM, Luong AU. What is allergic fungal sinusitis: A call to action. Int Forum Allergy Rhinol 2021; 12:141-146. [PMID: 34719135 DOI: 10.1002/alr.22911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 09/10/2021] [Accepted: 09/24/2021] [Indexed: 11/07/2022]
Affiliation(s)
- Jean Kim
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, Baltimore, Maryland, USA
| | - Chadi A Makary
- Department of Otolaryngology-Head and Neck Surgery, West Virginia University, Morgantown, West Virginia, USA
| | - Lauren T Roland
- Department of Otolaryngology-Head and Neck Surgery, University of California San Francisco, San Francisco, California, USA
| | - Merin Kuruvilla
- Department of Allergy and Immunology, Emory University, Atlanta, Georgia, USA
| | - Kent Lam
- Department of Otolaryngology-Head and Neck Surgery, Eastern Virginia Medical School, Norfolk, Virginia, USA
| | - Kristine A Smith
- Department of Otolaryngology-Head and Neck Surgery, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Kelly R Magliocca
- Department of Pathology & Laboratory Medicine, Emory University, Atlanta, Georgia, USA
| | - Sarah K Wise
- Department of Otolaryngology-Head and Neck Surgery, Emory University, Atlanta, Georgia, USA
| | - Elina Toskala
- Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Janmaris Marin Fermin
- Department of Otolaryngology, Louisiana State University (LSU) Health Shreveport, Shreveport, Louisiana, USA
| | | | - Joshua M Levy
- Department of Otolaryngology-Head and Neck Surgery, Emory University, Atlanta, Georgia, USA
| | - Amber U Luong
- Department of Otorhinolaryngology-Head and Neck Surgery, McGovern Medical School of the University of Texas Health Science Center at Houston, Houston, Texas, USA
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Burnham AJ, Magliocca KR, Pettitt-Schieber B, Edwards TS, Marcus S, DelGaudio JM, Wise SK, Levy JM, Roland LT. Intermediate Invasive Fungal Sinusitis, a Distinct Entity From Acute Fulminant and Chronic Invasive Fungal Sinusitis. Ann Otol Rhinol Laryngol 2021; 131:1021-1026. [PMID: 34694144 DOI: 10.1177/00034894211052854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The current classification system of invasive fungal sinusitis (IFS) includes acute (aIFS) and chronic (cIFS) phenotypes. Both phenotypes display histopathologic evidence of tissue necrosis, but differ by presence of angioinvasion, extent of necrosis, and disease progression. aIFS is defined by a rapid onset of symptoms, while cIFS slowly progresses over ≥12 weeks. However, a subset of IFS patients do not fit into the clinical presentation and histopathologic characteristics of either aIFS or cIFS. OBJECTIVES To investigate the demographic, clinical, and histopathologic characteristics of a distinct subset of IFS. METHODS Retrospective review of patients with IFS from a single tertiary-care institution (2010-2020). Patients with symptoms for ≤4 weeks were classified as aIFS if they displayed endoscopic evidence of mucosal necrosis or fungal angioinvasion on pathology. Patients with slowly progressive IFS for ≥12 weeks were classified as cIFS. Patients with symptom duration between 4 and 12 weeks with evidence of invasive fungal disease were classified as a new entity and were further investigated. RESULTS Of the 8 patients identified, 50% were immunosuppressed at presentation. The mean symptom duration prior to presentation was 50.5 days (SD 16.8), and common symptoms included facial pain (100%), vision change (87.5%), and blindness (37.5%). Two patients (25%) died of their disease. Sites of fungal involvement confirmed by histopathology included sphenoid (62.5%) and ethmoid sinuses (12.5%), orbital apex (25%), optic nerve (12.5%), pterygopalatine fossa (12.5%), and clivus (12.5%). Fungal elements but without obvious angioinvasion, were identified in all specimens, and fungus balls (50%), granulomas (37.5%), and giant cells (25%) were also observed on histopathology. CT and MRI radiographic imaging showed findings consistent with orbital, intracranial, or skull base involvement in all patients. CONCLUSION We propose intermediate IFS as a new subgroup of patients with IFS who do not fit into the standard classification of aIFS or cIFS.
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Affiliation(s)
| | - Kelly R Magliocca
- Department of Pathology and Laboratory Medicine, Emory University, Atlanta, GA, USA
| | | | - Thomas S Edwards
- Department of Otolaryngology - Head and Neck Surgery, Emory University, Atlanta, GA, USA
| | - Sonya Marcus
- Division of Otolaryngology - Head and Neck Surgery, Department of Surgery, Stony Brook Medicine, Stony Brook, NY, USA
| | - John M DelGaudio
- Department of Otolaryngology - Head and Neck Surgery, Emory University, Atlanta, GA, USA
| | - Sarah K Wise
- Department of Otolaryngology - Head and Neck Surgery, Emory University, Atlanta, GA, USA
| | - Joshua M Levy
- Department of Otolaryngology - Head and Neck Surgery, Emory University, Atlanta, GA, USA
| | - Lauren T Roland
- Department of Otolaryngology - Head and Neck Surgery, University of California, San Francisco, CA, USA
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FREITAS JD, PEREIRA NETO LM, SILVA TIBD, OLIVEIRA TFLD, ROCHA JHLD, SOUZA MD, MARCHI PGFD, ARAÚJO ÁVD. Counting and identification of molds and yeasts in dry salted shrimp commercialized in Rio Branco, Acre, Brazil. FOOD SCIENCE AND TECHNOLOGY 2021. [DOI: 10.1590/fst.16720] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Naik A, Yang DBY, Bellafiore FJ, Amine MA, Hassaneen W. Chronic allergic fungal sinusitis invading the skull base in an immunocompetent male: illustrative case. JOURNAL OF NEUROSURGERY: CASE LESSONS 2021; 1:CASE2161. [PMID: 35854973 PMCID: PMC9245780 DOI: 10.3171/case2161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 02/01/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND Allergic fungal sinusitis (AFS) is an immunoglobulin E–mediated reaction to fungal organisms in the sinonasal region and can be categorized as acute or chronic. Acute infection is typical in immunocompromised patients, while chronic infection is classically seen in immunocompetent patients. Spread of infection to the skull base is a rare and potentially lethal complication of prolonged infection. Surgical management is frequently augmented with steroid therapy to prevent recurrence. OBSERVATIONS The authors present a case of a 20-year-old African American male with prolonged headaches and blurred vision who was diagnosed with chronic invasive fungal sinusitis resulting in invasion of fungal burden into the anterior skull base and the posterior aspect of the clivus, in addition to complete obliteration of the maxillary sinus. The patient was managed surgically without complication and with gradual improvement in vision. LESSONS Early management and detection of AFS should be a focus to prevent erosion of the fungal burden into the skull base. Neurosurgery and ear, nose, and throat surgery have a multidisciplinary role in the management of advanced AFS cases.
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Affiliation(s)
- Anant Naik
- Carle Illinois College of Medicine, University of Illinois Urbana-Champaign, Champaign, Illinois; and
| | - Darrion Bo-Yun Yang
- Carle Illinois College of Medicine, University of Illinois Urbana-Champaign, Champaign, Illinois; and
| | | | | | - Wael Hassaneen
- Carle Illinois College of Medicine, University of Illinois Urbana-Champaign, Champaign, Illinois; and
- Neurosurgery, Carle Foundation Hospital, Champaign, Illinois
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Ma C, Ryan MW, Marple BF, Halderman AA. Fungal sinusitis: a spectrum of disease. Int Forum Allergy Rhinol 2020; 11:935-937. [PMID: 33185023 DOI: 10.1002/alr.22736] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 10/27/2020] [Accepted: 10/28/2020] [Indexed: 11/09/2022]
Affiliation(s)
- Connie Ma
- Department of Otolaryngology Head and Neck Surgery, University of Texas Southwestern, Dallas, TX
| | - Matthew W Ryan
- Department of Otolaryngology Head and Neck Surgery, University of Texas Southwestern, Dallas, TX
| | - Bradley F Marple
- Department of Otolaryngology Head and Neck Surgery, University of Texas Southwestern, Dallas, TX
| | - Ashleigh A Halderman
- Department of Otolaryngology Head and Neck Surgery, University of Texas Southwestern, Dallas, TX
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Krane NA, Beswick DM, Sauer D, Detwiller K, Shindo M. Allergic Fungal Sinusitis Imitating an Aggressive Skull Base Lesion in the Setting of Pembrolizumab Immunotherapy. Ann Otol Rhinol Laryngol 2020; 130:108-111. [PMID: 32597680 DOI: 10.1177/0003489420937728] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
OBJECTIVES We report a case of acutely worsening allergic fungal sinusitis in a patient receiving immunotherapy with pembrolizumab, a programmed cell death protein 1 (PD-1) inhibitor. METHODS A 53-year-old man with a history of metastatic melanoma and recent initiation of pembrolizumab therapy presented with acutely worsening headaches, left abducens nerve palsy, and neuroimaging demonstrating an erosive skull base lesion with bilateral cavernous sinus involvement. RESULTS Intraoperative findings were consistent with non-invasive allergic fungal sinus disease. Microbiology and histopathologic data ruled out malignancy and demonstrated Aspergillus fumigatus without concern for angioinvasion. After treatment with antifungal therapy, the patient's symptoms and abducens nerve palsy resolved. Symptoms were well-controlled 7 months after his initial presentation. CONCLUSIONS Inflammatory sinusitis in patients receiving anti-PD-1 therapy may be secondary to T-cell infiltration, a similar pathophysiology as immune-related adverse events, and warrants appreciation by otolaryngologists given our increasing exposure to immunotherapy and its head and neck manifestations.
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Affiliation(s)
- Natalie A Krane
- Department of Otolaryngology-Head & Neck Surgery, Oregon Health and Science University, Portland, OR, USA
| | - Daniel M Beswick
- Department of Otolaryngology-Head & Neck Surgery, Oregon Health and Science University, Portland, OR, USA
| | - David Sauer
- Department of Pathology, Oregon Health and Science University, Portland, OR, USA
| | - Kara Detwiller
- Department of Otolaryngology-Head & Neck Surgery, Oregon Health and Science University, Portland, OR, USA
| | - Maisie Shindo
- Department of Otolaryngology-Head & Neck Surgery, Oregon Health and Science University, Portland, OR, USA
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Humphreys IM, Wandell GM, Miller C, Rathor A, Schmidt RA, Turner JH, Hwang PH, Davis GE. A multi-institutional review of outcomes in biopsy-proven chronic invasive fungal sinusitis. Int Forum Allergy Rhinol 2020; 10:738-747. [PMID: 32282122 DOI: 10.1002/alr.22547] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2019] [Revised: 01/16/2020] [Accepted: 01/21/2020] [Indexed: 12/31/2022]
Abstract
BACKGROUND Chronic invasive fungal sinusitis (CIFS) is a rare, life-threatening infection of the nose and sinuses. This study aims to identify factors that impact survival in 1 of the largest cohorts to date. METHODS Pathology records were reviewed for biopsy-proven CIFS from 3 tertiary academic institutions from 1995 to 2016. Variables were analyzed using log-rank survival analysis. Univariate Cox regression was performed at 1 and 12 months. RESULTS Thirty-eight patients were included. Hematologic malignancy and diabetes were the most common underlying diseases (32% each). Aspergillus was the most common fungus (63%). Greater than 75% of the patients had an absolute neutrophil count (ANC) >1000 at the time of diagnosis. Overall survival at 1, 6, and 12 months was 89%, 68%, and 48%, respectively. In univariate analysis, factors associated with worse survival included: ANC <500 at 12 months (hazard ratio [HR] 4.8; p = 0.01), ANC <1000 at 12 months (HR 5.8; p = 0.001), and recent chemotherapy (HR 4; p = 0.01). The following factor was associated with improved survival in univariate analysis: ANC as a linear variable in the entire cohort (HR 0.7; p = 0.005). CONCLUSION We present a multi-institutional case-series of CIFS and long-term follow-up. ANC <1000 at time of diagnosis and recent chemotherapy (within 1 month of diagnosis) are associated with poorer survival, whereas a rising ANC >1000 is associated with improved survival at 12 months. Further prospective studies are needed to further define factors that affect outcomes.
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Affiliation(s)
- Ian M Humphreys
- Department of Otolaryngology, University of Washington, Seattle, WA
| | - Grace M Wandell
- Department of Otolaryngology, University of Washington, Seattle, WA
| | - Craig Miller
- Department of Otolaryngology, University of Washington, Seattle, WA
| | | | | | - Justin H Turner
- Department of Otolaryngology, Vanderbilt University, Nashville, TN
| | - Peter H Hwang
- Department of Otolaryngology, Stanford University, Stanford, CA
| | - Greg E Davis
- Department of Otolaryngology, University of Washington, Seattle, WA
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Alarifi I, Alsaleh S, Alqaryan S, Assiri H, Alsukayt M, Alswayyed M, Alromaih S, Aloulah M, Alroqi AS, AlQahtani A, Sumaily I. Chronic Granulomatous Invasive Fungal Sinusitis: A Case Series and Literature Review. EAR, NOSE & THROAT JOURNAL 2020; 100:720S-727S. [PMID: 32077324 DOI: 10.1177/0145561320904620] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Chronic granulomatous invasive fungal sinusitis (CGIFS) is a peculiar disease of the paranasal sinuses due to its rarity, patient subset, and disease course. We describe 7 cases of histopathologically confirmed CGIFS with different treatment plans and varying outcomes. Of particular note was that one of these patients developed allergic fungal rhinosinusitis after complete resolution of his primary invasive disease, a finding that has never been reported in the literature. Another patient had an atypical fungal species (Aspergillus nidulans) on fungal stain and culture, while one immunodeficient patient had a large intracerebral disease component and died after 2 months of treatment. We also present a review of the pertinent literature investigating this rare disease.
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Affiliation(s)
- Ibrahim Alarifi
- Department of Otolaryngology, College of Medicine, 37950King Saud University, Riyadh, Saudi Arabia
| | - Saad Alsaleh
- Department of Otolaryngology, College of Medicine, 37950King Saud University, Riyadh, Saudi Arabia
| | - Saleh Alqaryan
- Department of Otolaryngology, College of Medicine, 37950King Saud University, Riyadh, Saudi Arabia
| | - Hassan Assiri
- Department of Otolaryngology, College of Medicine, 37950King Saud University, Riyadh, Saudi Arabia
| | - Mohammed Alsukayt
- Department of Otorhinolaryngology, 37849King Fahad Medical City, Riyadh, Saudi Arabia
| | - Mohammed Alswayyed
- Department of Pathology and Laboratory Medicine, College of Medicine, 37850King Saud University, Riyadh, Saudi Arabia
| | - Saud Alromaih
- Department of Otolaryngology, College of Medicine, 37950King Saud University, Riyadh, Saudi Arabia
| | - Mohammad Aloulah
- Department of Otolaryngology, College of Medicine, 37950King Saud University, Riyadh, Saudi Arabia
| | - Ahmad Salman Alroqi
- Department of Otolaryngology, College of Medicine, 37950King Saud University, Riyadh, Saudi Arabia
| | - Abdulaziz AlQahtani
- Department of Otorhinolaryngology, 37849King Fahad Medical City, Riyadh, Saudi Arabia
| | - Ibrahim Sumaily
- Department of Otolaryngology, College of Medicine, 37950King Saud University, Riyadh, Saudi Arabia
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