Clinical Manifestation and Diagnosis of Invasive Fungal Sinusitis in Patients with Hematological Malignancy

Abstract

Background: Invasive fungal sinusitis (IFS) is a potentially deadly infection especially in patients with immunocompromising conditions. Objectives: The current study aimed to evaluate the clinical manifestations, outcomes and factors that may affect survival of patients with IFS. Methods: A cross sectional descriptive study was performed on hospitalized patients admitted to Taleghani hospital affiliated to Shahid Beheshti University of Medical Sciences, Tehran, Iran, from October 2012 to October 2013. The clinical data of 24 patients with IFS were reviewed. All patients had hematologic malignancies, and received broad spectrum chemotherapy. Demographic data, clinical characteristics, presented symptoms and signs, underlying diseases and outcomes of the patients were studied. Results: The age range of patients was 15 - 60 years. The IFS was proven, probable and possible in 25%, 66.7% and 8.3% of the cases, respectively. Serum galactomannan antigen was positive in 41.6% of the cases; 15 out of 24 cases with IFS had received antifungal chemoprophylaxis before diagnosis, 54% fluconazole and 8.3% itraconazole. Aspergillus flavus (33%), Aspergillus fumigatus (20.8%), Aspergillus niger (16.7%) and Mucor spp. (16.7%) were responsible for incidence of IFS; 54% of IFS cases occurred in summer and 91.6% of occurred during hospital construction; a risk factor in 91.6% of the cases. Conclusions: Current study revealed that A. flavus was the most common isolated pathogen. Moreover, A. fumigatus was the second commonisolated pathogen in patients with IFS. Additionally, the hospital construction was an important environmental risk factor for acquisition of infection in patients with hematological malignancy. The most common season for IFS incidence was summer. Additionally, the common causes of death in patients with IFS were primary disease and also resistance to chemotherapy (37.5%).