Impact of early detection of acute invasive fungal rhinosinusitis in immunocompromised patients

Mariana L. C. Silveira,Belinda P. Simões,Ricardo M. Lessa,Fabiana C. P. Valera,Edwin Tamashiro,Rodrigo L. Nogueira,Wilma T. Anselmo-Lima,Francesca M. Faria,Danielle L. C. Queiroz,Marcelo G. J. Leite

doi:10.1186/s12879-019-3938-y

Mariana L. C. Silveira, Belinda P. Simões + Show 8 more

Open Access

https://doi.org/10.1186/s12879-019-3938-y

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Abstract

BackgroundEarly diagnosis of acute invasive fungal rhinosinusitis (AIFRS) is vital to improving outcomes in immunocompromised patients. This study evaluated the impact of a systematic protocol with nasal endoscopy and biopsies to early detect AIFRS in immunocompromised patients. Additionally, we compared the accuracy of frozen-section biopsy and culture with formalin-fixed paraffin-embedded (FFPE) biopsy.MethodsRetrospective cohort in a Tertiary Referral Hospital. Patients with the suspected diagnosis of AIFRS were evaluated following a standardized protocol, including serial nasal endoscopies and biopsies when necessary. The sensitivity and specificity of frozen-section biopsy and culture were also compared with FFPE.ResultsThe mortality rate related to AIFRS of this standardized cohort (13/43) was 30.2%. Better outcomes were observed in patients with disease limited to the turbinates and in those with higher peripheral neutrophils count. Frozen-section biopsy positivity correlated with FFPE findings for fungi detection (p-value < 0.0001), with a sensitivity of 90.6%, specificity of 72.7%, and accuracy of 86.0%.ConclusionImplementation of this standardized protocol was related to a considerably low mortality rate among patients with suspected AIFRS at our Institution. Frozen-section biopsy revealed high accuracy to diagnose AIFRS. The current protocol including frozen-tissue biopsy improved the evaluation and survival rates of immunocompromised patients with presumed AIFRS.

Highlights

Diagnosis of acute invasive fungal rhinosinusitis (AIFRS) is vital to improving outcomes in immunocompromised patients
Forty-six patients with the suspected diagnosis of AIFRS were evaluated during the period
Our data reinforce that nasal endoscopy must be elected as the preferred choice to evaluate patients at risk because it can reveal subtle changes in the nasal mucosa [6, 14, 15] that are not detected by imaging exams [6, 15]

Summary

Introduction

Diagnosis of acute invasive fungal rhinosinusitis (AIFRS) is vital to improving outcomes in immunocompromised patients. Acute invasive fungal rhinosinusitis (AIFRS) is a lifethreatening disease, affecting mostly immunocompromised patients with neutrophilic dysfunction [1,2,3] In these patients, saprophytic fungi, Zygomycetes and Aspergillus, can invade the nasal mucosa and blood vessels, leading to rapid dissemination into the orbits, palate and the brain [2,3,4]. Saprophytic fungi, Zygomycetes and Aspergillus, can invade the nasal mucosa and blood vessels, leading to rapid dissemination into the orbits, palate and the brain [2,3,4] For this reason, a systematic review states that the overall survival rate of AIFRS patients is as low as 50% [2]. Nasal endoscopy can reveal crusting, pale mucosa, or necrosis in the affected areas [6, 7]

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