Invasive Fungal Rhinosinusitis: An Observational Study in an Indian Tertiary Care Hospital

Ravinder Kaur,Lavanya S

doi:10.4172/2472-1018.1000109

Abstract

Invasive fungal rhinosinusitis (IFRS) is a challenging condition and the mortality of IFRS in immuno compromised patients is very high. 75 patients of suspected FRS were included to study the burden and the clinicopathological and mycological profile of invasive fungal rhinosinusitis (FRS) in these patients. The samples collected were exudate from nasal debri, discharge and intraoperative tissue sample and were subjected to direct microscopy to histopathological examination and direct microscopy (KOH and calcofluor white) and culture on Sabouraud dextrose agar. Identification of molds and yeasts were done by conventional methods. 25 cases were suspected to have IFRS were confirmed by microbiological and histo pathological examination, comprising 56% of AIFRS (acute IFRS), 36% CIFRS (chronic IFRS) and 8% CGFRS (chronic granulomatous FRS). Rhizopus arrhizus (64.2%) was the most common isolate followed by Aspergillus flavus (35.7%). Mucor species were solely isolated from AIFRS (14.3%). In CIFRS, Aspergillus flavus (44.4%) seemed to be the major isolate with Aspergillus niger, Alternaria spp., Penicillium spp. and Candida albicans. Necrosis of submucosa, bone, vascular tissue was seen in 96% of cases with aseptate hyphae in 78.5% AIFRS and 77.7% in CIFRS. Radiological features help in presumptive diagnosis of FRS. Direct microscopy along with culture conformation is important for diagnosis and early initiation of treatment.

Highlights

fungal rhinosinusitis (FRS) is a known entity and has recently gained a lot of attention with increase in clinical suspicion, availability of a variety of diagnostic modalities and improvement in laboratory techniques for detection of fungi
Of the suspected cases of FRS, a total of 25 cases were suspected to have Invasive fungal rhinosinusitis (IFRS) based on clinical history, nasal endoscopic and radiological evidences and were confirmed by microbiological and histopathological examination (HPE)
AIFRS was seen in 56% cases, CIFRS in 36% cases and rest 8% had CGFRS

Summary

Introduction

FRS is a known entity and has recently gained a lot of attention with increase in clinical suspicion, availability of a variety of diagnostic modalities and improvement in laboratory techniques for detection of fungi. Classification of FRS depending on the host immune interaction with the fungi and is important for effective treatment and understanding the prognosis of the disease [1]. Disease is most commonly classified as non-invasive or invasive depending on the invasion of the fungi into the sinonasal, submucosal tissue resulting in tissue necrosis and destruction [2,3,4]. IFRS is a challenging condition especially in immunocompromised patients. Failure to diagnose and treat this entity promptly usually results in rapid progression and death [5]. The mortality of IFRS in immunocompromised patients ranges from 50% to 80%. Early physical findings are non-specific and ambiguous [6]

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