Abstract
Objective: It is to determine the causes of invasive fungal sinusitis in patients of Shiraz University hospitals, Iran. Methods: This cross-sectional study was conducted during 18 months (from 21 March 2009 till 22 September 2010) in three Shiraz University Hospitals. Thirty-six patients with sings of invasive fungal sinusitis were enrolled, and tissue samples were investigated for histopathology, culture and antifungal susceptibility test. The laboratory results with host factor and sinus computed tomography scan were evaluated for classification of patients as proven, probable and possible invasive fungal sinusitis. Results: Thirty-five patients have involved with at least one risk factor (immune compromised disease, diabetes mellitus, or use of immune suppressed drugs). Radiological findings of parasinus invasion or necrosis were present in 20 patients. By histopathology, 21 patients were considered as proven, from these, 17 samples had positive growth. The culture aetiology agents were 4 Candida, 8 Aspergillus, and 5 Mucor. All positive culture samples were matched with histopathology findings. Significant associations were considered for radiologic finding and histopathology and culture (p 0.05). From 8 patients with mucormycosis histopathology, 6 suffered from diabetes mellitus. None of the antifungal agents were effective on these three types of infections. Conclusion: DM is the most common predisposing factor for IFS followed by ALL and AML. The most common aetiology of IFS was found to be Aspergillus fumigant followed by Mucormycosis and Candida. None of antifungal agents could successfully cover all the species.
Highlights
Opportunistic fungal infections are usually results of immunosuppression and immunodeficiency
IFI is considered as an important complication of neutropenia which is suspected with persistent fever for 72 - 96 hours after treatment with broad-spectrum antibacterial antibiotic [1,2,3]
An international consensus on the diagnosis of opportunistic invasive fungal infections in immunocompromised patients with cancer and hematopoietic stem cell transplants was established by the Invasive Fungal Infections Cooperative Group of the European Organization for Research and Treatment of Cancer (EORTC) and the Mycoses Study Group of the National Institute of Allergy and Infectious Diseases (MSG-NIAID) [5,6]
Summary
Opportunistic fungal infections are usually results of immunosuppression and immunodeficiency. Several etiologies of immunosuppression lead to increase prevalence of invasive fungal infection (IFI) including leukemia, diabetes mellitus (DM), AIDS, solid organ transplantation, bone marrow transplantation and chemotherapy [1]. All these conditions result in neutropenia which should be treated with wide-spectrum antibiotics. Delay in the treatment of invasive fungal infection during neutropenia causes high mortality in patients with transplants and hematological malignancy [4,5,7].
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