Chronic Invasive Fungal Rhinosinusitis Research Articles

Imaging Features of Invasive Fungal Rhinosinusitis: A Systematic Review.

Fungal rhinosinusitis (FRS) includes non-invasive and invasive subtypes with the latter having significant morbidity and mortality. This systematic review aims to identify the imaging features most correlated with invasive fungal rhinosinusitis (IFRS) and present a checklist of these features to aid diagnosis. PubMed, Embase, CENTRAL, and Science Direct were searched from inception to May 2023, in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines. Primary research articles published in English describing the imaging features of IFRS were included. The systematic review was conducted in accordance with the PRISMA guidelines. Forty-eight articles were identified for inclusion. Six studies examined radiological features in acute invasive fungal rhinosinusitis (AIFRS), and 9 studies of chronic invasive fungal rhinosinusitis (CIFRS). A majority of studies did not specify whether IFRS cases were acute or chronic. On CT, bony erosion and mucosal thickening were the most common features. Other features include nasal soft tissue thickening, nasal cavity opacification, opacification of the affected sinus, and perisinus soft tissue infiltration. Extra-sinus extension was commonly observed on MRI, most often invading intraorbitally and intracranially. Other sites of extra-sinus extension included the cavernous sinus, pterygopalatine fossa, infratemporal fossa, masticator space, and facial soft tissue. IFRS is a condition with potential for high morbidity and mortality. Several radiological features are highly suggestive of IFRS. Early identification of high-risk radiological features using a checklist may aid prompt diagnosis and early treatment. Future research investigating the radiological differentiation between IFRS and other significant pathology including bacterial orbital cellulitis would be beneficial.

A retrospective study of invasive fungal rhinosinusitis in adults for surgical outcomes at tertiary care hospital

Background: An invasive fungal rhinosinusitis is most lethal form of sinusitis. It includes acute and chronic invasive fungal rhinosinusitis. The most lethal fungi are Aspergillous species and mucormycosis, others are Alternaria, P. boydii and Sprothrix. Endoscopic debridement combined with intravenous antifungals are efficacious in management of invasive fungal rhinosinusitis. Methods: Study conducted at department of otorhinolaryngology, GMERS Medical College and Hospital, Sola, Ahmedabad. The period of the study October 2020 to October 2022. Total 100 cases taken. All cases of biopsy proven invasive fungal rhinosinusitis above the age of 18 years are included in this study. Oral and written consent taken from all included patients. A nasal endoscopy followed by KOH mount, magnetic resonance imaging – peripheral nervous system (MRI PNS) done. Results: In our study, 57% patients were surgically treated with functional endoscopic sinus surgery, 23% patients treated with modified Denker’s approach debridement. On basis of MRI PNS, nasal endoscopy and symptomatic improvement of the disease, only 10 patients have recurrence of disease and 90 patients are completely recovered after surgical and medical management. Conclusions: Maintaining high index of suspicion in at risk patient populations, followed by prompt evaluation and management is crucial in suspected invasive fungal rhinosinusitis. Early management with antifungal e.g. Amphotericin B intravenous injections, tab Posaconazole, tab Voriconazole and surgical intervention e.g. FESS, modified Denker’s approach debridement, FESS with middle meatal antrostomy very efficacious in terms of preventing the recurrence and mortality in patients.

Identification of a Unique Morphological Pattern for the Diagnosis of Fungal Rhinosinusitis.

Fungal rhinosinusitis (FRS) is a relatively common, but often misdiagnosed disease of paranasal sinuses. The FRS is classified into invasive and non-invasive forms. The non-invasive form includes fungal ball and allergic FRS, and invasive form includes acute invasive FRS, chronic invasive FRS, and granulomatous FRS. Invasive fungal infections are associated with high morbidity and mortality, hence requiring urgent medical and surgical intervention. The histomorphology can help identify certain fungal organisms that cannot be cultured or are rarely visible in exudates. The morphologic diagnosis of tissue invasive and non-invasive fungal infection is essential for appropriate treatment. We analyzed cases of rhinosinusitis from 2017 to 2019 in Pathology Department at a tertiary care cancer hospital, Lahore, Pakistan. All clinical information was retrieved from patient records. Paraffin-embedded tissue blocks were stained with hematoxylin and eosin (H&E), special Grocott methenamine silver stain (GMS), and periodic acid Schiff stain (PAS) according to standard protocol. They were reviewed by two pathologists blinded by fungus status. A total of 169 cases of rhinosinusitis were reviewed. FRS comprised 146 (86.4%) of them. The mean age of patients with FRS was 32.8±14 years. The male:female ratio was 1.4:1. Maxillary sinus was the main site of involvement in 39 (27%) FRS cases. Aspergillus was identified in 117 (80.1%) cases of FRS. The culture reports were available in 44/146 (30.14%) FRS cases. They were negative in 22/44 (50.0%), and Aspergillus species were isolated in 18/44 (40.9%) cases of FRS. There were 84 (57.5%) cases of non-invasive FRS and 59 (40.4%) cases of invasive FRS. Among invasive FRS, there were 56 (38.4%) chronic granulomatous FRS cases including mixed patterns. Majority cases, 54 (96.4%), of chronic granulomatous FRS showed a unique crowded giant cell pattern comprising of foreign body and Langhans type giant cells. These giant cells were arranged closely forming irregular non-caseating granulomas surrounded by lymphocytes and fibrosis. Interestingly, the giant cells were scattered haphazardly without forming a granuloma as well. Fungal organisms were identified in all 56 cases of chronic granulomatous FRS. Histologically, predominant organism was Aspergillus in 48 (85.7%) on GMS and PAS stain. Our study observed a unique crowded giant cell pattern, which is a hallmark of invasive fungal infection. If pathologists are familiar with this unique pattern, they can make a quick and accurate diagnosis on histology. The physician can start antifungal treatment timely for better prognosis.

From delay to diagnosis: Chronic invasive fungal rhinosinusitis presenting with facial and orbital complications

Key Clinical MessageEarly identification and management of chronic invasive fungal rhinosinusitis (CIFRS) is key to optimizing outcomes. A missed diagnosis can result in permanent vision loss, chronic facial pain, or death. We present a case of CIFRS and literature review.AbstractThis case report presents a 56‐year‐old female with CIFRS involving orbital and facial complications. The patient experienced delayed diagnosis despite multiple ED visits for sinusitis with progressive facial pain and ocular deficits not alleviated with antibiotics, emphasizing the importance of early identification and maintaining high clinical suspicion for CIFRS. Prompt recognition, initiation of antifungal therapy, and aggressive surgical debridement were crucial for preventing disease progression and improving the patient's quality of life.

Hronični granulomatozni invazivni gljivični sinusitis - pregled literature i prikaz slučaja netipičnog za balkansku regiju

Introduction. Chronic granulomatous invasive fungal rhinosinusitis (CGIFRS) is an extremely rare form of invasive fungal sinusitis. The disease has a long-lasting and indolent course, so the invasion and destruction in the sinonasal and adjacent regions is progressing slowly. This disease has been reported primarily in Middle East, North Africa, India and Pakistan; however, it is very rare in western countries. It is primarily caused by Aspergillus flavus. Case Report. A 40-year-old man, who was repeatedly surgically treated for chronic rhinosinusitis with nasal polyps, was presented to our Otorhinolaryngology Department with a progressive, sudden right-sided proptosis. Contrast-enhanced paranasal sinus computed tomography (CT) showed almost complete soft tissue opacification of the sinonasal region, eroded bone structures and expansion into the right orbit. Erosion of the walls of the right frontal sinus was also seen but without intracranial propagation. Histopathological examination was necessary for the final diagnosis. The finding of granulomatous response along with fibrosis and strong inflammatory infiltrate was typical for chronic granulomatous invasive fungal sinusitis. The patient was successfully treated with a combination of surgery and postoperative medical therapy with voriconazole. To our knowledge, this is the first case of CGIFRS presented in Serbia. In addition, we reviewed the literature concerning this rare form of fungal sinusitis, especially for the Balkan region. Conclusion. Although we reported an extremely rare case of fungal sinusitis for the Balkan region, it is important to suspect on it in all cases where chronic inflammation of the paranasal sinuses does not respond to conventional treatment.

LBODP072 Squamous Cell Carcinoma Or Fungal Infection? An Unusual Presentation Of Anterior Hypopituitarism

Abstract Introduction Intracranial squamous cell carcinomas are rare tumours with a poor prognosis. Lack of specific imaging characteristics mandates a high index of clinical suspicion and ultimately histopathological confirmation. Chronic invasive fungal rhinosinusitis (CIFRS) is often difficult to distinguish from Sino nasal squamous cell carcinomas (SNSCC) in clinical practice. Our case draws attention to the fact that biopsy results are necessary in discriminating between the two entities, due to the diagnostic conundrum in context of Anterior Hypopituitarism. Case detailsWe report a case of 78-year-old lady who presented with a 3-month history of increasing headache, lethargy and confusion. There was no change in urinary habit. On examination she had right sided ptosis and restricted eye movements with a reported 4-week duration. Primary care physicians referred her for ophthalmic assessment. Past medical history was significant for absent vision in the affected eye due to Ischaemic optic neuropathy since 2018. A CT Angiogram was organised which revealed a large soft tissue mass that could not be differentiated from the optic chiasma. Differentials included chondrosarcoma, chordoma, invasive pituitary macroadenoma and skull base Plasmacytoma. Subsequent MRI imaging suggested appearances could be consistent with aggressive fungal sinusitis. Endocrine investigations showed partial anterior hypopituitarism. ManagementEmpiric treatment was started with Intravenous anti-fungals and steroids, alongside appropriate pituitary hormone replacement. Her case was discussed in the Skull Base Multi-disciplinary Team (MDT) meeting. She was then transferred to the regional tertiary centre for surgical intervention, where she underwent debridement of the Ethmoid sinus, Sphenoid Sinus and Anterior base of skull for presumed chronic invasive fungal sinusitis. Post-operative imaging displayed satisfactory debulking of the central skull base tumour. Histopathology from sphenoid sinus reported invasive squamous cell carcinoma. The post-operative imaging and histopathology results were discussed in the regional MDT and considering the advanced stage a decision was made for best supportive care. Within 2 months neurological symptoms progressed and further imaging demonstrated radiological tumour progression. Discussion Sinonasal Squamous cell carcinoma (SNSCC) is a rare tumour and thus pose difficulty in detection. Presentation usually occurs at an advanced stage since initial symptoms are nonspecific and the tumour remains indolent for many months to years. There is limited evidence in relation to detection and follow up of these cases. Clinical presentation and radiological appearance can be varied. This case highlights the need for histological confirmation of the diagnosis to guide appropriate treatment pathways and ensure compassionate, appropriate care. Presentation: No date and time listed

Invasive mucormycosis of nasal cavity, paranasal sinuses, bones of the skull in post COVID-19 patients: prospective study

INTRODUCTION: Since 2020, the number of patients with complications after a new coronavirus infection (COVID-19) has increased, including mycoses. Mucormycosis ranks third in the frequency of detection among invasive mycoses in patients with reduced immunity. Acute and chronic invasive fungal rhinosinusitis is the most severe and dangerous variant of the disease.OBJECTIVE: To analyze the features of the osteodestructive process of invasive mucormycosis, its relationship with blood supply, the dynamics of the process under the influence of treatment.MATERIALS AND METHODS: The study evaluated changes in the bone structures of the skull, soft tissues of the facial region, brain, and thorax in a group of 10 patients (62.3±11.4 y.o.) examined in the clinic of maxillofacial surgery and the clinic otorhinolaryngology in the post- covid period. The results of cone-beam computed tomography (Sirona) of the maxillofacial region, Xray computed tomography Optima 540 CT (General Electric) of the maxillofacial region and thoracic cavity organs, magnetic resonance imaging (GE Signa HDxt) of the brain and maxillofacial region with intravenous administration of a paramagnetic contrast agent were analyzed.RESULTS: In all cases, osteolytic lesions as a classical manifestations of invasive mucormycosis, were revealed in: alveolar processes of the upper jaws and walls of the maxillary sinuses in 100% of cases; palatine processes — 90%; nasal septum, walls of the ethmoid sinuses and walls the orbits — 70%; walls of the sphenoid sinus — 50%; pterygoid processes and zygomatic bone — 40%; the body of the sphenoid bone, nasal bones, frontal bones — 30%; the alveolar part of the mandible and temporal bone — 10%. All patients underwent surgery with resection of the affected bones — 100%, while 7 out of 10 patients received antimycotic therapy. When assessing the revealed changes in dynamics in all patients in the long-term postoperative period, sclerosis of small foci of destruction, a decrease in the extent of bone defects, a decrease in the size of sequesters, hyperostosis of the walls of the paranasal sinuses, cells ethmoid sinuses of the after sequestrectomy were noted. There were no fatal cases among the 10 patients we observed at the time of publication.CONCLUSION: The combination of anatomical features and the state of blood supply contributes to the development of invasive mucormycosis of the bones of the facial skull and the RCT data help with determining treatment tactics, the volume of surgery, and assessing dynamics in the early and long-term postoperative period.

Estimation of Serum Levels of Heavy Metals in Patients with Chronic Invasive Fungal Rhinosinusitis Before the COVID-19 Era: A Pilot Study.

Objective:Various metals play role in the survival and pathogenesis of the invasive fungal disease. The objectives of this study were to compare the levels of heavy metals in patients with chronic invasive fungal rhinosinusitis (CIFR) and healthy controls, and to analyze their role in disease outcome.Methods:Twenty-three patients (15 with invasive mucormycosis and 8 with invasive aspergillosis, Group 1), and 14 healthy controls (Group 2) were recruited. Blood samples were collected from each group into ion-free tubes and analyzed for serum levels of Nickel (Ni), Copper (Cu), Zinc (Zn), Gallium (Ga), Arsenic (As), Selenium (Se), Rubidium (Rb), Strontium (Sr), Cadmium (Cd), and Lead (Pb). The final outcome of the patients during their hospital stay was categorized clinico-radiologically as improved or worsened, or death.Results:The levels of all metals were higher in Group 1 except for As and Pb. However, the differences in Cu (p=0.0026), Ga (p=0.002), Cd (p=0.0027), and Pb (p=0.0075) levels were significant. Higher levels of Zn (p=0.009), Se (p=0.020), and Rb (p=0.016) were seen in the invasive aspergillosis subgroup. Although Zn (p=0.035), As (p=0.022), and Sr (p=0.002) levels were higher in patients with improved outcome, subgroup analysis showed no differences.Conclusion:The levels of some heavy metals in CIFR significantly differ from those of the general population and also vary with the type of the disease and its outcome. These levels may not have a direct effect on the outcome of the patient, but they do play a role in the pathogenesis of the invading fungus.

First report of chronic invasive fungal rhinosinusitis in a patient with ovarian cancer caused by Didymella pedeiae and successful treatment with voriconazole: A case report.

Background and Purpose:Didymella pedeiae is a dematiaceous fungus that belongs to the Coelomycetes class. While species within this class are known to cause human infection, D. pedeiae had previously only been known as phytopathogens and had never been isolated from a human sample.Case report: A 51-year-old Iranian female patient with ovarian cancer was admitted with unilateral lesions in paranasal sinuses and a five-month history of nasal obstruction, headache, postnasal drainage, swelling on the left side of the face, and orbital pain. Paranasal sinus computerized tomography scan revealed a soft tissue mass that filled the left nasal cavity, ethmoid, sphenoid, and frontal sinuses with more involvement in the maxillary and ethmoid sinuses. Antifungal treatment was simultaneously initiated with itraconazole+prednisolone 15 mg/day, and levofloxacin. Due to poor clinical response, IV voriconazole and amphotericin B were added to the treatment as well. The patient recovered completely after 10 weeks of therapy.Conclusion: Here, we report the first case of human D. pedeiae infection in a patient with ovarian cancer.

Definition and management of invasive fungal rhinosinusitis: a single-centre retrospective study.

SUMMARYObjectivesThe purpose of this study was to correlate acute invasive fungal rhinosinusitis (AIFRS) and chronic invasive fungal rhinosinusitis with underlying diseases, aetiological microorganisms, clinical symptoms, radiological findings, and surgical and medical treatment to determine the subset of patients who require more accurate diagnostic investigation and to prevent irreversible complications.MethodsThis retrospective monocentric study included 17 patients who underwent endoscopic sinus surgery evaluated by paranasal computed tomography and magnetic resonance imaging. Age, sex and symptoms, and location of the invasive fungal infection and the causative fungus were analysed.ResultsIn total, 4 patients were affected by the AIFRS form, and 13 by the chronic form. Diabetes mellitus was reported in 41.17% of cases, and haematological diseases in 23.52%. The maxillary sinuses were involved in 47.05% of cases and sphenoidal sinuses in 52.94%; Aspergillus fumigatus was the fungus in 76.47% of cases, and Zygomycetes in 23.53%.ConclusionsAn understanding of the different types of fungal sinusitis and knowledge of their features play a crucial role in reaching prompt diagnosis and initiation of appropriate therapy, which is essential to avoid a protracted or fatal outcome.

Chronic granulomatous invasive fungal rhinosinusitis in Nigeria: challenges of management

<p class="abstract"><strong>Background:</strong> Chronic granulomatous invasive fungal rhinosinusitis affects mainly immunocompetent patients and has been widely reported in tropical regions such as South East Asia and North Africa. Nigeria has a tropical climate, however, there is paucity of data on this disease condition in Nigeria. This study documents the clinical, diagnostic, therapeutic challenges of managing patients with this condition in Nigeria.</p><p class="abstract"><strong>Methods:</strong> A retrospective study of patients diagnosed and treated for chronic granulomatous invasive fungal rhinosinusitis between 2010 and 2019. Diagnosis was based on clinical presentation, computed tomographic scan findings and confirmed by histopathology and/or microbiology results. </p><p class="abstract"><strong>Results:</strong> Ten patients aged 12 to 49 years with mean age of 33.9±13.8 years were studied. Male to female ratio was 2.3:1. All were immunocompetent. Duration of symptoms before presentation ranged from 3 months to 8 years with a mean duration of 3.5±2.4 years. Commonest clinical presentation was unilateral proptosis 80% followed by nasal mass 50%. Commonest sinus involved was the ethmoid (80%). There was orbital extension in 70% and intracranial involvement in 50%. Aspergillus species was the commonest fungal agent cultured. Treatment was by surgical excision followed by antifungal drugs. Some of the challenges we encountered in the management included; late presentation, delay in diagnosis, limited experience in histopathologic and mycology diagnosis and high cost of treatment amidst scarce resource.</p><p class="abstract"><strong>Conclusions:</strong> Chronic invasive granulomatous rhinosinusitis is not rare in Nigeria. A high index of suspicion is however needed for the diagnosis. Development of a National management protocol for this disease is recommended to avoid misdiagnosis.</p><p class="abstract"> </p>

Early and noninvasive diagnosis using serological antigen biomarkers in chronic invasive fungal rhinosinusitis

Background: Chronic invasive form of fungal rhinosinusitis (FRS) is characterized by the invasion of fungal organisms into the sinonasal mucosa in the background of diabetes mellitus and corticosteroid treatment. Although the histopathology has traditionally been used to make a proven diagnosis of invasive fungal infections, the dependence on tissue samples and the slow turnaround time hamper the early confirmation of such infections. Methodology: This is a retrospective case series conducted over 6 years. All patients with a chronic course and immunosuppressive background of FRS diagnosed by radiologic imaging and treated with endoscopic sinus surgery were eligible for inclusion. Data were collected through medical records, including basic characteristics, symptoms and signs, imaging findings, laboratory investigations, pathology, treatment, and outcomes. Results: Fifteen patients with chronic course and immunosuppressive background of FRS diagnosed by radiologic imaging were identified. High values of 1,3-b-D-glucan (BDG) assay were recognized in 5 patients, whereas the other 10 patients with negative findings in the BDG assay showed sinus mycetomas. All the 5 patients showing significant elevations of serum BDG showed positive findings in the polymerase chain reaction (PCR), but only 2 patients were positive in the histopathology. The findings of the BDG assay were consistent with those of the PCR method, which was superior in sensitivity to the histopathology. Conclusion: We first applied BDG assay as a diagnostic tool for chronic invasive FRS. The BDG assay may be useful to distinguish chronic invasive FRS, including its early stage, from noninvasive mycetoma, contributing to timely treatment.

Chronic invasive fungal rhinosinusitis vs sinonasal squamous cell carcinoma: the differentiating value of MRI.

To investigate MRI features in discriminating chronic invasive fungal rhinosinusitis (CIFRS) from sinonasal squamous cell carcinomas (SNSCC). MRI findings of 33 patients with CIFRS and 47 patients with SNSCC were retrospectively reviewed and compared. Multivariate logistic regression analysis was performed to identify significant imaging features in distinguishing between CIFRS and SNSCC. The ROC curves and the AUC were used to evaluate diagnostic performance. There were significant differences in cavernous sinus involvement (p < 0.001), sphenoid sinus involvement (p < 0.001), meningeal involvement (p = 0.024), T2 signal intensity (p =0.006), and enhancement pattern (p < 0.001) between CIFRS and SNSCC. Multivariate logistic regression analysis identified cavernous sinus involvement (odds ratio [OR] = 0.06, 95% confidence interval [95% CI] = 0.02-0.20) and sphenoid sinus involvement (OR = 0.14, 95% CI = 0.05-0.45) as significant indicators for CIFRS and T2 isointensity to gray matter (OR = 4.44, 95% CI = 1.22-16.22) was a significant indicator for SNSCC. ROC curve analysis showed the AUC from a combination of three imaging features was 0.95 in differentiating CIFRS and SNSCC. MRI showed significant differences between CIFRS and SNSCC features. In immunocompromised patients, a sinonasal hypointense mass on T2WI with septal enhancement or loss of contrast enhancement, and involvement of cavernous sinus, sphenoid sinus, and meninges strongly suggest CIFRS. • Chronic invasive fungal rhinosinusitis (CIFRS) is often difficult to distinguish from sinonasal squamous cell carcinomas (SNSCC) in clinical practice. • Cavernous sinus and sphenoid sinus involvement appear to be significant indicators for CIFRS. T2 isointensity to gray matter appears to be a significant indicator for SNSCC. • Loss of contrast enhancement and septal enhancement can be used to distinguish CIFRS from SNSCC with a high degree of specificity.

亜急性から慢性の経過をたどったアスペルギルスによる浸潤性副鼻腔真菌症の 2 例

亜急性から慢性の経過をたどったアスペルギルスによる浸潤性副鼻腔真菌症の 2 例

Clinical Features of Chronic Invasive Fungal Rhinosinusitis in 16 Cases.

Clinical Features of Chronic Invasive Fungal Rhinosinusitis in 16 Cases.

Invasive fungal rhinosinusitis

Abstract Invasive fungal rhinosinusitides are a group of disorders with three subtypes (acute invasive fungal rhinosinusitis, chronic invasive fungal rhinosinusitis and granulomatous invasive fungal rhinosinusitis), requiring urgent diagnosis and early treatment due to the reserved vital and functional prognosis. This disorder occurs in immunocompromised patients, but it can also occur in immunocompetent people. Aspergillus and Mucormicosis species are the most common microorganisms found in invasive fungal rhinosinusites. The otorhinolaryngologic clinical examination and imaging techniques provide important diagnostic information in patients with risk factors for invasive fungal rhinosinusitis, including intracranial or orbital extension identification. The treatment of invasive fungal rhinosinusites (acute or chronic) consists of reversing immunosuppression, appropriate systemic antifungal therapy and aggressive and prompt surgical debridement of the affected tissues.

Randomised Comparison of Safety Profile and Short Term Response of Itraconazole, Voriconazole and Amphotericin B in the Management of Chronic Invasive Fungal Rhinosinusitis.

Chronic invasive fungal rhino sinusitis (CIFS) is a well described clinical entity characterized by mucosal and sub mucosal infiltration of mycotic organisms and angio-centric extension into orbital and intracranial structures. Itraconazole, Voriconazole and Amphotericin B are commonly used for CIFS. In the present study we have evaluated short term clinical response of these drugs. Thirty diagnosed patients of CIFS who presented to us from January 2011 to December 2015 were divided into three groups randomly. Group A, B and C received Itraconazole, Voriconazole and Amphotericin respectively. Visual Analogue scale (VAS), Lund Mackay (LM) radiological scores and Kupferberg's nasal endoscopic grades were seen and compared in all patients before treatment, after primary surgical debridement and biopsy and after post biopsy antifungal drug treatment. We assessed the serum drug levels using HPLC assay at 4 and 8weeks of therapy and correlated them for efficacy and safety. All the groups had significant improvement after treatment compared to beginning of study. Inter group comparison showed that mean LM, NE and VAS scores were significantly better in Voriconazole group compared to Itraconazole and amphotericin B therapy. The reduction of these objective parameters with treatment was also significantly high in Voriconazole group compared to the other two groups. Voriconazole has shown to be the most effective treatment modality for chronic invasive fungal sinusitis compared to other commonly used drugs such as Itraconazole and Amphotericin B.

“Localized” chronic invasive fungal rhinosinusitis without serological abnormalities

“Localized” chronic invasive fungal rhinosinusitis without serological abnormalities

Entities of Chronic and Granulomatous Invasive Fungal Rhinosinusitis: Separate or Not?

BackgroundChronic and granulomatous invasive fungal rhinosinusitis are important causes of blindness and craniocerebral complications. However, the classification of these 2 diseases remains controversial.MethodsWe retrospectively analyzed patients with chronic and granulomatous invasive fungal rhinosinusitus in a Chinese tertiary hospital from 2009 to 2017, with a focus on classification and comparisons.ResultsAmong 55 patients enrolled in our study, 11 (11/55, 20%) had granulomatous invasive fungal rhinosinusitis (GIFRS) and 44 (44/55, 80%) had chronic invasive fungal rhinosinusitis (CIFRS). Aspergillus fumigatus and Dematiaceous hyphomycetes were identified in 2 patients with GIFRS. Compared with granulomatous type, CIFRS was more frequently encountered in immunocompromised patients (P = .022), and the time from onset to diagnosis was much shorter (P = .001). Proptosis and orbital apex syndrome showed no significant difference between granulomatous and CIFRS in our study. The treatment options and prognosis of both diseases also showed no significant difference.ConclusionsDespite the consensus on histopathology, the classification of the chronic and granulomatous types may need further evaluation in clinical considerations.

A retrospective review of 46 cases of chronic invasive fungal rhinosinusitis

Objective To investigate the clinical characteristics of chronic invasive fungal rhinosinusitis. Methods Clinical features and outcomes of 46 proven cases of chronic invasive fungal rhinosinusitis admitted in Huashan Hospital, Fudan University from January 2009 to December 2016 were retrospectively reviewed. Results Of the 46 patients enrolled, left sphenoid sinus, ethmoid sinus and maxillary sinus were affected in 24, 23 and 20 cases, respectively, while right maxillary sinus, ethmoid sinus and sphenoid sinus were affected in 18, 16 and 15 cases, respectively. Left and right frontal sinus were affected in 9 and 6 cases, respectively. The central nervous system and orbit were the most commonly affected sites in external nasal involvements, noted in 22 cases respectively. Left sphenoid (17 cases) and ethmoid sinus (15 cases) involvements were most common in central nervous system affected patients. Left sphenoid (14 cases) and ethmoid sinus (13 cases) involvements were most common in orbit affected patients. Aspergillus species were the primary pathogens observed in 42 cases. Zygomycete, candida and dark filamentous fungus were observed in two, one and one case, respectively. Pathologically, 37 of the cases were chronic nongranulomatous type and the left 9 were chronic granulomatous type who were all immunocompetent hosts. The initial symptoms usually included headache, dizziness and nasal discomforts including nasal obstruction and purulent secretion. The chief complaints usually included headache, dizziness, and visual disturbances including blurred vision, vision loss or even blindness. Antifungal treatment combined with surgical interventions for removal or drainage focus lesions achieved significant effect, and 42 patients were cured. Conclusions Chronic invasive fungal rhinosinusitis should be taken into consideration in the presence of nasal discomforts or nonspecific symptoms such as headache and dizziness. The possibility of chronic invasive fungal rhinosinusitis should be cautious after the emergence of vision abnormalities. Key words: Chronic; Fungal rhinosinusitis; Clinical characteristics; Treatment