Division of Otorhinolaryngology, Department of Otorhinolaryngology, Ophthalmology and Head and Neck Surgery, School of Medicine of Ribeirão Preto, University of São Paulo, Av. Bandeirantes 3900, 14049-900 Ribeirão Preto, São Paulo, Brazil.
Int J Infect Dis. 2011 Dec;15(12):e841-4. doi: 10.1016/j.ijid.2011.08.005. Epub 2011 Oct 2.
Acute invasive fungal rhinosinusitis (AIFRS) is a rare disease with high morbidity and mortality rates. The objective of this study was to correlate the initial clinical features of AIFRS to the prognosis after surgery.
Thirty-two patients with AIFRS were evaluated retrospectively. The correlation of underlying disease, fungus isolated, and extent of the disease to the clinical outcome of AIFRS was also evaluated.
The most common underlying disease was hematological malignancy and aplasia (n=20). Aspergillus (n=13) and Mucoraceae (n=11) were the main fungi found in AIFRS. Mucosal biopsy confirmed fungal invasion to the nasal mucosa in all cases. Computed tomography and endoscopic findings showed a predominance of unilateral disease, with various stages of nasal involvement. All patients underwent surgical debridement and systemic antifungal therapy immediately after diagnosis. Sixteen patients died (50%) due to AIFRS. A poor prognosis was related to the extensiveness of AIFRS and to the underlying disease (patients with aplastic anemia and diabetes had the worst outcomes), but not to the fungus isolated.
Early medical and surgical treatment is essential to improve the prognosis of AIFRS patients. A poorer prognosis was associated with underlying disease and extensiveness of AIFRS, but not to the fungus isolated.
急性侵袭性真菌性鼻-鼻窦炎（AIFRS）是一种罕见的疾病，具有较高的发病率和死亡率。本研究的目的是探讨 AIFRS 的初始临床特征与术后预后的相关性。
回顾性评估了 32 例 AIFRS 患者。还评估了潜在疾病、分离出的真菌以及疾病的严重程度与 AIFRS 临床结果的相关性。
最常见的潜在疾病是血液系统恶性肿瘤和再生障碍（n=20）。AIFRS 中主要发现的真菌为曲霉菌（n=13）和毛霉菌科（n=11）。所有病例的鼻黏膜活检均证实了真菌侵袭。计算机断层扫描和内镜检查结果显示单侧疾病为主，伴有不同程度的鼻腔受累。所有患者在诊断后立即接受手术清创和全身抗真菌治疗。16 例患者（50%）因 AIFRS 死亡。预后不良与 AIFRS 的广泛性和潜在疾病有关（再生障碍性贫血和糖尿病患者的结局最差），但与分离出的真菌无关。
早期的医学和手术治疗对于改善 AIFRS 患者的预后至关重要。较差的预后与潜在疾病和 AIFRS 的广泛性有关，但与分离出的真菌无关。
