Department of Ophthalmology, Otorhinolaryngology, and Head and Neck Surgery, Ribeirão Preto Medical School, University of São Paulo, Av. Bandeirantes, 3900 - 12° andar., São Paulo, São Paulo, CEP: 14049-900, Brazil.
Division of Pathology, Clinics Hospital of Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil.
BMC Infect Dis. 2019 Apr 5;19(1):310. doi: 10.1186/s12879-019-3938-y.
Early 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.
Retrospective 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.
The 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%.
Implementation 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.
早期诊断急性侵袭性真菌性鼻-鼻窦炎（AIFRS）对于改善免疫功能低下患者的预后至关重要。本研究评估了通过鼻内镜检查和活检的系统方案对免疫功能低下患者进行早期检测 AIFRS 的影响。此外，我们比较了冰冻切片活检和培养与福尔马林固定石蜡包埋（FFPE）活检的准确性。
回顾性队列研究，在一家三级转诊医院进行。对疑似 AIFRS 的患者按照标准化方案进行评估，包括必要时进行连续鼻内镜检查和活检。还比较了冰冻切片活检和培养的敏感性和特异性与 FFPE 的比较。
该标准化队列（43 例）中与 AIFRS 相关的死亡率为 30.2%。在疾病仅限于鼻甲和外周中性粒细胞计数较高的患者中，观察到更好的结局。冰冻切片活检阳性与 FFPE 真菌检测结果相关（p 值<0.0001），敏感性为 90.6%，特异性为 72.7%，准确性为 86.0%。
在我们的机构中，实施该标准化方案与疑似 AIFRS 患者的死亡率显著降低有关。冰冻切片活检对诊断 AIFRS 具有很高的准确性。当前包括冰冻组织活检的方案改善了疑似 AIFRS 免疫功能低下患者的评估和生存率。
