Department of Otolaryngology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile.
School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile.
Clin Otolaryngol. 2021 Jul;46(4):775-781. doi: 10.1111/coa.13734. Epub 2021 Mar 10.
To describe a group of patients with suspected acute invasive fungal rhinosinusitis (AIFRS) diagnosis, and identify factors associated with a greater risk of presenting this disease.
Non-concurrent cohort study.
A single-centre non-concurrent follow-up of patients with suspected AIFRS between August 2015 and July 2018.
50 inpatients referred due to suspected AIFRS at Hospital Clínico Universidad Católica based on the association of a predisposing factor (neutropenia/immunodeficiency/poorly controlled diabetes) with fever of unknown origin.
The primary outcome was AIFRS diagnosis, defined as a concordant tissue biopsy.
Acute invasive fungal rhinosinusitis was confirmed in 18% (9/50) of the evaluated patients. AIFRS was significantly associated with a positive galactomannan (P = .04), and a paranasal sinus MRI with lack of contrast enhancement (LoCE) (P = .04) orbit compromise (P = .03) or global extrasinusal extension (P = .04). LoCE and extrasinusal extension in the paranasal sinus/brain MRI were risk factors for AIFRS (OR 16; CI 1.2-210.6 and OR 12.75; CI 1.3-128.8, respectively). Conversely, a nasal endoscopy showing healthy mucosa was identified as a protective factor for AIFRS (OR 0.06; CI 0.007-0.57).
In patients with suspected AIFRS, we identified laboratory and radiologic variables associated with the disease, which may help for a more accurate diagnostic algorithm and approach in this population.
描述一组疑似急性侵袭性真菌性鼻-鼻窦炎（AIFRS）的患者，并确定与该疾病发生风险较高相关的因素。
非同期队列研究。
2015 年 8 月至 2018 年 7 月，在一所单中心对疑似 AIFRS 的患者进行非同期随访。
50 名因疑似 AIFRS 而入住 Hospital Clínico Universidad Católica 的住院患者，其依据是与发热原因不明相关的易患因素（中性粒细胞减少/免疫缺陷/未控制的糖尿病）存在关联。
主要结局为 AIFRS 诊断，定义为组织活检结果一致。
在评估的 50 名患者中，18%（9/50）确诊为 AIFRS。AIFRS 与半乳甘露聚糖检测阳性（P=.04）、鼻窦 MRI 缺乏对比增强（LoCE）（P=.04）、眼眶受累（P=.03）或广泛鼻窦外扩展（P=.04）显著相关。鼻窦/脑 MRI 中的 LoCE 和鼻窦外扩展是 AIFRS 的危险因素（OR 16；CI 1.2-210.6 和 OR 12.75；CI 1.3-128.8）。相反，鼻内镜检查显示健康的黏膜被认为是 AIFRS 的保护因素（OR 0.06；CI 0.007-0.57）。
在疑似 AIFRS 的患者中，我们确定了与该疾病相关的实验室和影像学变量，这可能有助于为该人群制定更准确的诊断算法和方法。
