2nd Otolaryngology Department, School of Medicine, National & Kapodistrian University of Athens, Attikon" University Hospital, Rimini 1, 124 62, Chaidari, Athens, Greece.
1st Otolaryngology Department, School of Medicine, National & Kapodistrian University of Athens, "Ippokrateion" General Hospital, Athens, Greece.
Oral Maxillofac Surg. 2024 Mar;28(1):157-162. doi: 10.1007/s10006-022-01120-8. Epub 2022 Oct 6.
Acute invasive fungal rhinosinusitis (AIFRS) is a rare, fulminant, angio-invasive infection with high mortality rate. Treatment of AIFRS includes aggressive surgical debridement combined with antifungal agents and treatment of the underlying disease. The aim of this study is to report our experience with this often fatal disease and estimate the long-term survival of AIFRS patients with more conservative surgery.
A retrospective study was performed on immunocompromised adults with AIFRS from January 2011 to December 2020. The diagnosis was histologically confirmed by tissue fungus invasion. We analyze epidemiological and microbiological findings, the underlying disease and discuss our patients' treatment plan and long-term survival.
Fourteen patients were included in the study. Mean age was 53.8 ± 18.9 years. The underlying disease was hematologic malignancy in nine patients, diabetes mellitus in three, aplastic anemia in one, and renal/liver failure in one. Leukopenia was not significantly correlated with outcome or survival. Histological and culture findings revealed that Mucor/Rhizopus were the causative organisms in nine cases. All patients received systemic antifungal therapy. Surgery was performed in nine patients (endoscopic for all patients, combined in three with an external approach). Overall survival was 35.7% as five patients survived, two who underwent surgery, and three who were treated non-surgically. Nine patients died, two from AIFRS after central nervous system involvement and seven from their primary disease, free of fungi. Older individuals and patients with hematologic malignancies had a worse outcome.
Early surgical debridement, antifungal agents, and treatment of the underlying disease remain the cornerstones of AIFRS management. Prognosis is overall defined by the underlying disease and in some selected cases, medical treatment alone could be a reasonable option.
急性侵袭性真菌性鼻-鼻窦炎（AIFRS）是一种罕见的、暴发性的、血管侵袭性感染，死亡率很高。AIFRS 的治疗包括积极的手术清创术，结合抗真菌药物和治疗基础疾病。本研究旨在报告我们对这种经常致命疾病的经验，并估计采用更保守手术的 AIFRS 患者的长期生存率。
对 2011 年 1 月至 2020 年 12 月免疫功能低下的成人 AIFRS 患者进行回顾性研究。通过组织真菌侵袭的组织学证实诊断。我们分析了流行病学和微生物学发现、基础疾病，并讨论了患者的治疗计划和长期生存情况。
研究纳入 14 例患者。平均年龄为 53.8±18.9 岁。9 例患者的基础疾病为血液恶性肿瘤，3 例为糖尿病，1 例为再生障碍性贫血，1 例为肾功能衰竭/肝功能衰竭。白细胞减少与结果或生存无关。组织学和培养结果显示，9 例患者为毛霉/根霉。所有患者均接受系统抗真菌治疗。9 例患者接受手术治疗（所有患者均行内镜手术，3 例患者联合外治法）。5 例患者存活，2 例接受手术，3 例接受非手术治疗，总生存率为 35.7%。9 例患者死亡，2 例死于 AIFRS 合并中枢神经系统受累，7 例死于基础疾病，无真菌感染。年龄较大的患者和血液恶性肿瘤患者预后较差。
早期手术清创、抗真菌药物和治疗基础疾病仍然是 AIFRS 管理的基石。总体预后由基础疾病决定，在某些选定的情况下，单纯药物治疗可能是合理的选择。
