Abstract
Objectives/Hypothesis Document a 15-year experience with 29 cases of acute invasive fungal rhinosinusitis (AIFR) and evaluate factors predictive of disease clearance and overall survival. Study Design Case series with chart review. Methods Patients were identified by review of department billing records between 1995 and 2010. Medical records were reviewed for patient demographics, disease characteristics, clinical course including surgical and medical therapy, treatment outcomes, and long-term survival. Results Twenty-nine patients with AIFR were identified. Causes of immunosuppression included hematologic malignancy (n=16), diabetes (n=12), medication (n=10), and acquired immunodeficiency syndrome (n=1), with 10 patients having multiple causes of immunosuppression. Facial pain, swelling and orbital symptoms were the most common presenting symptoms. Fungal organisms included Mucor (n=18) and Aspergillus (n=10) species, with one patient infected with both. Disease-specific survival (DSS) from AIFR was 57%. Intracranial (P=.01) and ethmoid sinus (P=.05) involvement were significantly linked with short-term disease-related mortality. Overall survival (OS) at 6 months was 18%. For OS, intracranial involvement (hazard ratio [HR], 4.47; 95% confidence interval [CI], 1.51-13.22) and cranial neuropathy at presentation (HR, 3.2; 95% CI, 1.3-8.2) were significantly associated with shortened survival. Of the five patients surviving >6 months, two developed long-term major sinonasal complications. Conclusions DSS and OS remain low for patients with AIFR. Extensive surgical resection in patients with these poor prognostic signs should be considered carefully in light of their poor survival. Long-term survivors are at significant risk of sinonasal complications and should be followed closely. Level of Evidence 4. Laryngoscope, 2012
| Original language | English (US) |
|---|---|
| Pages (from-to) | 1583-1587 |
| Number of pages | 5 |
| Journal | Laryngoscope |
| Volume | 123 |
| Issue number | 7 |
| DOIs | |
| State | Published - Jul 2013 |
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Keywords
- aspergillosis
- Aspergillus
- fulminant
- fungus
- Immunocompromise
- invasive fungal sinusitis
- mold
- Mucor
- rhinocerebral mucormycosis
ASJC Scopus subject areas
- Otorhinolaryngology
Cite this
Invasive fungal rhinosinusitis : A 15-year experience with 29 patients. / Monroe, Marcus M.; McLean, Max; Sautter, Nathan; Wax, Mark; Andersen, Peter; Smith, Timothy; Gross, Neil D.
In: Laryngoscope, Vol. 123, No. 7, 07.2013, p. 1583-1587.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Invasive fungal rhinosinusitis
T2 - A 15-year experience with 29 patients
AU - Monroe, Marcus M.
AU - McLean, Max
AU - Sautter, Nathan
AU - Wax, Mark
AU - Andersen, Peter
AU - Smith, Timothy
AU - Gross, Neil D.
PY - 2013/7
Y1 - 2013/7
N2 - Objectives/Hypothesis Document a 15-year experience with 29 cases of acute invasive fungal rhinosinusitis (AIFR) and evaluate factors predictive of disease clearance and overall survival. Study Design Case series with chart review. Methods Patients were identified by review of department billing records between 1995 and 2010. Medical records were reviewed for patient demographics, disease characteristics, clinical course including surgical and medical therapy, treatment outcomes, and long-term survival. Results Twenty-nine patients with AIFR were identified. Causes of immunosuppression included hematologic malignancy (n=16), diabetes (n=12), medication (n=10), and acquired immunodeficiency syndrome (n=1), with 10 patients having multiple causes of immunosuppression. Facial pain, swelling and orbital symptoms were the most common presenting symptoms. Fungal organisms included Mucor (n=18) and Aspergillus (n=10) species, with one patient infected with both. Disease-specific survival (DSS) from AIFR was 57%. Intracranial (P=.01) and ethmoid sinus (P=.05) involvement were significantly linked with short-term disease-related mortality. Overall survival (OS) at 6 months was 18%. For OS, intracranial involvement (hazard ratio [HR], 4.47; 95% confidence interval [CI], 1.51-13.22) and cranial neuropathy at presentation (HR, 3.2; 95% CI, 1.3-8.2) were significantly associated with shortened survival. Of the five patients surviving >6 months, two developed long-term major sinonasal complications. Conclusions DSS and OS remain low for patients with AIFR. Extensive surgical resection in patients with these poor prognostic signs should be considered carefully in light of their poor survival. Long-term survivors are at significant risk of sinonasal complications and should be followed closely. Level of Evidence 4. Laryngoscope, 2012
AB - Objectives/Hypothesis Document a 15-year experience with 29 cases of acute invasive fungal rhinosinusitis (AIFR) and evaluate factors predictive of disease clearance and overall survival. Study Design Case series with chart review. Methods Patients were identified by review of department billing records between 1995 and 2010. Medical records were reviewed for patient demographics, disease characteristics, clinical course including surgical and medical therapy, treatment outcomes, and long-term survival. Results Twenty-nine patients with AIFR were identified. Causes of immunosuppression included hematologic malignancy (n=16), diabetes (n=12), medication (n=10), and acquired immunodeficiency syndrome (n=1), with 10 patients having multiple causes of immunosuppression. Facial pain, swelling and orbital symptoms were the most common presenting symptoms. Fungal organisms included Mucor (n=18) and Aspergillus (n=10) species, with one patient infected with both. Disease-specific survival (DSS) from AIFR was 57%. Intracranial (P=.01) and ethmoid sinus (P=.05) involvement were significantly linked with short-term disease-related mortality. Overall survival (OS) at 6 months was 18%. For OS, intracranial involvement (hazard ratio [HR], 4.47; 95% confidence interval [CI], 1.51-13.22) and cranial neuropathy at presentation (HR, 3.2; 95% CI, 1.3-8.2) were significantly associated with shortened survival. Of the five patients surviving >6 months, two developed long-term major sinonasal complications. Conclusions DSS and OS remain low for patients with AIFR. Extensive surgical resection in patients with these poor prognostic signs should be considered carefully in light of their poor survival. Long-term survivors are at significant risk of sinonasal complications and should be followed closely. Level of Evidence 4. Laryngoscope, 2012
KW - aspergillosis
KW - Aspergillus
KW - fulminant
KW - fungus
KW - Immunocompromise
KW - invasive fungal sinusitis
KW - mold
KW - Mucor
KW - rhinocerebral mucormycosis
UR - http://www.scopus.com/inward/record.url?scp=84879413920&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84879413920&partnerID=8YFLogxK
U2 - 10.1002/lary.23978
DO - 10.1002/lary.23978
M3 - Article
C2 - 23417294
AN - SCOPUS:84879413920
VL - 123
SP - 1583
EP - 1587
JO - Laryngoscope
JF - Laryngoscope
SN - 0023-852X
IS - 7
ER -