Invasive fungal sinusitis: a 15-year review from a single institution.
BACKGROUND
The aim of this study was to review our experience with patients with invasive fungal sinusitis (IFS) to determine outcomes and identify factors that may affect patient survival.


METHODS
A retrospective review was performed.


RESULTS
Forty-three patients were identified accounting for 45 cases of IFS. The underlying reasons for immunosuppression were hematologic malignancy (28 patients), diabetes mellitus (10 patients), solid organ transplant (3 patients), chronic steroid use (3 patients), and acquired immunodeficiency syndrome (1 patient). Eight of 45 cases (18%) died of IFS. Of the 28 cases associated with hematologic malignanancy, 3 patients died of IFS (11%) and 4 patients (14%) died of other causes with persistent IFS. None of these 7 patients had recovery of their absolute neutrophil count, and all patients who recovered from IFS recovered to a normal absolute neutrophil count. Four of 10 (40%) diabetic patients died of IFS, and 66% of survivors had persistent neurological or visual morbidity. The imortality rate was 29% for patients infected with Mucor and 11% for patients injected with Aspergillus.


CONCLUSIONS
We have found the overall mortality rate directly related to IFS to be 18%. The rate is higher for diabetic patients than for patients with hematologic causes for their immunosuppression. This is likely because of the higher index of suspicion and early diagnosis and treatment of patients with neutropenia and a less-fulminant, slower-progressing form of IFS from Aspergillus, apparently a less virulent fungus than Mucor. Intracranial involvement and failure to recover from neutropenia are the factors that led to poor prognosis in this series.
Parikh
Shatul L
SL
Department of Otolaryngology--Head and Neck Surgery, Emory University School of Medicine, Atlanta, Georgia, USA.
Venkatraman
Giridhar
G
DelGaudio
John M
JM
D000046:Academic Medical Centers; D005260:Female; D016469:Fungemia / Q000453:epidemiology / Q000276:immunology / Q000382:microbiology*; D005658:Fungi / Q000145:classification*; D006801:Humans; D016867:Immunocompromised Host; D008297:Male; D009181:Mycoses / Q000175:diagnosis* / Q000453:epidemiology / Q000276:immunology; D009894:Opportunistic Infections / Q000175:diagnosis* / Q000453:epidemiology / Q000276:immunology; D011379:Prognosis; D012189:Retrospective Studies; D012720:Severity of Illness Index; D012852:Sinusitis / Q000453:epidemiology / Q000276:immunology / Q000382:microbiology*; D016019:Survival Analysis