title: Invasive fungal rhinosinusitis in adult patients: Our experience in diagnosis and management.
abstract: BACKGROUND
  This paper describes our experience in the management of acute and chronic invasive fungal rhinosinusitis (IFRS) in adults.
  
  
  METHODS
  Medical files of all patients aged >18 years treated in our institutions for IFRS from 2002 to 2013 were retrospectively reviewed.
  
  
  RESULTS
  A total of 18 cases (10 acute and 8 chronic) were recorded. In acute form, haematological malignancies represented the principal comorbidity (100%), while in chronic form this was diabetes mellitus (87.5%). All patients received systemic antifungal agents. Endoscopic sinus surgery was performed in 16/18 patients (88.9%). Among patients with an acute IFRS, 4/10 died of fungal infection (40%), on the other side 2/8 patients with chronic IFRS died of the evolution of the mycosis (25%).
  
  
  CONCLUSIONS
  Acute and chronic IFRS are different entities: in acute form, prognosis is poor, so therapy should be promptly performed, although host immune status and evolution of the haematological disease are key factors for the outcome. In chronic form, a wide surgical excision of the disease is recommended in order to obtain a complete removal of fungal infection. In both forms, early clinical findings are non-specific and ambiguous, so diagnosis depends on a high index of suspicion, taking into account predisposing factors.
authors: Department of Otorhinolaryngology, Istituto di Ricovero e Cura a Carattere Scientifico (I.R.C.C.S.) Policlinico San Matteo, University of Pavia, Pavia, Italy.
authors: Fabio
authors: F
authors: Pagella
authors: Department of Otorhinolaryngology, Ospedale di Circolo e Fondazione Macchi, University of Insubria, Varese, Italy.
authors: Francesca
authors: F
authors: De Bernardi
authors: Infectious and Tropical Diseases Unit, Department of Surgical and Morphological Sciences, Ospedale di Circolo e Fondazione Macchi, University of Insubria, Varese, Italy.
authors: Daniela
authors: D
authors: Dalla Gasperina
authors: Department of Otorhinolaryngology, Istituto di Ricovero e Cura a Carattere Scientifico (I.R.C.C.S.) Policlinico San Matteo, University of Pavia, Pavia, Italy. Electronic address: ale.pusateri@gmail.com.
authors: Alessandro
authors: A
authors: Pusateri
authors: Department of Otorhinolaryngology, Istituto di Ricovero e Cura a Carattere Scientifico (I.R.C.C.S.) Policlinico San Matteo, University of Pavia, Pavia, Italy.
authors: Elina
authors: E
authors: Matti
authors: Department of Otorhinolaryngology, Istituto di Ricovero e Cura a Carattere Scientifico (I.R.C.C.S.) Policlinico San Matteo, University of Pavia, Pavia, Italy.
authors: Irene
authors: I
authors: Avato
authors: Laboratory Medicine/Virology and Microbiology Unit, Istituto di Ricovero e Cura a Carattere Scientifico (I.R.C.C.S.) Policlinico San Matteo, Pavia, Italy.
authors: Caterina
authors: C
authors: Cavanna
authors: Department of Haematology, Istituto di Ricovero e Cura a Carattere Scientifico (I.R.C.C.S.) Policlinico San Matteo, University of Pavia, Pavia, Italy.
authors: Patrizia
authors: P
authors: Zappasodi
authors: Department of Otorhinolaryngology, Ospedale di Circolo e Fondazione Macchi, University of Insubria, Varese, Italy.
authors: Maurizio
authors: M
authors: Bignami
authors: Department of Otorhinolaryngology, Ospedale di Circolo e Fondazione Macchi, University of Insubria, Varese, Italy.
authors: Elena
authors: E
authors: Bernardini
authors: Infectious and Tropical Diseases Unit, Department of Surgical and Morphological Sciences, Ospedale di Circolo e Fondazione Macchi, University of Insubria, Varese, Italy.
authors: Paolo Antonio
authors: PA
authors: Grossi
authors: Department of Otorhinolaryngology, Ospedale di Circolo e Fondazione Macchi, University of Insubria, Varese, Italy.
authors: Paolo
authors: P
authors: Castelnuovo
mesh_terms: D000328:Adult; D000935:Antifungal Agents / Q000627:therapeutic use*; D006801:Humans; D009181:Mycoses / Q000175:diagnosis / Q000188:drug therapy; D010256:Paranasal Sinuses; D012220:Rhinitis / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology; D012852:Sinusitis / Q000175:diagnosis* / Q000188:drug therapy* / Q000382:microbiology
chemical_list: D000935:Antifungal Agents
keywords: Aspergillus; Endoscopic sinus surgery; Fungal rhinosinusitis; Mucor; Mycosis; Skull base