title: Acute Invasive Fungal Rhinosinusitis: A 15-Year Experience with 41 Patients.
abstract: OBJECTIVE
  To describe a 15-year single-institution experience of 41 cases of acute invasive fungal sinusitis (AIFRS), identify clinical indicators predictive of AIFRS, and discuss our approach to these high-acuity patients.
  
  
  METHODS
  Case series with chart review.
  
  
  METHODS
  Tertiary referral center; The Pennsylvania State University Hershey Medical Center.
  
  
  METHODS
  A retrospective review was performed for AIFRS consultations between September 1999 and March 2014. Variables reviewed included underlying condition, presenting symptoms, absolute neutrophil count, disease extent on examination, radiographic findings, medical treatment, biopsy results, surgical treatment, and outcomes. Univariate analysis was performed to determine variables significantly associated with AIFRS. Outcome measures were assessed and patient assessment algorithm developed.
  
  
  RESULTS
  Of 131 patients evaluated, 41 were diagnosed with AIFRS; 92.7% had an underlying hematologic malignancy. Disease predictive variables included absolute neutrophil count <500/μL (P < .0001; sensitivity = 78%), mucosal abnormalities of middle turbinate (P < .0001; specificity = 88%) and septum (P < .0001; specificity = 97%), and specifically, necrosis of the middle turbinate (P < .0001; specificity = 97%). Twenty-five AIFRS patients (61%) survived until discharge; 25% (n = 10) expired secondary to AIFRS infection explicitly.
  
  
  CONCLUSIONS
  This series represents one of the largest single-institution experiences of AIFRS published to date. Timely diagnosis is necessary to improve patient outcomes and limit morbidity. Maintaining a high index of suspicion in at-risk patient populations, followed by prompt evaluation and management, is crucial in suspected AIFRS. The presence or absence of certain findings appear to correlate with biopsy results and may aid in appropriately gauging clinical suspicion for the presence of AIFRS.
authors.affiliation: Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, The Pennsylvania State Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA spayne1@hmc.psu.edu.
authors.forename: Sakeena J
authors.initials: SJ
authors.lastname: Payne
authors.affiliation: ENT and Allergy Associates, LLP, Lake Success, New York, USA.
authors.forename: Ron
authors.initials: R
authors.lastname: Mitzner
authors.affiliation: Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, The Pennsylvania State Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA.
authors.forename: Sudhir
authors.initials: S
authors.lastname: Kunchala
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Washington University in St Louis, St Louis, Missouri, USA.
authors.forename: Lauren
authors.initials: L
authors.lastname: Roland
authors.affiliation: Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, The Pennsylvania State Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA.
authors.forename: Johnathan D
authors.initials: JD
authors.lastname: McGinn
mesh_terms: D000208:Acute Disease; D000465:Algorithms; D001706:Biopsy; D004724:Endoscopy; D005260:Female; D006801:Humans; D016867:Immunocompromised Host; D008297:Male; D008875:Middle Aged; D009181:Mycoses / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy; D010414:Pennsylvania / Q000453:epidemiology; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012220:Rhinitis / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy; D012680:Sensitivity and Specificity; D012852:Sinusitis / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy; D015996:Survival Rate
keywords: algorithm; clinical indicators; invasive fungal sinusitis; middle turbinate biopsy; mucormycosis; neutropenia