title: Acute Invasive Fungal Rhinosinusitis: Presentation of 19 Cases, Review of the Literature, and a New Classification System.
abstract: The aim of this study was to determine the correlation between acute invasive fungal rhinosinusitis (AIFRS) and underlying diseases, micro-organisms, presenting symptoms, extent of disease, radiologic findings, and outcomes and propose a new classification system.
  
  
  
  The data of 19 AIFRS cases were analyzed retrospectively. Magnetic resonance imaging and computed tomography were performed in all patients preoperatively. All patients underwent at least 1 surgical debridement.
  
  
  
  Hematologic diseases were the most common (52%) underlying diseases. Patients with type 2 diabetes and those with multiple etiologies causing immunosuppression had the lowest survival. Aspergillus and Mucoraceae species were isolated in 9 patients but were not associated with poor prognosis. Headache and nasal discharge or crusting were the most common presenting symptoms. Premaxillary involvement was significantly correlated with poor prognosis (P = .001). Unilateral involvement was correlated with poor prognosis, although this finding was not significant (P = .111). The overall mortality rate was 61.2%. Patients with neutropenia that was corrected had 80% survival (P = .014). Cessation of corticosteroids and regulating blood glucose levels in patients with immunosuppression from corticosteroid use resulted in 75% survival.
  
  
  
  There is no single curative treatment for AIFRS. For a favorable prognosis, underlying conditions must be treated in addition to surgical debridement and antifungals.
authors.affiliation: General Practitioner Otorhinolaryngologist, Department of Otorhinolaryngology Head and Neck Surgery, Faculty of Medicine, Hacettepe University, Ankara, Turkey. Electronic address: ergunooc@yahoo.com.
authors.forename: Onur
authors.initials: O
authors.lastname: Ergun
authors.affiliation: General Practitioner Otorhinolaryngologist, Department of Otorhinolaryngology Head and Neck Surgery, Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey.
authors.forename: Emel
authors.initials: E
authors.lastname: Tahir
authors.affiliation: Consultant, Department of Otorhinolaryngology Head and Neck Surgery, Faculty of Medicine, Hacettepe University, Ankara, Turkey.
authors.forename: Oguz
authors.initials: O
authors.lastname: Kuscu
authors.affiliation: Associate Professor, Department of Radiology, Faculty of Medicine, Hacettepe University, Ankara, Turkey.
authors.forename: Burce
authors.initials: B
authors.lastname: Ozgen
authors.affiliation: Professor and Department Head, Department of Otorhinolaryngology Head and Neck Surgery, Faculty of Medicine, Hacettepe University, Ankara, Turkey.
authors.forename: Taner
authors.initials: T
authors.lastname: Yilmaz
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D000935:Antifungal Agents / Q000627:therapeutic use; D001706:Biopsy; D002648:Child; D002675:Child, Preschool; D003131:Combined Modality Therapy; D003287:Contrast Media; D003646:Debridement; D005260:Female; D006801:Humans; D016867:Immunocompromised Host; D007223:Infant; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009181:Mycoses / Q000145:classification* / Q000000981:diagnostic imaging / Q000382:microbiology* / Q000628:therapy; D011379:Prognosis; D012189:Retrospective Studies; D012220:Rhinitis / Q000000981:diagnostic imaging / Q000382:microbiology* / Q000628:therapy; D012852:Sinusitis / Q000000981:diagnostic imaging / Q000382:microbiology* / Q000628:therapy; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D000935:Antifungal Agents; D003287:Contrast Media