Risk factors and predictors of mortality in acute invasive fungal sinusitis - a single-institution experience
OBJECTIVE: To determine risk factors affecting mortality in acute invasive fungal sinusitis.
METHOD: This observational cohort study was conducted over a five-year period.
RESULTS: Of 109 recruited patients, 90 (82.6 per cent) had diabetes mellitus. Predominant fungi were zygomycetes (72.6 per cent) with Rhizopus arrhizus being most common. Of the patients, 12.8 per cent showed a positive biopsy report from radiologically normal sinuses. Factors affecting mortality on multivariate analysis were: female sex (p = 0.022), less than two weeks between symptoms and first intervention (p = 0.01), and intracranial involvement (p = 0.034). Other factors significant on univariate analysis were: peri-orbital swelling (p = 0.016), restricted ocular movements (p = 0.053), intracranial symptoms (p = 0.008), posterior disease (p = 0.058), imaging showing ocular involvement (p = 0.041), fungus being zygomycetes (p = 0.050) and post-operative cavity infection (p = 0.032). Bilateral, palatal and retromaxillary involvement were not associated with poor prognosis.
CONCLUSION: Diagnosis of acute invasive fungal sinusitis requires a high index of clinical suspicion. Recognition of factors associated with poor prognosis can help when counselling patients, and can help initiate urgent intervention by debridement and antifungal therapy. Post-operative nasal and sinus cavity care is important to reduce mortality.
| Medienart: |
E-Artikel |
|---|
| Erscheinungsjahr: |
2022 |
|---|---|
| Erschienen: |
2022 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:136 |
|---|---|
| Enthalten in: |
The Journal of laryngology and otology - 136(2022), 12 vom: 16. Dez., Seite 1320-1327 |
| Sprache: |
Englisch |
|---|
| Beteiligte Personen: |
Varghese, L [VerfasserIn] |
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| Links: |
|---|
| Themen: |
Antifungal Agents |
|---|
| Anmerkungen: |
Date Completed 16.11.2022 Date Revised 16.11.2022 published: Print-Electronic Citation Status MEDLINE |
|---|
| doi: |
10.1017/S0022215122000755 |
|---|
| funding: |
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|---|---|
| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM338228101 |
|---|
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| 500 | |a Date Revised 16.11.2022 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a OBJECTIVE: To determine risk factors affecting mortality in acute invasive fungal sinusitis | ||
| 520 | |a METHOD: This observational cohort study was conducted over a five-year period | ||
| 520 | |a RESULTS: Of 109 recruited patients, 90 (82.6 per cent) had diabetes mellitus. Predominant fungi were zygomycetes (72.6 per cent) with Rhizopus arrhizus being most common. Of the patients, 12.8 per cent showed a positive biopsy report from radiologically normal sinuses. Factors affecting mortality on multivariate analysis were: female sex (p = 0.022), less than two weeks between symptoms and first intervention (p = 0.01), and intracranial involvement (p = 0.034). Other factors significant on univariate analysis were: peri-orbital swelling (p = 0.016), restricted ocular movements (p = 0.053), intracranial symptoms (p = 0.008), posterior disease (p = 0.058), imaging showing ocular involvement (p = 0.041), fungus being zygomycetes (p = 0.050) and post-operative cavity infection (p = 0.032). Bilateral, palatal and retromaxillary involvement were not associated with poor prognosis | ||
| 520 | |a CONCLUSION: Diagnosis of acute invasive fungal sinusitis requires a high index of clinical suspicion. Recognition of factors associated with poor prognosis can help when counselling patients, and can help initiate urgent intervention by debridement and antifungal therapy. Post-operative nasal and sinus cavity care is important to reduce mortality | ||
| 650 | 4 | |a Observational Study | |
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Immunocompromised Host | |
| 650 | 4 | |a Mucormycosis | |
| 650 | 4 | |a Mycoses | |
| 650 | 4 | |a Prognosis | |
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