Patient’s outcome in acute invasive fungal sinusitis



Acute invasive fungal sinusitis (AIFS) is an aggressive and often fatal infection. Despite improvements in medical and surgical therapy, survival remains limited and the factors that contribute to patient outcomes remain poorly understood. Turner et al from the Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University School of Medicine, Nashville, Tennessee performeda  systematically reviews of  the literature to characterize prognostic factors associated with survival after AIFS..
The authors reviewed 52 studies comprising a total of 807 patients, and analyzed the prognostic factors as they related to the treatment, presentation, and outcomes. Univariate and multivariate logistic regression was used to identify prognostic factors.
The most common presenting symptoms of patients with AIFS were facial swelling (64.5%), fever (62.9%), and nasal congestion (52.2%). Most patients were treated with a combination of intravenous antifungal medication and surgery. The overall survival rate was 49.7%. Poor prognosis was associated with renal/liver failure, altered mental status, and intracranial extension. Patients who were diabetic, had surgery, or received liposomal amphotericin B had an improved chance of survival. Advanced age and intracranial involvement were identified as independent negative prognostic factors. Positive prognostic factors again included diabetes and surgical resection.
The conclusion of the analysis was that the overall mortality of patients with AIFS remains high, with only half of the patients surviving. Diabetic patients appear to have a better overall survival than patients with other comorbidities. Patients who have intracranial involvement, or who do not receive surgery as part of their therapy, have a poor prognosis.

                             

CT scan of acute invasive fungal sinusitis caused by zygomycosis. There is increased attenuation in the ethmoid air cells with destruction of the median wall of the left orbit (arrow).


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