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Acute invasive fungal rhinosinusitis: our 2 year experience and outcome analysis

  • Raghunath Shanbag
  • Nita Rachel RajanEmail author
  • Arun Kumar
Article
  • 33 Downloads

Abstract

Purpose

The incidence of Acute invasive fungal rhinosinusitis (AIFRS) is on the rise considering the multitude of comorbidities present in a single patient.The delay in suspecting the fungal etiology, presentation of the patient for an Otorhinolaryngology consult and lack of defined protocols affects outcome.This study looks in to the various aspects of treatment of AIFRS including sample collection, diagnosis and medicosurgical treatment. We propose a protocol for the management of these patients crafted from our outcome.

Methods

Between September 2015–September 2017, 14 patients presented with AIFRS. Targeted samples were taken for Potassium hydroxide mount, histopathological studies and fungal culture. Management was initiated with antifungals and multi-approach surgical debridement.

Results

Six of these patients had multiple comorbidities and most were uncontrolled diabetics. The average delay in presentation was 9 days. Potassium hydroxide mount was the screening test of choice. A minimum of two sittings of debridement was essential. In an average follow-up period of 15.12 months, all the patients are alive and disease free.

Conclusion

A high index of suspicion, awareness among medical fraternity and precise sample collection aids a firm diagnosis. Simultaneous initiation of surgical debridement and anti-fungals is fundamental.

Keywords

Invasive fungal rhinosinusitis Mucormycosis Diabetes mellitus Liposomal amphotericin B Outcome 

Abbreviations

AIFRS

Acute invasive fungal rhinosinusitis

AmB

Amphotericin B

AE

Anterior ethmoidotomy

BA

Bronchial asthma

CKD

Chronic kidney disease

CT

Computerized tomography

DKA

Diabetic ketoacidosis

DNE

Diagnostic nasal endoscopy

FS

Frontal sinus

FESS

Functional endoscopic sinus surgery

HPE

Histopathological examination

HTN

Hypertension

IT

Inferior turbinate

IHD

Ischemic heart disease

LP

Lamina papyracea

Lip AmB

Liposomal amphotericin B

MS

Maxillary sinus

MMA

Middle meatal antrostomy

MT

Middle turbinate

MPGN

Membranoproliferative glomerulonephritis

NLD

Nasolacrimal duct

Pin

Posaconazole

PE

Posterior ethmoidotomy

KOH mount

Potassium hydroxide mount

T1DM

Type 1 diabetes mellitus

T2DM

Type 2 diabetes mellitus

ST

Superior turbinate

V

Voricanazole

Notes

Compliance with ethical standards

Conflict of interest

We have no conflicts of interest to declare.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and or national research committee and with 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

This was a retrospective chart review and thus informed consent was not required by our human ethics board.

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of ENTSDM College of Medical SciencesHubli-DharwadIndia

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