Acute invasive fungal rhinosinusitis: our 2 year experience and outcome analysis
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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.
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.
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.
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.
KeywordsInvasive fungal rhinosinusitis Mucormycosis Diabetes mellitus Liposomal amphotericin B Outcome
Acute invasive fungal rhinosinusitis
Chronic kidney disease
Diagnostic nasal endoscopy
Functional endoscopic sinus surgery
Ischemic heart disease
- Lip AmB
Liposomal amphotericin B
Middle meatal antrostomy
- KOH mount
Potassium hydroxide mount
Type 1 diabetes mellitus
Type 2 diabetes mellitus
Compliance with ethical standards
Conflict of interest
We have no conflicts of interest to declare.
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.
This was a retrospective chart review and thus informed consent was not required by our human ethics board.
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