Risk factors and predictors of mortality in acute invasive fungal sinusitis – a single-institution experience. Issue 12 (16th December 2022)

• Record Type: Journal Article
• Authors: Varghese, L; Malleshappa, V; Yadav, B K; Kurien, R; Rupa, V
• Is Part Of: Journal of laryngology & otology. Volume 136:Issue 12(2022)
• Page Start: 1320
• Page End: 1327
• Publication Date: 2022-12-16
• Subjects: Sinusitis -- Immunocompromised Host -- Mycoses -- Mucormycosis -- Risk Factors -- Prognosis; Otolaryngology -- Periodicals; 617.51
• DOI: 10.1017/S0022215122000755
• Languages: English
• ISSNs: 0022-2151

Abstract

Abstract: 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.