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).
