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Bahethi R, Talmor G, Choudhry H, Lemdani M, Singh P, Patel R, Hsueh W. Chronic invasive fungal rhinosinusitis and granulomatous invasive fungal sinusitis: A systematic review of symptomatology and outcomes. Am J Otolaryngol 2024; 45:104064. [PMID: 37769504 DOI: 10.1016/j.amjoto.2023.104064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 09/18/2023] [Accepted: 09/20/2023] [Indexed: 10/03/2023]
Abstract
INTRODUCTION Chronic invasive fungal rhinosinusitis (CIFRS) and granulomatous invasive fungal sinusitis are two uncommon diseases differentiated primarily by the pathologic finding of non-caseating granulomas in GIFRS. Both share many similarities in presentation. We aim to characterize the symptomatology and outcomes of these diseases. METHODS A comprehensive search strategy was designed to identify studies in the Cochrane, EMBASE and PubMed databases from database inception to January 2022. Inclusion criteria included all patients with a diagnosis of either CIFRS or GIFRS. All studies were screened by two reviewers. Chi-square analyses were used where appropriate. RESULTS 51 studies were included totaling 513 patients. The majority were diagnosed with CIFRS (389, 75.8 %) compared to GIFRS (124, 24.4 %). CIFRS was more common in immunocompromised or diabetic patients (p < 0.0001; p = 0.02). Patients with CIFRS were more likely to exhibit nasal symptoms including discharge (p = 0.0001), obstruction (p = 0.03) and congestion (p = 0.001) as well as systemic symptoms including fever, which no GIFRS patient exhibited, facial pain (p = 0.007), headache (p = 0.004). Aspergillus was the most common organism identified in both groups with a slight predominance among GIFRS patients (p = 0.01). GIFRS patients were also more likely to present with no identifiable organisms (p = 0.0006). CIFRS patients were more likely to die of disease (p = 0.0008). CONCLUSIONS CIFRS generally presents with more symptoms and is associated with poorer outcomes primarily occurring in an immunocompromised population. GIFRS likely follows a more insidious course in immunocompetent patients. Understanding the key differences in symptomatology and outcomes for these two populations is critical for appropriate diagnosis and prognostication.
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Affiliation(s)
- Rohini Bahethi
- Department of Otolaryngology-Head and Neck Surgery at Rutgers New, Jersey Medical School, Newark, NJ, United States.
| | - Guy Talmor
- Department of Otolaryngology-Head and Neck Surgery at Rutgers New, Jersey Medical School, Newark, NJ, United States
| | - Hannaan Choudhry
- Department of Otolaryngology-Head and Neck Surgery at Rutgers New, Jersey Medical School, Newark, NJ, United States
| | - Mehdi Lemdani
- Department of Otolaryngology-Head and Neck Surgery at Rutgers New, Jersey Medical School, Newark, NJ, United States
| | - Priyanka Singh
- Department of Otolaryngology-Head and Neck Surgery at Rutgers New, Jersey Medical School, Newark, NJ, United States
| | - Rushi Patel
- Department of Otolaryngology-Head and Neck Surgery at Rutgers New, Jersey Medical School, Newark, NJ, United States
| | - Wayne Hsueh
- Department of Otolaryngology-Head and Neck Surgery at Rutgers New, Jersey Medical School, Newark, NJ, United States
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Rupa V, Peter J, Michael JS, Thomas M, Irodi A, Rajshekhar V. Chronic Granulomatous Invasive Fungal Sinusitis in Patients With Immunocompetence: A Review. Otolaryngol Head Neck Surg 2023; 168:669-680. [PMID: 35503655 DOI: 10.1177/01945998221097006] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Accepted: 04/05/2022] [Indexed: 11/16/2022]
Abstract
OBJECTIVE We aimed to study the literature on chronic granulomatous invasive fungal sinusitis to elucidate the changing trends in the management of the disease. DATA SOURCES Using specific keywords, we searched the PubMed, PubMed Central, and Scopus databases over the past 50 years, which yielded 938 articles in the English language. REVIEW METHODS Scrutiny of 147 relevant articles revealed 15 homogenous case series (255 cases of histologically proven chronic granulomatous fungal sinusitis alone) and 8 heterogeneous case series (patients with other types of fungal sinusitis included), which were analyzed in detail (all with >5 cases each). CONCLUSIONS The disease typically affected middle-aged adults with immunocompetence. Most reports were from Sudan, India, and Saudi Arabia. A slowly progressive orbital, cheek, or palatal mass with proptosis (88.2%) or sinonasal symptoms (39.2%) was typical. Ethmoid (57.2%) and maxillary (51.4%) sinuses were chiefly affected with intracranial extension in 35.1%. Aspergillus flavus (64%) was the most frequent isolate reported. Endoscopic excision (78.8%) followed by azole therapy was the preferred treatment in recent reports. Orbital exenteration and craniotomy were infrequently performed. Complete resolution or improvement was reported in 91.3% of patients. Mortality ranged from 5.9% to 22.2%. There is a trend in the literature toward less radical and disfiguring surgery and preferential use of azoles, with good outcomes even in advanced cases. IMPLICATIONS FOR PRACTICE Chronic granulomatous fungal sinusitis should be diagnosed on the basis of well-defined histopathologic features. A combination of endoscopic sinus surgery and azole therapy usually yields good outcomes.
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Affiliation(s)
- Vedantam Rupa
- Department of Otorhinolaryngology, Christian Medical College Hospital, Vellore, India
| | - Jayanthi Peter
- Department of Ophthalmology, Christian Medical College Hospital, Vellore, India
| | | | - Meera Thomas
- Department of Pathology, Christian Medical College Hospital, Vellore, India
| | - Aparna Irodi
- Department of Radiology, Christian Medical College Hospital, Vellore, India
| | - Vedantam Rajshekhar
- Department of Neurological Sciences, Christian Medical College Hospital, Vellore, India
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Treviño-Gonzalez JL, Santos-Santillana KM, Maldonado-Chapa F, Morales-Del Angel JA, Gomez-Castillo P, Cortes-Ponce JR. "Chronic granulomatous invasive fungal rhinosinusitis associated with SARS-CoV-2 infection: A case report". Ann Med Surg (Lond) 2021; 72:103129. [PMID: 34873446 PMCID: PMC8636311 DOI: 10.1016/j.amsu.2021.103129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 11/22/2021] [Accepted: 11/30/2021] [Indexed: 11/18/2022] Open
Abstract
Introduction and importance Granulomatous chronic invasive fungal rhinosinusitis (GCIFR) is a rare entity with scarce cases reported mainly in subtropical areas. Its prevalence among individuals with clinical suspicion of fungal rhinosinusitis has been reported in approximately 20% in subtropical populations, unlike North America with a prevalence of 0.5%. It is typically associated with Aspergillus flavus and the presence of noncaseating granulomas or Langerhans giant cells on histopathologic examination. Case presentation We describe a case of a patient with clinical history of recent SARS-CoV-2 infection and development of intense cephalalgia, visual impairment, palpebral ptosis, and limitation of extraocular movements. MRI demonstrated the presence of opacification of paranasal sinuses, and a left intraconal abscess. A surgical endoscopic approach was performed and histopathologic examination revealed frontal GCIFR and maxillary fungus ball. Treatment with IV azoles provided adequate clinical response. Clinical discussion The spectrum of the fungal rhinosinusitis disease is not clear. However, non-invasive fungal rhinosinusitis is not often found concomitantly with invasive types. GCIFR typically manifests with an indolent and gradual progression at early stages. Advanced stages can exhibit orbital and intracranial involvement leading to visual impairment, frequent relapses, and a poor prognosis. A higher incidence of invasive fungal rhinosinusitis has been reported in patients with SARS-CoV-2 infection despite an unremarkable medical history, associated with immune dysregulation. Conclusion GCIFR is a rare condition with few cases reported in America. Because of its uncommonness, its diagnosis is often delayed leading to increased morbidity and mortality. Granulomatous chronic invasive fungal rhinosinusitis is a rare entity with scarce cases reported. Non-invasive fungal rhinosinusitis is not often found concomitantly with invasive types. A higher incidence of invasive fungal rhinosinusitis is observed in SARS-CoV-2 infection. Early diagnosis of fungal rhinosinusitis is essential due to possibly fatal outcome. Physicians should be aware of atypical manifestations for a prompt diagnosis.
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Affiliation(s)
| | | | | | - Josefina Alejandra Morales-Del Angel
- Corresponding author. Otolaryngology and Head and Neck Surgery Division, School of Medicine and University Hospital “Dr. Jose E. González”, Universidad Autónoma de Nuevo León, Ave. Madero y Gonzalitos s/n, Mitras Centro, 64460, Monterrey, Nuevo Leon, Mexico.
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Zhou LH, Wang X, Wang RY, Zhao HZ, Jiang YK, Cheng JH, Huang LP, Chen ZQ, Wang DH, Zhu LP. Entities of Chronic and Granulomatous Invasive Fungal Rhinosinusitis: Separate or Not? Open Forum Infect Dis 2018; 5:ofy228. [PMID: 30302354 PMCID: PMC6171569 DOI: 10.1093/ofid/ofy228] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Accepted: 09/10/2018] [Indexed: 01/19/2023] Open
Abstract
Background Chronic and granulomatous invasive fungal rhinosinusitis are important causes of blindness and craniocerebral complications. However, the classification of these 2 diseases remains controversial. Methods We retrospectively analyzed patients with chronic and granulomatous invasive fungal rhinosinusitus in a Chinese tertiary hospital from 2009 to 2017, with a focus on classification and comparisons. Results Among 55 patients enrolled in our study, 11 (11/55, 20%) had granulomatous invasive fungal rhinosinusitis (GIFRS) and 44 (44/55, 80%) had chronic invasive fungal rhinosinusitis (CIFRS). Aspergillus fumigatus and Dematiaceous hyphomycetes were identified in 2 patients with GIFRS. Compared with granulomatous type, CIFRS was more frequently encountered in immunocompromised patients (P = .022), and the time from onset to diagnosis was much shorter (P = .001). Proptosis and orbital apex syndrome showed no significant difference between granulomatous and CIFRS in our study. The treatment options and prognosis of both diseases also showed no significant difference. Conclusions Despite the consensus on histopathology, the classification of the chronic and granulomatous types may need further evaluation in clinical considerations.
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Affiliation(s)
- Ling-Hong Zhou
- Department of Infectious Diseases, Huashan Hospital, Fudan University, Shanghai, China
| | - Xuan Wang
- Department of Infectious Diseases, Huashan Hospital, Fudan University, Shanghai, China
| | - Rui-Ying Wang
- Department of Infectious Diseases, Huashan Hospital, Fudan University, Shanghai, China
| | - Hua-Zhen Zhao
- Department of Infectious Diseases, Huashan Hospital, Fudan University, Shanghai, China
| | - Ying-Kui Jiang
- Department of Infectious Diseases, Huashan Hospital, Fudan University, Shanghai, China
| | - Jia-Hui Cheng
- Department of Infectious Diseases, Huashan Hospital, Fudan University, Shanghai, China
| | - Li-Ping Huang
- Department of Infectious Diseases, Huashan Hospital, Fudan University, Shanghai, China
| | - Zhong-Qing Chen
- Pathology Department, Huashan Hospital, Fudan University, Shanghai, China
| | - De-Hui Wang
- Department of Otolaryngology, Eye and Ear, Nose and Throat Hospital, Fudan University, Shanghai, China
| | - Li-Ping Zhu
- Department of Infectious Diseases, Huashan Hospital, Fudan University, Shanghai, China
- Correspondence: L.-P. Zhu, MD, PhD, Department of Infectious Diseases, Huashan Hospital, Fudan University, 12 Central Urumqi Road, Shanghai 200040, China ()
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Paknezhad H, Borchard NA, Charville GW, Ayoub NF, Choby GW, Thamboo A, Nayak JV. Evidence for a 'preinvasive' variant of fungal sinusitis: Tissue invasion without angioinvasion. World J Otorhinolaryngol Head Neck Surg 2017; 3:37-43. [PMID: 29204577 PMCID: PMC5683596 DOI: 10.1016/j.wjorl.2017.01.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Accepted: 01/28/2017] [Indexed: 11/26/2022] Open
Abstract
Clinical experience has suggested the existence of an intermediate form of fungal sinusitis between the categories of non-invasive fungal sinusitis (non-IFS) and invasive fungal sinusitis (IFS). This fungal sinusitis variant demonstrates unhealthy mucosa by endoscopy with fungal invasion, but lacks angioinvasion microscopically, representing what clinically behaves as a 'pre-invasive' subtype of fungal sinusitis. Unlike non-IFS disease, patients with pre-invasive fungal sinusitis were still felt to require anti-fungal medications due to histologic presence of invasive fungus. While sharing some clinical features of IFS, these 'intermediate' patients were successfully spared extended and repeated surgical debridements given the microscopic findings, and have been successfully treated with shorter courses of antifungal therapy. These select patients have had favorable outcomes when managed in a judicious and semi-aggressive manner, in an undefined zone between the treatments for routine fungal ball and aggressive IFS.
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Affiliation(s)
- Hassan Paknezhad
- Division of Rhinology, Department of Otolaryngology - Head and Neck Surgery, Stanford University School of Medicine, USA
| | - Nicole A Borchard
- Division of Rhinology, Department of Otolaryngology - Head and Neck Surgery, Stanford University School of Medicine, USA
| | - Greg W Charville
- Division of Rhinology, Department of Otolaryngology - Head and Neck Surgery, Stanford University School of Medicine, USA
| | - Noel F Ayoub
- Division of Rhinology, Department of Otolaryngology - Head and Neck Surgery, Stanford University School of Medicine, USA
| | - Garret W Choby
- Division of Rhinology, Department of Otolaryngology - Head and Neck Surgery, Stanford University School of Medicine, USA
| | - Andrew Thamboo
- Division of Rhinology, Department of Otolaryngology - Head and Neck Surgery, Stanford University School of Medicine, USA
| | - Jayakar V Nayak
- Division of Rhinology, Department of Otolaryngology - Head and Neck Surgery, Stanford University School of Medicine, USA
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Orlandi RR, Kingdom TT, Hwang PH, Smith TL, Alt JA, Baroody FM, Batra PS, Bernal-Sprekelsen M, Bhattacharyya N, Chandra RK, Chiu A, Citardi MJ, Cohen NA, DelGaudio J, Desrosiers M, Dhong HJ, Douglas R, Ferguson B, Fokkens WJ, Georgalas C, Goldberg A, Gosepath J, Hamilos DL, Han JK, Harvey R, Hellings P, Hopkins C, Jankowski R, Javer AR, Kern R, Kountakis S, Kowalski ML, Lane A, Lanza DC, Lebowitz R, Lee HM, Lin SY, Lund V, Luong A, Mann W, Marple BF, McMains KC, Metson R, Naclerio R, Nayak JV, Otori N, Palmer JN, Parikh SR, Passali D, Peters A, Piccirillo J, Poetker DM, Psaltis AJ, Ramadan HH, Ramakrishnan VR, Riechelmann H, Roh HJ, Rudmik L, Sacks R, Schlosser RJ, Senior BA, Sindwani R, Stankiewicz JA, Stewart M, Tan BK, Toskala E, Voegels R, Wang DY, Weitzel EK, Wise S, Woodworth BA, Wormald PJ, Wright ED, Zhou B, Kennedy DW. International Consensus Statement on Allergy and Rhinology: Rhinosinusitis. Int Forum Allergy Rhinol 2016; 6 Suppl 1:S22-209. [DOI: 10.1002/alr.21695] [Citation(s) in RCA: 333] [Impact Index Per Article: 41.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Revised: 11/13/2015] [Accepted: 11/16/2015] [Indexed: 02/06/2023]
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Valerie Lund
- Royal National Throat Nose and Ear Hospital; London UK
| | - Amber Luong
- University of Texas Medical School at Houston
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Kim D, Kim JW, Ahn SJ, Hong SL. Chronic Invasive Sinonasal Mucormycosis; A Rare Disease Entity. JOURNAL OF RHINOLOGY 2016. [DOI: 10.18787/jr.2016.23.2.119] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- Dongwon Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Pusan National University Hospital, Busan, Korea
| | - Jae-wook Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Pusan National University Hospital, Busan, Korea
| | - Sang-Jung Ahn
- Department of Pathology, Pusan National University Hospital, Busan, Korea
| | - Sung-Lyong Hong
- Department of Otorhinolaryngology-Head and Neck Surgery, Pusan National University Hospital, Busan, Korea
- Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
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Halderman A, Shrestha R, Sindwani R. Chronic granulomatous invasive fungal sinusitis: an evolving approach to management. Int Forum Allergy Rhinol 2014; 4:280-3. [DOI: 10.1002/alr.21299] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2013] [Revised: 01/02/2014] [Accepted: 01/07/2014] [Indexed: 11/07/2022]
Affiliation(s)
- Ashleigh Halderman
- Section of Rhinology; Sinus and Skull Base Surgery, Head & Neck Institute, Cleveland Clinic Foundation; Cleveland OH
| | - Rabin Shrestha
- Section of Infectious Disease; Medicine Institute, Cleveland Clinic Foundation; Cleveland OH
| | - Raj Sindwani
- Section of Rhinology; Sinus and Skull Base Surgery, Head & Neck Institute, Cleveland Clinic Foundation; Cleveland OH
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An Atypical Case of Chronic Invasive Fungal Sinusitis and its Management. Otolaryngol Head Neck Surg 2010; 142:150-1. [DOI: 10.1016/j.otohns.2009.06.743] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2009] [Revised: 06/22/2009] [Accepted: 06/26/2009] [Indexed: 11/22/2022]
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Abstract
Chronic rhinosinusitis often fails to respond to standard medical or surgical treatment. In some of these cases, the underlying disease may be a chronic granulomatous process that requires aggressive topical, local, and in some instances, systemic therapy. Diseases that can present in this manner include autoimmune vasculitis, sarcoidosis, indolent infections, neoplastic processes, and various other miscellaneous conditions. This article reviews the typical presentations for some of these unusual conditions and discusses the appropriate evaluations that will lead to clinical identification and effective medical management.
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Affiliation(s)
- Thomas A Tami
- University of Cincinnati College of Medicine, 231 Albert Sabin Way, P.O. Box 670528, Cincinnati, OH 45267, USA.
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