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Risk factors and predictors of mortality in acute invasive fungal sinusitis – a single-institution experience

Published online by Cambridge University Press:  16 March 2022

L Varghese Open the ORCID record for L Varghese [Opens in a new window] ,
V Malleshappa ,
B K Yadav ,
R Kurien Open the ORCID record for R Kurien [Opens in a new window]  and
V Rupa
L Varghese*
Affiliation:
Department of Otorhinolaryngology, Christian Medical College, Vellore, India
V Malleshappa
Affiliation:
Department of Otorhinolaryngology, Christian Medical College, Vellore, India
B K Yadav
Affiliation:
Department of Biostatistics, Christian Medical College, Vellore, India
R Kurien
Affiliation:
Department of Otorhinolaryngology, Christian Medical College, Vellore, India
V Rupa
Affiliation:
Department of Otorhinolaryngology, Christian Medical College, Vellore, India
*
Author for correspondence: Dr Lalee Varghese, Department of ENT, Christian Medical College, Vellore, Tamil Nadu, India – 632004 E-mail: laleevarghese@cmcvellore.ac.in
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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.

Keywords

SinusitisImmunocompromised HostMycosesMucormycosisRisk FactorsPrognosis
Type
Main Article
Information
The Journal of Laryngology & Otology , Volume 136 , Issue 12 , December 2022 , pp. 1320 - 1327
Copyright
Copyright © The Author(s), 2022. Published by Cambridge University Press on behalf of J.L.O. (1984) LIMITED

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Footnotes

Dr L Varghese takes responsibility for the integrity of the content of the paper

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