Impact of early detection of acute invasive fungal rhinosinusitis in immunocompromised patients

• Published in: BMC infectious diseases 2019-04, Vol.19 (1), p.310-310, Article 310
• Main Authors: Silveira, Mariana L C, Anselmo-Lima, Wilma T, Faria, Francesca M, Queiroz, Danielle L C, Nogueira, Rodrigo L, Leite, Marcelo G J, Lessa, Ricardo M, Simões, Belinda P, Tamashiro, Edwin, Valera, Fabiana C P
• Format: Article
• Language: English
• Subjects: Accuracy; Acute invasive fungal rhinosinusitis; Adolescent; Adult; Aged; Biopsy; Biopsy - methods; Blood tests; Child; Child, Preschool; Culture; Development and progression; Diagnosis; Disease; Disease control; Early Diagnosis; Endoscopy; Endoscopy - methods; Female; Formaldehyde; Frozen Sections; Frozen-section biopsy; Fungi; Hematology; Histopathology; Humans; Immunocompromised Host; Immunocompromised hosts; Infant; Infectious diseases; Invasive Fungal Infections - diagnosis; Invasive Fungal Infections - microbiology; Invasive Fungal Infections - mortality; Laboratories; Leukocytes (neutrophilic); Male; Medical imaging; Medical prognosis; Medical research; Methenamine; Middle Aged; Mortality; Nose; Oncology; Paraffin; Paraffin Embedding; Paraffin-embedded paraffin; Paraffins; Patients; Prognosis; Retrospective Studies; Rhinitis; Rhinitis - diagnosis; Rhinitis - microbiology; Rhinitis - mortality; Rhinosinusitis; Sensitivity; Sensitivity and Specificity; Sinuses; Sinusitis; Sinusitis - diagnosis; Sinusitis - microbiology; Sinusitis - mortality; Stains & staining; Survival Rate; Systematic review
• ISSN: 1471-2334; 1471-2334
• DOI: 10.1186/s12879-019-3938-y

Early diagnosis of acute invasive fungal rhinosinusitis (AIFRS) is vital to improving outcomes in immunocompromised patients. This study evaluated the impact of a systematic protocol with nasal endoscopy and biopsies to early detect AIFRS in immunocompromised patients. Additionally, we compared the accuracy of frozen-section biopsy and culture with formalin-fixed paraffin-embedded (FFPE) biopsy. Retrospective cohort in a Tertiary Referral Hospital. Patients with the suspected diagnosis of AIFRS were evaluated following a standardized protocol, including serial nasal endoscopies and biopsies when necessary. The sensitivity and specificity of frozen-section biopsy and culture were also compared with FFPE. The mortality rate related to AIFRS of this standardized cohort (13/43) was 30.2%. Better outcomes were observed in patients with disease limited to the turbinates and in those with higher peripheral neutrophils count. Frozen-section biopsy positivity correlated with FFPE findings for fungi detection (p-value