What is the mortality rate of acute invasive fungal sinusitis?

From the Guidelines

Acute invasive fungal sinusitis has a high mortality rate, typically ranging from 50-80% despite aggressive treatment, and requires immediate intervention with a multifaceted approach including urgent surgical debridement and systemic antifungal therapy to improve survival rates. This life-threatening condition primarily affects immunocompromised patients, particularly those with uncontrolled diabetes, hematologic malignancies, or prolonged neutropenia 1. Early diagnosis and treatment are crucial for survival, and treatment should include systemic antifungal medication, such as liposomal amphotericin B at 5-10 mg/kg/day IV, and surgical debridement of all necrotic tissue 1.

Key Considerations

• The patient’s immune suppression should be reduced when feasible 1
• Prognostic factors associated with worse survival include haematologic malignancy, recent chemotherapy, recent bone marrow transplant, and infection with atypical fungi 1
• Improved survival is associated with increasing A1c% and surgical debridement 1
• Mortality is highest when diagnosis is delayed, in patients with intracranial or orbital extension, and in those with persistent immunosuppression 1

Treatment Approach

• Systemic antifungal therapy should be started immediately, with liposomal amphotericin B preferred for suspected mucormycosis and voriconazole preferred for Aspergillus infections 1
• Patients should undergo at least endoscopic surgical debridement of necrotic sinonasal tissue, with repeated debridement often necessary to ensure removal of all infected tissue 1
• Addressing underlying immunosuppression is crucial to improve prognosis 1

From the Research

Acute Invasive Fungal Sinusitis Mortality

• The mortality rate for acute invasive fungal sinusitis (AIFS) is high, with some studies suggesting it approaches 50% 2.
• The degree of immunosuppression, extension of fungal sinusitis, and species of fungus are important factors determining the clinical response and mortality rate 3.
• Early diagnosis and aggressive surgical and medical management, including reversal of underlying immunosuppression, are crucial in reducing mortality 2, 4.
• A multidisciplinary approach to management, including a combination of surgery, antifungal therapy, and correction of sources of immunosuppression, is recommended 4.
• The use of liposomal amphotericin B as an empiric therapy for AIFS, with transition to targeted therapy when a fungal pathogen is identified, is also recommended 2.

Factors Affecting Mortality

• Immunocompromised status: Patients with immunocompromised status, such as those with cancer or transplant patients, are at higher risk of mortality from AIFS 3, 2.
• Extension of fungal sinusitis: The extent of fungal invasion into adjacent tissues and vessels can affect mortality rate 3.
• Species of fungus: Different species of fungi, such as Aspergillus and Mucorales, can have varying levels of virulence and affect mortality rate 3, 2.

Management Strategies

• Surgery: Surgical debridement and resection of necrotic tissue are important components of management 3, 2, 4.
• Antifungal therapy: The use of antifungal agents, such as liposomal amphotericin B, is crucial in managing AIFS 3, 2.
• Reversal of immunosuppression: Correcting sources of immunosuppression is essential in reducing mortality rate 2, 4.