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ORIGINAL RESEARCH

Two-Center Experience with Acute Invasive Fungal Rhinosinusitis
Akut Ä°nvaziv Fungal Rinosinüzitte Ä°ki Merkezli Deneyim
Received Date : 07 Feb 2020
Accepted Date : 20 Apr 2020
Available Online : 07 Oct 2020
Doi: 10.24179/kbbbbc.2020-74192 - Makale Dili: TR
KBB ve BBC Dergisi. 2020;28(3):165-72
Copyright © 2020 by Turkey Association of Society of Ear Nose Throat and Head Neck Surgery. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/)
ABSTRACT
Objective: Modern advances in solid organ transplantation and immunosuppresive therapy have led to an increase in immunocompromised patients and a corresponding rise in acute invasive fungal rhinosinusitis (AIFR). In this study, we aimed to examine the predispose situations causing AIFR, to determine the average time to diagnosis and to discuss the medical and surgical methods applied. Material and Methods: The clinical characteristics, histopathological results, medical treatments, surgical methods, intranasal endoscopic, and radiologic findings of 16 patients who had diagnosed with AIFR between 2007-2019 were examined in detail. Related pathogens, comorbid diseases that predispose to the disease, the prognosis of the disease has been revealed, the importance of early diagnosis and treatment were discussed. Results: While 8 (50%) patients had uncontrolled diabetes mellitus, 4 (25%) patients had haematopoietic malignancies, 2 (12.5%) patients had solid organ transplantation (SOD), 2 (12.5%) patient had both uncontrolled diabetes mellitus and SOD. According to the radiological examination, there were 2 (12.5%) patients who have limited disease only to the sinonasal region. 13 (81.2%) patients had orbital involvement and 7 (43.7%) of whom were also present in intracranial involvement. Endoscopic sinus surgery, surgical debridement and medical therapy were applied to all patients. Zygomycetes was the most frequently identified species (n=12, 75%). The average time from the first symptom to surgery was 3.6 days. The overall mortality rate was 68.8% (11/16 patients). Conclusion: In this study, the most common cause of AIFR disease is uncontrolled diabetes, while the most common fungal pathogen is zygomycetes species. Physicians should be skeptical of AIFR disease in patients with risk factors and early consultation should be requested in the otorhinolaryngology department.
ÖZET
Amaç: Solid organ transplantasyonu ve immünsüpresif tedavi modalitelerindeki gelişim, bağışıklık sistemi baskılanmış hasta sayısında ve buna bağlı olarak akut invaziv fungal sinüzit (AİFR) te bir artışa yol açmıştır. Bu çalışmada AİFR’ye neden olan predispose durumları incelemek, tanıya kadar geçen ortalama zamanı tespit etmek ve uygulanan medikal ve cerrahi yöntemleri tartışmak amaçladı. Gereç ve Yöntemler: 2007-2019 yılları arasında AİFR tanısı alan 16 hastanın klinik özellikleri, histopatolojik sonuçları, medikal tedavileri, cerrahi yöntemler, intranazal endoskopik ve radyolojik bulguları ayrıntılı olarak incelendi. İlgili patojenler, hastalığa predispozisyon oluşturan komorbid hastalıklar, hastalığın prognozu ortaya konuldu, erken tanı ve tedavinin önemi tartışıldı. Bulgular: Sekiz (%50) hastada kontrolsüz diabetes mellitus, 4 (%25) hastada hematolojik malignite, 2 (%12,5) hastada solid organ transplantasyonu (SOD) mevcut iken, 2 (%12,5) hastada hem kontrolsüz diabetes mellitus hem de SOD mevcuttu. Radyolojik incelemeye göre hastalığı sadece sinozal bölge ile sınırlı olan 2 (%12,5) hasta mevcuttu. On üç (%81,2) hastanın orbita tutulumu mevcuttu ve bunların 7 (%43,7)’sinde aynı zamanda intrakraniyal tutulum da mevcuttu. Tüm hastalara endoskopik sinüs cerrahisi, lokal cerrahi debridman ve medikal tedavi birlikte uygulandı. İlk şikâyetten cerrahiye kadar geçen süre ise ortalama ise 3,6 gün’dü. Zgomiçes en sık tespit edilen (n:12, %75) türdü. Genel mortalite oranı %68,8 (11/16 hasta) idi. Sonuç: Bu çalışmada, AİFR hastalığına en sık neden olan durum kontrolsüz diyabet hastalığı iken en sık fungal patojen ise zigomiçes türleridir. Hekimler risk faktörlerine sahip olan hastalarda AİFR hastalığı için şüpheci olmalı ve kulak burun boğaz bölümüne erken konsültasyon istenmelidir.
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