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
Alper KÖYCÜa, Alper Nabi ERKANb
aBaşkent Üniversitesi Tıp Fakültesi, Kulak Burun Boğaz Hastalıkları ABD Ankara, TÜRKİYE
bBaşkent Üniversitesi Tıp Fakültesi, Kulak Burun Boğaz Hastalıkları ABD, Adana, TÜRKİYE
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.
Keywords: Invasive fungal infections; mucormycosis; sinusitis
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.
Anahtar Kelimeler: İnvaziv fungal enfeksiyonlar; mukormikoz; sinüzit
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