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

• Main Authors: Mariana L. C. Silveira, Wilma T. Anselmo-Lima, Francesca M. Faria, Danielle L. C. Queiroz, Rodrigo L. Nogueira, Marcelo G. J. Leite, Ricardo M. Lessa, Belinda P. Simões, Edwin Tamashiro, Fabiana C. P. Valera
• Format: Article
• Language: English
• Published: BMC 2019-04-01
• Series: BMC Infectious Diseases
• Subjects: Rhinosinusitis; Acute invasive fungal rhinosinusitis; Fungi; Frozen-section biopsy; Paraffin-embedded paraffin; Accuracy
• Online Access: http://link.springer.com/article/10.1186/s12879-019-3938-y

Abstract Background 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. Methods 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. Results 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 < 0.0001), with a sensitivity of 90.6%, specificity of 72.7%, and accuracy of 86.0%. Conclusion Implementation of this standardized protocol was related to a considerably low mortality rate among patients with suspected AIFRS at our Institution. Frozen-section biopsy revealed high accuracy to diagnose AIFRS. The current protocol including frozen-tissue biopsy improved the evaluation and survival rates of immunocompromised patients with presumed AIFRS.