An Early Detection Protocol for Invasive Fungal Sinusitis in Neutropenic Patients Successfully Reduces Extent of Disease at Presentation and Long Term Morbidity

Objectives: To evaluate a multidisciplinary early intervention protocol for invasive fungal sinusitis (IFS) in neutropenic patients and its effect on degree of tissue involvement at time of presentation and effect on morbidity and mortality. Study Design: Retrospective review. Methods: A chart review was performed for cases of acute fulminant IFS in neutropenic patients at Emory University Hospital from 1995 to 2007. Inclusion required tissue diagnosis of IFS, neutropenia, and adequate records of the following: tissue involvement at presentation, number and extent of surgical procedures performed, morbidity, and mortality. Group 1 included patients prior to 2001, and group 2 included patients after protocol initiation in 2001. The groups were compared for the number of tissue sites involved at presentation, number of surgical procedures performed, long-term morbidity, and mortality. Results: Twenty-eight cases of IFS were identified. The average number of sites involved at presentation was 2.5 in group 1 and 1.5 in group 2 (P = .059). The average number of procedures was 2.2 in group 1 and 1.0 in group 2 (P = .026). Long-term morbidity occurred in 43% (6/14) of group 1 patients compared with 7.1% (1/14) of group 2 patients (P = .029). Mortality from IFS was 7.1% in group 1 and 7.1% in group 2. Conclusions: IFS requires early diagnosis and treatment for optimum outcome. A protocol of early intervention for neutropenic patients is effective in early detection of IFS with fewer sites of involvement at diagnosis, fewer surgeries, and less long-term morbidity. No difference in survival was found, as this is more a factor of the underlying cause of the neutropenia.