Acute invasive fungal rhinosinusitis: our 2year experience and outcome analysis

PurposeThe incidence of Acute invasive fungal rhinosinusitis (AIFRS) is on the rise considering the multitude of comorbidities present in a single patient.The delay in suspecting the fungal etiology, presentation of the patient for an Otorhinolaryngology consult and lack of defined protocols affects outcome.This study looks in to the various aspects of treatment of AIFRS including sample collection, diagnosis and medicosurgical treatment. We propose a protocol for the management of these patients crafted from our outcome.MethodsBetween September 2015-September 2017, 14 patients presented with AIFRS. Targeted samples were taken for Potassium hydroxide mount, histopathological studies and fungal culture. Management was initiated with antifungals and multi-approach surgical debridement.ResultsSix of these patients had multiple comorbidities and most were uncontrolled diabetics. The average delay in presentation was 9days. Potassium hydroxide mount was the screening test of choice. A minimum of two sittings of debridement was essential. In an average follow-up period of 15.12months, all the patients are alive and disease free.ConclusionA high index of suspicion, awareness among medical fraternity and precise sample collection aids a firm diagnosis. Simultaneous initiation of surgical debridement and anti-fungals is fundamental.