Published in:
Open Access
01-12-2019 | Endoscopy | Research article
Impact of early detection of acute invasive fungal rhinosinusitis in immunocompromised patients
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
Published in:
BMC Infectious Diseases
|
Issue 1/2019
Login to get access
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.