Diagnosis, Prognosticators, and Management of Acute Invasive Fungal Rhinosinusitis: Multidisciplinary Consensus Statement and Evidence-Based Review with Recommendations

Lauren T Roland; Ian M Humphreys; Christopher H Le; Jennifer M Babik; Christopher E Bailey; Lilangi S Ediriwickrema; Monica Fung; Joshua A Lieberman; Kelly R Magliocca; Hannah H Nam; Neville W Teo; Penelope C Thomas; Blair A Winegar; Jack L Birkenbeuel; Abel P David; Khodayar Goshtasbi; Patricia G Johnson; Elaine C Martin; Theodore V Nguyen; Neil N Patel; Hannan A Qureshi; Kaijun Tay; Milind Vasudev; Waleed M Abuzeid; Peter H Hwang; Aria Jafari; Matthew S Russell; Justin H Turner; Sarah K Wise; Edward C Kuan

doi:10.1002/alr.23132

Diagnosis, Prognosticators, and Management of Acute Invasive Fungal Rhinosinusitis: Multidisciplinary Consensus Statement and Evidence-Based Review with Recommendations

Int Forum Allergy Rhinol. 2023 Sep;13(9):1615-1714. doi: 10.1002/alr.23132. Epub 2023 Feb 19.

Authors

Lauren T Roland¹, Ian M Humphreys², Christopher H Le³, Jennifer M Babik⁴, Christopher E Bailey⁵, Lilangi S Ediriwickrema⁶, Monica Fung⁴, Joshua A Lieberman⁷, Kelly R Magliocca⁸, Hannah H Nam⁹, Neville W Teo¹⁰, Penelope C Thomas¹¹, Blair A Winegar¹², Jack L Birkenbeuel¹³, Abel P David¹⁴, Khodayar Goshtasbi¹³, Patricia G Johnson¹⁵, Elaine C Martin¹³, Theodore V Nguyen¹³, Neil N Patel¹⁴, Hannan A Qureshi², Kaijun Tay¹⁰, Milind Vasudev¹³, Waleed M Abuzeid², Peter H Hwang¹⁶, Aria Jafari², Matthew S Russell¹⁴, Justin H Turner¹⁷, Sarah K Wise¹⁸, Edward C Kuan¹³

Affiliations

¹ Department of Otolaryngology-Head and Neck Surgery, Washington University in St. Louis, St. Louis, Missouri, USA.
² Department of Otolaryngology-Head and Neck Surgery, University of Washington, Seattle, Washington, USA.
³ Department of Otolaryngology-Head and Neck Surgery, University of Arizona College of Medicine, Tucson, Arizona, USA.
⁴ Division of Infectious Diseases, Department of Medicine, University of California, San Francisco, San Francisco, California, USA.
⁵ Department of Otolaryngology-Head and Neck Surgery, West Virginia University School of Medicine, Morgantown, West Virginia, USA.
⁶ Gavin Herbert Eye Institute, Department of Ophthalmology, University of California, Irvine, Irvine, California, USA.
⁷ Department of Pathology and Laboratory Medicine, University of Washington Medical Center, Seattle, Washington, USA.
⁸ Department of Pathology and Laboratory Medicine, Emory University Medical Center, Atlanta, Georgia, USA.
⁹ Division of Infectious Diseases, Department of Medicine, University of California, Irvine, Orange, California, USA.
¹⁰ Department of Otorhinolaryngology, Head and Neck Surgery, Singapore General Hospital, Singapore.
¹¹ Department of Radiology, University of Washington Medical Center, Seattle, Washington, USA.
¹² Department of Radiology and Imaging Sciences, University of Utah Hospital, Salt Lake City, Utah, USA.
¹³ Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, Orange, California, USA.
¹⁴ Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, San Francisco, California, USA.
¹⁵ Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, Allegheny Health Network, Pittsburgh, Pennsylvania, USA.
¹⁶ Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Palo Alto, California, USA.
¹⁷ Department of Otolaryngology-Head and Neck Surgery, Vanderbilt School of Medicine, Nashville, Tennessee, USA.
¹⁸ Department of Otolaryngology-Head and Neck Surgery, Emory University Medical Center, Atlanta, Georgia, USA.

PMID: 36680469
DOI: 10.1002/alr.23132

Abstract

Background: Acute invasive fungal sinusitis (AIFS) is an aggressive disease that requires prompt diagnosis and multidisciplinary treatment given its rapid progression. However, there is currently no consensus on diagnosis, prognosis, and management strategies for AIFS, with multiple modalities routinely employed. The purpose of this multi-institutional and multidisciplinary evidence-based review with recommendations (EBRR) is to thoroughly review the literature on AIFS, summarize the existing evidence, and provide recommendations on the management of AIFS.

Methods: The PubMed, EMBASE, and Cochrane databases were systematically reviewed from inception through January 2022. Studies evaluating management for orbital, non-sinonasal head and neck, and intracranial manifestations of AIFS were included. An iterative review process was utilized in accordance with EBRR guidelines. Levels of evidence and recommendations on management principles for AIFS were generated.

Results: A review and evaluation of published literature was performed on 12 topics surrounding AIFS (signs and symptoms, laboratory and microbiology diagnostics, endoscopy, imaging, pathology, surgery, medical therapy, management of extrasinus extension, reversing immunosuppression, and outcomes and survival). The aggregate quality of evidence was varied across reviewed domains.

Conclusion: Based on the currently available evidence, judicious utilization of a combination of history and physical examination, laboratory and histopathologic techniques, and endoscopy provide the cornerstone for accurate diagnosis of AIFS. In addition, AIFS is optimally managed by a multidisciplinary team via a combination of surgery (including resection whenever possible), antifungal therapy, and correcting sources of immunosuppression. Higher quality (i.e., prospective) studies are needed to better define the roles of each modality and determine diagnosis and treatment algorithms.

Keywords: antifungals; aspergillosis; fungus; immunosuppression; intracranial; invasive fungal sinusitis; management; mucormycosis; orbit; outcomes; surgery; survival.

Publication types

Review

MeSH terms

Acute Disease
Humans
Invasive Fungal Infections* / diagnosis
Prognosis
Prospective Studies
Sinusitis* / diagnosis
Sinusitis* / microbiology
Sinusitis* / therapy