Invasive Fungal Infections of the Head and Neck: A Tertiary Hospital Experience
Abstract
1. Introduction
2. Materials and Methods
3. Results
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Invasive (Inv) | Non-Invasive (Non-Inv) | Ratio Non-Inv/Inv | |||
---|---|---|---|---|---|
Site | n | % | n | % | |
Sinonasal | 45 | 58.4 | 203 | 60.4 | 4.5 |
Ear/mastoid | 3 | 3.9 | 7 | 2.1 | 2.3 |
Larynx | 2 | 2.6 | 10 | 3.0 | 5 |
Oral cavity | 3 | 3.9 | 86 | 25.6 | 28.3 |
Oropharynx/esophagus | 0 | 0 | 30 | 8.9 | >30 |
Base of skull | 2 | 2.6 | N/A | N/A | |
Orbit | 14 | 18.2 | N/A | N/A | |
Mandible | 8 | 10.4 | N/A | N/A |
Demographics (N = 45) | |
---|---|
Age (yrs.) | n (%) |
≤18 | 3 (7) |
19–≤40 | 9 (20) |
>40 | 33 (73) |
Gender | n (%) |
M | 31 (69) |
F | 14 (31) |
Morphology | Genus/Species | n (%) | N (%) |
---|---|---|---|
Mucorales | Mucor sp. Rhizopus sp. Rhizomucor sp. Sincephalastrum racemosum | 18 (64) 5 (18) 4 (14) 1 (4) | 28 (51) |
Hyaline molds | Aspergillus spp. Fusarium sp. Scedosporium sp. | 14 (88) 1 (6) 1 (6) | 16 (29) |
Candida | C. albicans C. parasilopsis C. glabrata C. dubliniensis Candida sp. | 2 (33) 1 (17) 1 (17) 1 (17) 1 (17) | 6 (11) |
Dematiaceous | Curvularia sp. Dematiaceous sp. | 1 (50) 1 (50) | 2 (4) |
Other | Blastomyces dermatitides Kluyveromyces marxianus Mycelia sterilia | 1 (33) 1 (33) 1 (33) | 3 (6) |
Extension | n | % |
---|---|---|
Sinonasal only | 12 | 27 |
Beyond sinonasal | 33 | 73 |
Extrasinonasal extension | ||
Orbit | 19 | 42 |
Intracranial | 5 | 11 |
Base of skull | 5 | 11 |
Facial soft tissue | 3 | 7 |
Palate | 3 | 7 |
Nasopharynx | 2 | 4 |
Oropharynx | 1 | 2 |
Risk Factor | Subgroup n (%) | n (%) | Dead n (%) | All Risk Factors | n (%) | Dead n (%) | |
---|---|---|---|---|---|---|---|
Malignancy (Malig.) | Hematolymphoid | 19 (83) | 23 (51) | 19 (83) | Malig. only Malig. + TX Malig. + DM Malig. + drugs Malig. + TX + DM TX only TX + DM TX + drugs DM only DM + drugs Drugs only | 12 (27) 8 (18) 1 (2) 0 2 (4) 1 (2) 2 (4) 0 11 (24) 2 (4) 3 (7) | 9 (75) 7 (87.5) 1 (100) 0 2 (100) 1 (100) 1 (50) 0 3 (27.3) 1 (50) 0 |
Somatic | 4 (17) | ||||||
Transplant (TX) | Bone marrow | 9 (69) | 13 (29) | 11 (85) | |||
Pancreas/kidney | 1 (8) | ||||||
Pancreas | 1 (8) | ||||||
Kidney | 1 (8) | ||||||
Liver | 1 (8) | ||||||
Diabetes mellitus (DM) | Type 1 | 5 (28) | 18 (40) | 7 (39) | |||
Type 2 | 13 (72) | ||||||
Illicit drug | Marijuana | 2 (40) | 5 (11) | 1 (20) | |||
Methamph. * | 3 (60) | ||||||
Opioids * | 3 (60) | ||||||
None | - | 3 (7) | 0 |
Outcome | n (%) | Cause Specific Mortality | n (%) |
---|---|---|---|
Alive Dead | 21 (47) 24 (53) | Fungal infection Malignancy | 18 (75) 6 (25) |
Risk Factor | Pearson Chi2 Test (Two-Sided) | Fisher’s Exact Test (Two-Sided) | Odds Ratio | 95% Confidence Interval |
---|---|---|---|---|
Malignancy | <0.001 *** | <0.001 *** | 16.150 | 3.718–70.142 * |
Transplant | 0.007 ** | 0.009 ** | 8.038 | 1.523–42.430 * |
Diabetes mellitus | 0.113 | 0.138 | 0.374 | 0.110–1.278 |
Illicit drug | 0.113 | 0.169 | 0.185 | 0.019–1.805 |
Therapy | n | % | Triazoles | n (%) |
---|---|---|---|---|
Surgery | Voriconazole | 14 (40%) | ||
One surgery | 25 | 56 | Itraconazole | 1 (3%) |
Multiple surgeries | 15 | 33 | Posaconazole | 9 (26%) |
No surgery (biopsy only) | 5 | 11 | Isavuconazole | 9 (26%) |
Antifungals | Fluconazole | 2 (6%) | ||
At least one antifungal | 42 | 93 | ||
No antifungals | 3 | 7 | ||
Specific antifungals * | ||||
Amphotericin B | 27 | 60 | ||
Triazoles (see right columns) | 35 | 78 | ||
Micafungin | 3 | 7 | ||
Terbinafine | 2 | 4 |
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Hou, T.; Bell, W.R.; Mesa, H. Invasive Fungal Infections of the Head and Neck: A Tertiary Hospital Experience. Pathogens 2024, 13, 530. https://doi.org/10.3390/pathogens13070530
Hou T, Bell WR, Mesa H. Invasive Fungal Infections of the Head and Neck: A Tertiary Hospital Experience. Pathogens. 2024; 13(7):530. https://doi.org/10.3390/pathogens13070530
Chicago/Turabian StyleHou, Tieying, W. Robert Bell, and Hector Mesa. 2024. "Invasive Fungal Infections of the Head and Neck: A Tertiary Hospital Experience" Pathogens 13, no. 7: 530. https://doi.org/10.3390/pathogens13070530
APA StyleHou, T., Bell, W. R., & Mesa, H. (2024). Invasive Fungal Infections of the Head and Neck: A Tertiary Hospital Experience. Pathogens, 13(7), 530. https://doi.org/10.3390/pathogens13070530