Invasive Fungal Rhinosinusitis with and without Orbital Complications: Clinical and Laboratory Differences
Abstract
:1. Introduction
2. Materials and Methods
2.1. Patients
2.2. Statistical Analysis
3. Results
3.1. Demographic Data, Lab Data, and Symptoms
3.2. Microbiology
3.3. Treatment and Outcome
3.4. Clinical Signs Associated with IFSwOC
4. Discussion
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Conflicts of Interest
References
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All Patients (n = 38) No. (%) | IFSsOC (n = 29) No. (%) | IFSwOC (n = 9) No. (%) | p Value | |
---|---|---|---|---|
Age (mean ± SD) | 61.18 ± 12.30 | 60.03 ± 12.10 | 64.89 ± 12.96 | 0.308 |
Gender (male: female) | 14:24 | 11:18 | 3:6 | 1.000 |
Classification | <0.001 | |||
Acute invasive | 6 (15.8) | 0 (0.0) | 6 (66.7) | |
Chronic invasive | 32 (84.2) | 29 (100.0) | 3 (33.3) | |
Side | ||||
Left | 22 (57.9) | 17 (58.6) | 5 (55.6) | 1.000 |
Right | 18 (47.4) | 12 (41.4) | 6 (66.7) | 0.260 |
Location | ||||
Maxillary | 26 (68.4) | 24 (82.8) | 2 (22.2) | 0.002 |
Sphenoid | 11 (28.9) | 4 (13.8) | 7 (77.8) | 0.001 |
Anterior ethmoid | 3 (7.9) | 2 (6.9) | 1 (11.1) | 1.000 |
Posterior ethmoid | 4 (10.5) | 1 (3.4) | 3 (33.3) | 0.035 |
Others * | 2 (5.3) | 2 (6.9) | 0 (0.0) | 1.000 |
Underlying Diseases | ||||
Hypertension | 11 (28.9) | 6 (20.7) | 5 (55.6) | 0.088 |
Diabetes mellitus | 7 (18.4) | 4 (13.8) | 3 (33.3) | 0.322 |
Coronary artery disease | 5 (13.2) | 3 (10.3) | 2 (22.2) | 0.574 |
Chronic kidney disease | 1 (2.6) | 1 (3.4) | 0 (0.0) | 1.000 |
Hyperlipidemia | 5 (13.2) | 4 (13.8) | 1 (11.1) | 1.000 |
Atrial fibrillation | 2 (5.3) | 1 (3.4) | 1 (11.1) | 0.422 |
Autoimmune disease | 2 (5.3) | 2 (6.9) | 0 (0.0) | 1.000 |
Lab Data | ||||
WBC (/μL) | 8252.63 ± 5850.74 | 6686.21 ± 1796.97 | 13,300.00 ± 10,462.43 | 0.066 |
ANC (/μL) | 5623.95 ± 5660.50 | 4194.62 ± 1619.37 | 10,229.56 ± 10,379.96 | 0.103 |
CRP (mg/dL) | 4.50 ± 8.17 | 0.53 ± 0.92 | 9.79 ± 10.52 | <0.001 |
ESR (mm/h) | 42.35 ± 32.37 | 28.67 ± 23.34 | 62.88 ± 34.44 | 0.031 |
Symptoms Duration (days, mean ± SD) | 236.22 ± 631.58 | 297.52 ± 736.53 | 79.56 ± 124.36 | 0.389 |
Purulent rhinorrhea | 14 (36.8) | 14 (48.3) | 0 (0.0) | 0.014 |
Headache | 12 (31.6) | 5 (17.2) | 7 (77.8) | 0.002 |
Nasal obstruction | 8 (21.1) | 8 (27.6) | 0 (0.0) | 0.159 |
Diplopia | 6 (15.8) | 0 (0.0) | 6 (66.7) | <0.001 |
Fever | 5 (13.2) | 0 (0.0) | 5 (55.6) | <0.001 |
Foul odor | 5 (13.2) | 5 (17.2) | 0 (0.0) | 0.312 |
Blood-tinged rhinorrhea | 4 (10.5) | 4 (13.8) | 0 (0.0) | 0.554 |
Facial pain/fullness | 4 (10.5) | 4 (13.8) | 0 (0.0) | 0.554 |
Blurred vision | 3 (7.9) | 0 (0.0) | 3 (33.3) | 0.010 |
Proptosis | 2 (5.3) | 0 (0.0) | 2 (22.2) | 0.051 |
Ptosis | 2 (5.3) | 0 (0.0) | 2 (22.2) | 0.051 |
Facial numbness | 2 (5.3) | 2 (6.9) | 0 (0.0) | 1.000 |
Facial swelling | 2 (5.3) | 1 (3.4) | 1 (11.1) | 0.422 |
Consciousness disturbance | 1 (2.6) | 0 (0.0) | 1 (11.1) | 0.237 |
Imaging Results | ||||
Cavernous sinus or orbital involvement suspected on CT/MRI | 7 (18.4) | 0 (0.0) | 7 (77.8) | <0.001 |
All Patients (n = 38) No. (%) | IFSsOC (n = 29) No. (%) | IFSwOC (n = 9) No. (%) | p Value | |
---|---|---|---|---|
Follow-up Duration (days) | 275.43 ± 262.01 | 286.76 ± 284.83 | 220.67 ± 90.26 | 0.983 |
Surgery | ||||
Interval between onset of symptoms and surgery (days) | 107.13 ± 99.19 | 145.14 ± 93.77 | 14.22 ± 11.38 | <0.001 |
Antifungal Therapy | ||||
Voriconazole | 24 (63.2) | 17 (58.6) | 7 (77.8) | 0.438 |
Amphotericin B | 1 (2.6) | 0 (0.0) | 1 (11.1) | 0.237 |
Liposomal amphotericin B | 2 (5.3) | 0 (0.0) | 2 (22.2) | 0.051 |
Others * | 4 (10.5) | 2 (6.9) | 2 (22.2) | 0.233 |
Duration (days) | 73.85 ± 67.86 | 70.11 ± 79.32 | 82.25 ± 32.41 | 0.140 |
Antibiotic | ||||
Duration (days) | 27.71 ± 39.76 | 22.95 ± 43.83 | 42.00 ± 19.82 | 0.005 |
Sequelae | 2 (5.3) | 0 (0.0) | 2 (22.2) | 0.051 |
Mortality | 1 (2.6) | 0 (0.0) | 1 (11.1) | 0.237 |
Sequelae or Mortality | 3 (7.9) | 0 (0.0) | 3 (33.3) | 0.010 |
Odds Ratio | 95% CI | p Value | |
---|---|---|---|
Location | |||
Maxillary | 0.060 | 0.009–0.376 | 0.002 |
Sphenoid | 21.875 | 3.295–145.237 | 0.001 |
Posterior ethmoid | 14.000 | 1.234–158.844 | 0.035 |
Symptoms | |||
Headache | 16.800 | 2.659–106.135 | 0.002 |
Fever | 8.25 * | <0.001 | |
Lab Data | |||
CRP (≥1.025 mg/dL) | 88.000 | 4.758–1627.704 | <0.001 |
ESR (≥46.5 mm/h) | 15.000 | 1.652–136.172 | 0.019 |
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Twu, K.-H.; Kuo, Y.-J.; Ho, C.-Y.; Kuan, E.C.; Wang, W.-H.; Lan, M.-Y. Invasive Fungal Rhinosinusitis with and without Orbital Complications: Clinical and Laboratory Differences. J. Fungi 2021, 7, 573. https://doi.org/10.3390/jof7070573
Twu K-H, Kuo Y-J, Ho C-Y, Kuan EC, Wang W-H, Lan M-Y. Invasive Fungal Rhinosinusitis with and without Orbital Complications: Clinical and Laboratory Differences. Journal of Fungi. 2021; 7(7):573. https://doi.org/10.3390/jof7070573
Chicago/Turabian StyleTwu, Kuan-Hsiang, Ying-Ju Kuo, Ching-Yin Ho, Edward C. Kuan, Wei-Hsin Wang, and Ming-Ying Lan. 2021. "Invasive Fungal Rhinosinusitis with and without Orbital Complications: Clinical and Laboratory Differences" Journal of Fungi 7, no. 7: 573. https://doi.org/10.3390/jof7070573