American journal of otolaryngology · 2026
Immune status appears more closely associated with survival than surgical extent in acute invasive fungal rhinosinusitis with cranio-orbital invasion: A retrospective analysis of 14 cases.
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Yang Yang, Xiao Nianci, Shen Lifang, Chen Haihong
Аннотация
OBJECTIVE: Acute invasive fungal rhinosinusitis with cranio-orbital invasion (AIFRS-CO) is associated with high mortality. The relative contributions of host immune status, fungal species, and surgical extent to survival remain uncertain. This study evaluated clinical outcomes and prognostic determinants in patients with AIFRS-CO.
METHODS: A retrospective cohort study was performed including 14 immunocompromised patients with AIFRS-CO treated at a tertiary center between February 2016 and December 2024. Patients were stratified according to severity of immunocompromise. Clinical features, fungal pathogens, treatment strategies (antifungal therapy with or without surgical debridement), and survival outcomes were analyzed descriptively.
RESULTS: Overall mortality was 10/14 (71%, 95% CI: 42-92%). Among non-survivors, Mucorales infection was identified in 9/10 cases (90%, 95% CI: 55-100%). Severe immunosuppression appeared to be closely associated with poor outcomes. Radical debridement did not show a consistent survival benefit, whereas selected patients undergoing limited debridement with recoverable immune function achieved longer-term survival. The median follow-up duration was 2.25 months (IQR: 0.50-18; range: 0.23-48 months).
CONCLUSION: In this cohort, survival in AIFRS-CO appeared to be more closely associated with host immune status and fungal species than with surgical extent. Severe immunosuppression combined with Mucorales infection was associated with extremely poor prognosis. Multidisciplinary management prioritizing immune recovery and appropriate antifungal therapy may be important in selected patients.
METHODS: A retrospective cohort study was performed including 14 immunocompromised patients with AIFRS-CO treated at a tertiary center between February 2016 and December 2024. Patients were stratified according to severity of immunocompromise. Clinical features, fungal pathogens, treatment strategies (antifungal therapy with or without surgical debridement), and survival outcomes were analyzed descriptively.
RESULTS: Overall mortality was 10/14 (71%, 95% CI: 42-92%). Among non-survivors, Mucorales infection was identified in 9/10 cases (90%, 95% CI: 55-100%). Severe immunosuppression appeared to be closely associated with poor outcomes. Radical debridement did not show a consistent survival benefit, whereas selected patients undergoing limited debridement with recoverable immune function achieved longer-term survival. The median follow-up duration was 2.25 months (IQR: 0.50-18; range: 0.23-48 months).
CONCLUSION: In this cohort, survival in AIFRS-CO appeared to be more closely associated with host immune status and fungal species than with surgical extent. Severe immunosuppression combined with Mucorales infection was associated with extremely poor prognosis. Multidisciplinary management prioritizing immune recovery and appropriate antifungal therapy may be important in selected patients.