Akut invaziv fungal rinosinüzit tanılı diabetes mellitus hastalarında tedavi ve prognozu etkileyen faktörler

Year 2021, Volume: 4 Issue: 3, 182 - 190, 31.12.2021

Elvan Onan , Özgür Sürmelioğlu , Muhammed Dağkıran , Çağlar Eker Süleyman Özdemir , Özgür Tarkan Sümbül Bayraktar Mete Kıroğlu

Abstract

Giriş: Akut invaziv fungal rinosinüzit (AİFRS) çoğunlukla diabetik ve immün sistemi baskılanmış hastalarda görülen; yüksek morbidite ve mortalite oranına sahip ciddi bir hastalıktır.
Gereç ve Yöntemler: Bu çalışmada Çukurova Üniversitesi Tıp Fakültesi Kulak Burun Boğaz Hastalıkları Anabilim Dalında Ocak 2010- Ocak 2020 tarihleri arasında AİFRS tanısı ile takip ve tedavi edilen on yedi diabetik hastayı medikal kayıtlardan retrospektif olarak incelendi. Hastaların demografik özellikleri, risk faktörleri, başvuru şikayetleri, tanı yaşları, fungal sinüzitin yaygınlığı, yapılan operasyon, ameliyat öncesi muayene ve lezyon yaygınlığı, prognozu etkileyen faktörler ve uygulanan tedaviler değerlendirilmiştir.
Sonuçlar: Hastaların yaş ortalaması 52 idi. Hastaların %47’si (n:8) kadın, %53’ü (n:9) erkekti. Tüm hastalar diabetikti, 2 hastada ek olarak kronik böbrek hastalığı, 1 hastada ise kronik karaciğer hastalığı mevcuttu. En sık semptom yüzde şişlik ve ağrı (%58,8), periorbital ödem (%41,1) ve ateşti (%35,2). Hastaların 12 sine endoskopik sinüs cerrahisi, 5 ine açık ve endoskopik sinüs cerrahisi, 4 hastaya ise orbita ekzenterasyonu uygulanmıştır. Hayatta kalma oranı %53’dü. Serebral tutulumun, yüksek HbA1c seviyesinin, ileri evre sinonazal tutulumun kötü prognostik faktör olduğu görülmüştür.
Karar: Akut invaziv fungal rinosinüzit, cerrahi ve medikal tedaviye rağmen hala yüksek mortaliteye sahip bir hastalıktır. Diabete bağlı immunsupresyon nedeniyle, bu hastalarda gözlenen her türlü sinonazal semptom ve bulgu klinisyenlerde invaziv fungal rinosinüzit için şüphe uyandırmalıdır.

ABSTRACT
İntroduction: Acute invasive fungal rhinosinusitis (AIFRS) which is a serious disease with a high morbidity and mortality rate is mostly seen in diabetic and immunocompromised patients.
Material and Methods: In this study, seventeen diabetic patients who were treated for AIFRS in Çukurova University Faculty of Medicine, Department of Otorhinolaryngology between January 2010 and January 2020 were retrospectively analyzed from medical records.Demographic characteristics, risk factors, complaints at presentation, age at diagnosis, localization of fungal sinusitis, operation type, preoperative examination and lesion extensity, factors affecting prognosis and treatments of the patients were evaluated.
Results: The mean age of the patients was 52 years. 47% (n:8) of the patients were female and 53% (n:9) were male. All patients were diabetic, 2 patients had additional chronic renal disease and 1 patient had chronic liver disease. The most common presenting symptoms of patients with AIFS were facial swelling and pain (58.8%), periorbital edema (41,1%) and fever (35.2%)
We performed endoscopic sinus surgery in 12 patients, open and endoscopic sinus surgery in 5 patients and orbital exenteration in 4 patients.The overall survival rate was 53%. Intracranial extension, high HbA1c level and advanced sinonasal involvement were found to be poor prognostic factors.
Conclusion: Acute invasive fungal rhinosinusitis is still a disease with high mortality despite surgical and medical treatment. Because of diabetes-related immunosuppression, when any sinonasal symptoms and signs observed in these patients, clinicians should raise suspicion for invasive fungal rhinosinusitis.

Keywords

Fungal sinüzit, mukor, diabetes mellitus

References

• 1. Kohn R, Hepler R (1985) Management of limited rhino-orbital mucormycosis without exenteration. Ophthalmology 92:1440–1443
• 2. Gillespie MB, O'Malley BW. An algorithmic approach to the diagnosis and management of invasive fungal rhinosinusitis in the immunocompromised patient Otolaryngol Clin North Am. 2000 Apr;33(2):323-34
• 3. Bitar D, Van Cauteren D, Lanternier F, Dannaoui E, Che D, Dromer F, et al. Increasing incidence of zygomycosis (mucormycosis), France, 1997-2006. Emerg Infect Dis. 2009 Sep;15(9):1395-401.
• 4. Geerlings SE, Hoepelman AI. Immune dysfunction in patients with diabetes mellitus (DM). FEMS Immunol Med Microbiol. 1999;26(3-4): 259-65.
• 5. Saedi B, Sadeghi M, Seilani P. Endoscopic management of rhinocerebral mucormycosis with topical and intravenous amphotericin B. J Laryngol Otol. 2011 Aug;125(8):807-10
• 6. Chakrabarti A, Das A, Sharma A, Panda N, Das S, Gupta KL, et al. Ten years’ experience in zygomycosis at a tertiary care centre in India. J Infect. 2001; 42(4):261-6.
• 7. Roden MM, Zaoutis TE, Buchanan WL, Knudsen TA, Sarkisova TA, Schaufele RL, et al. Epidemiology and outcome of zygomycosis: a review of 929 reported cases. Clin Infect Dis. 2005; 41(5):634-53.
• 8. Vaezi A, Moazeni M, Rahimi MT, de Hoog S, Badali H. Mucormycosis in Iran: a systematic review. Mycoses. 2016; 59(7):402-15.
• 9. Turner JH, Soudry E, Nayak JV, Hwang PH: Survival outcomes in acute invasive fungal sinusitis: a systematic review and quantitative synthesis of published evidence. Laryngoscope 2013;123:1112, 2013
• 10. Ergun O, Tahir E, Kuscu O, Ozgen B, Yilmaz T. Acute Invasive Fungal Rhinosinusitis: Presentation of 19 Cases, Review of the Literature, and a New Classification System. J Oral Maxillofac Surg. 2017 ;75(4):767-767.
• 11. Chen CY, Sheng WH, Cheng A, et al. Invasive fungal sinusitis in patients with hematological malignancy: 15 years experience in a single university hospital in Taiwan. BMC Infect Dis 2011;11:250.
• 12. Vener C, Carrabba M, Fracchiolla NS, Costa A, Fabio G, Hu C, Sina C, Guastella C, Pignataro L, Deliliers GL. Invasive fungal sinusitis: an effective combined treatment in five haematological patients. Leuk Lymphoma 2007;48(8):1577-86.
• 13. Chinn RY, Diamond RD. Generation of chemotactic factors by Rhizopus oryzae in the presence and absence of serum: relationship to hyphal damage mediated by human neutrophils and effects of hyperglycemia and ketoacidosis. Infect Immun. 1982;38(3):1123-9
• 14. Wu PW, Huang YL, Yang SW,Lee YS, Huang CC,Chang PH, Huang CC, Lee TJ. Acute invasive fungal rhinosinusitis in twenty-one diabetic patients. Clin Otolaryngol. 2018;43(4):1163-7
• 15. Nyunt TPK, Abdullah B, Khaing MM, Seresirikachorn K, Shukri NM, Aeumjaturapat S, Chusakul S, Kanjanaumporn J, Harvey RJ, Snidvongs K. Overall survival and prognostic factors in diabetic patients with invasive fungal rhinosinusitis. Asian Pac J Allergy Immunol
• 16. Roxbury CR, Smith DF, Higgins TS, et al. Complete surgical resection and short-term survival in acute invasive fungal rhinosinusitis. Am J Rhinol Allergy 2017; 31:109–116.
• 17. Munir N, Jones NS. Rhinocerebral mucormycosis with orbital and intracranial extension: a case report and review of optimum management. J Laryngol Otol 2007; 121:192–195.
• 18. Ma J, Jia R, Li J, et al. Retrospective clinical study of eighty-one cases of intracranial mucormycosis. J Glob Infect Dis 2015; 7:143–150.
• 19. Monroe MM, McLean M, Sautter N, et al. Invasive fungal rhinosinusitis: a 15-year experience with 29 patients. Laryngoscope 2013; 123:1583–1587.
• 20. Yohai RA, Bullock JD, Aziz AA, Markert RJ. Survival factors in rhino-orbitalcerebral mucormycosis. Surv Ophthalmol 1994; 39:3–22.