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

Yıl 2021, Cilt: 4 Sayı: 3, 182 - 190, 31.12.2021

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

Öz

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.

Anahtar Kelimeler

Fungal sinüzit, mukor, diabetes mellitus

Kaynakça

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