Risk Factors Associated with Morbidity and Mortality of Acute Invasive Fungal Rhinosinusitis

Acute invasive fungal rhinosinusitis (RSFIA) is a potentially lethal disease that occurs in immunocompromised patients who have a rapidly progressive evolution to adjacent structures in a disseminated infection and death of the patient.

Material and Methods: An observational, cross-sectional, retrospective, analytical study was designed. There were 19 patients diagnosed with Acute Invasive Fungal Rhinosinusitis, we considered the risk factors associated with morbidity and mortality, such as age, gender, comorbidities, immunocompromise.

Results: 94.74% had diabetes mellitus and 21.05% had chronic kidney disease. The most frequent agent was Mucormycosis 78.95%, followed by 15.79% for Aspergillus. 89.47% underwent surgical debridement. Mortality was estimated at 42.11%. The following associations with mortality were found: age equal to or greater than 65 years Student’s T-score of -2.1 and p0.04, the visual and state of consciousness alteration had a p 0.01, p 0.02 and p 0.008 with RR of 3.61 (95% CI 1.25 - 10.37), RR of 5.09 (95% CI 0.77 - 35.59) and RR of 3.75 (95% CI 1.62 - 8.67)) respectively. Necrosis of the hard palate showed a p-value of 0.04; RR of 2.8 (95% CI 1.09 - 7.14). Bone erosion by CT p 0.03; RR (95% CI 0.88 - 12.51). Conclusions: The variables associated with mortality cases are older than 65 years, altered state of consciousness, diplopia, decreased visual acuity, hard palate necrosis and bone erosion. While the only protective factor to mortality identified was early surgical debridement, decreasing the mortality event up to three times. 

Keywords: Acute invasive fungal rhinosinusitis; Mucormycosis; Mortality; Associated factors.

Abbreviations: AIFR: Acute Invasive Fungal Rhinosinusitis TC: Computed Tomography, DM: Diabetes mellitus, CKD: Chronic kidney disease, LV: Liver disease, LK Leukemia.