Author(s)
Tawfiq Khoury, MD
Clifford Brown, MD
David Jang, MD
Ralph Abi-Hachem, MD
Affiliation(s)
Duke University
Abstract:
Introduction: Acute invasive fungal sinusitis (AIFS) remains a significant cause of morbidity and mortality in immunocompromised patients. Recently three cases of AIFS arose within a ten day timeframe. This report discusses the presentation, treatment, and presumed etiology of this cluster.Methods: All cases of AIFS were reviewed over a 10-year-period at our tertiary care center. Patient characteristics and frequency of case diagnosis were compared to our recent cluster of 3 patients in order to identify a source for this recent cluster.Results: Over a 10 year period 35 biopsy proven cases of AIFS were diagnosed. Recently 3 cases of AIFS within 10 days were diagnosed. This represents a statistically significant increase over our baseline incidence on chi squared analysis (P<0.01). All patients in this recent cluster had acute myeloid leukemia. The primary site of necrosis involved the middle turbinate in 2 cases and the septum, nasal floor and inferior turbinate in 1 case. All patients were in rooms in a single inpatient unit that had recently undergone maintenance. The unit is near an active construction site. These rooms were not fitted with high efficiency particulate air (HEPA) filters initially. Portable HEPA filters were implemented during room maintenance after these cases and there have been no additional diagnoses of AIFS. Conclusion:We suspect that this cluster was related to the release of fungal spores from disrupted soil during construction combined with the room maintenance without air filtration. We advocate for the use of HEPA filters to avoid AIFS in immunocompromised patients.