Multi-centre cohort study suggests immune stimulating therapies may be useful in the treatment of acute invasive fungal sinusitis (AIFS)

Acute invasive fungal sinusitis (AIFS) is a rare and aggressive infection occurring in immunocompromised patients. Even when diagnosis and treatment occurs promptly, the mortality rates stand at around 50% and there is currently little known about factors that influence survival.

A new paper by Grace Wandell et al. reports on the largest retrospective, multi-centre cohort of AIFS patients to date, and the factors that affected their survival rates. The study included 114 biopsy-confirmed AIFS patients from 3 academic institutions, between the years of 1995 and 2016. Wandell et al. studied the demographics of the group, presenting signs and symptoms, radiographic and endoscopic findings, laboratory data, procedures performed, and survival outcomes. They also investigated the use of immune-stimulating therapies (IST), and whether these had an impact on patient outcomes.

Of the total patients studied, 83% survived for one month and 63% survived for three months. The most common immunosuppressive risk factors were hematologic malignancy and diabetes. Hematologic malignancy was associated with significantly increased risk of death at 3 months whereas diabetes was associated with improved survival at 3 months. Recent (within 1 month) chemotherapy increased the risk of death at both 1 and 3 months.

Of the fungi identified, Aspergillus was the most common, followed by Mucor and Rhizopus. 12% of patients were infected with atypical organisms and these were responsible for a 2-3-fold higher risk of death. Many of these organisms were resistant to amphotericin B and other antifungals.

Four types of IST were studied: G-CSF alone; GM-CSF alone; granulocyte transfusions; G-CSF plus granulocyte transfusions. In this study IST increased 1 month survival rates by 70% in 2 multivariate studies. This is significant short term improvement. However, survival benefit declined after 60 days; this is plausible given that IST briefly augments the immune response.

Further research is required in order to better understand the various prognostic factors and effective treatments for invasive fungal infections; the potential use of immune stimulating therapies being a particular target for future studies.