Protocolo de detecção precoce de rinossinusite fúngica invasiva aguda

Introduction: Invasive fungal rhinosinusitis is a nosologic entity with increasing prevalence. This tendency is mainly due to a larger number of immunosuppressed patients. Despite the progress in medical and surgical treatment, mortality rate is still high in acute Invasive fungal rhinosinusitis, ranging from 20 to 80%. The authors present a multidisciplinary protocol for a precocious intervention in immunosuppressed patients with suspected acute Invasive fungal rhinosinusitis. Material and Methods: The articles analyzed in this review were identified through a systematic survey, conducted in PubMed. We selected 18 articles published between September 1993 and January 2014. Were included articles that could be analyzed for host factors that predispose to RSFIA, and for the early signs and symptoms that lead to suspicion of disease. For the diagnosis and treatment were used “guidelines” and international consensus. Results: The neutrophil dysfunction seems to be a cross predisposing factor to virtually all patients who developed RSFIA. Fever and / or local symptoms (swelling and facial pain, nasal obstruction, rhinorrhea, headache) are considered the earliest symptoms, and pale mucosa, slightly crumbly, edema, granulation and crusts are considered the earliest signs of RSFI. The imaging tests most commonly used for the initial evaluation of patients with suspected RSFI is the TAC SPN. The RSFIA diagnostic criteria are defined by the groups ISHAM and EORTC / MSG-NIAID. Treatment includes correcting the immunodeficiency, medical therapy with systemic antifungal and surgical debridement. Conclusions: The authors present a protocol for identification and treatment of patients with acute invasive fungal rhinosinusitis.