Abstract：
Acute invasive fungal sinusitis (AIFS) is an aggressive disease that requires prompt diagnosis and multidisciplinary treatment given its rapid progression. However, there is currently no consensus on diagnosis, prognosis, and management strategies for AIFS, with multiple modalities routinely employed. The purpose of this multi-institutional and multidisciplinary evidence-based review with recommendations (EBRR) is to thoroughly review the literature on AIFS, summarize the existing evidence, and provide recommendations on the management of AIFS.
The PubMed, EMBASE, and Cochrane databases were systematically reviewed from inception through January 2022. Studies evaluating management for orbital, non-sinonasal head and neck, and intracranial manifestations of AIFS were included. An iterative review process was utilized in accordance with EBRR guidelines. Levels of evidence and recommendations on management principles for AIFS were generated.
A review and evaluation of published literature was performed on 12 topics surrounding AIFS (signs and symptoms, laboratory and microbiology diagnostics, endoscopy, imaging, pathology, surgery, medical therapy, management of extrasinus extension, reversing immunosuppression, and outcomes and survival). The aggregate quality of evidence was varied across reviewed domains.
Based on the currently available evidence, judicious utilization of a combination of history and physical examination, laboratory and histopathologic techniques, and endoscopy provide the cornerstone for accurate diagnosis of AIFS. In addition, AIFS is optimally managed by a multidisciplinary team via a combination of surgery (including resection whenever possible), antifungal therapy, and correcting sources of immunosuppression. Higher quality (i.e., prospective) studies are needed to better define the roles of each modality and determine diagnosis and treatment algorithms.
The PubMed, EMBASE, and Cochrane databases were systematically reviewed from inception through January 2022. Studies evaluating management for orbital, non-sinonasal head and neck, and intracranial manifestations of AIFS were included. An iterative review process was utilized in accordance with EBRR guidelines. Levels of evidence and recommendations on management principles for AIFS were generated.
A review and evaluation of published literature was performed on 12 topics surrounding AIFS (signs and symptoms, laboratory and microbiology diagnostics, endoscopy, imaging, pathology, surgery, medical therapy, management of extrasinus extension, reversing immunosuppression, and outcomes and survival). The aggregate quality of evidence was varied across reviewed domains.
Based on the currently available evidence, judicious utilization of a combination of history and physical examination, laboratory and histopathologic techniques, and endoscopy provide the cornerstone for accurate diagnosis of AIFS. In addition, AIFS is optimally managed by a multidisciplinary team via a combination of surgery (including resection whenever possible), antifungal therapy, and correcting sources of immunosuppression. Higher quality (i.e., prospective) studies are needed to better define the roles of each modality and determine diagnosis and treatment algorithms.
摘要：
背景：急性侵袭性真菌性鼻窦炎（AIFS）是一种侵袭性疾病，由于其进展迅速，需要及时诊断和多学科治疗。然而,目前在诊断上没有共识，预后,和AIFS的管理策略，常规采用多种模式。Thepurposeofthismulti-institutionalandmulticientevidence-basedreviewwithrecommendations(EBRR)istothroughlyreviewtheliteratureonAIFS,总结现有证据，并就AIFS的管理提供建议。
方法：PubMed，EMBASE,和Cochrane数据库从开始到2022年1月进行了系统审查。评估轨道管理的研究，非鼻窦的头部和颈部,包括AIFS的颅内表现。根据EBRR指南使用了迭代审查过程。生成了有关AIFS管理原则的证据和建议水平。
结果：针对围绕AIFS的十二个主题（体征和症状，实验室和微生物学诊断，内窥镜检查,成像,病理学,手术,医学治疗,extrasinus扩展的管理，逆转免疫抑制，以及结果和生存)。证据的总体质量在审查的领域有所不同。
结论：根据现有证据，明智地利用历史和体检相结合，实验室和组织病理学技术，和内窥镜检查为AIFS的准确诊断提供了基石。此外,AIFS由多学科团队通过手术组合（包括尽可能的切除）进行最佳管理。抗真菌治疗,纠正免疫抑制的来源。更高的质量(即，需要前瞻性)研究来更好地定义每种模式的作用，并确定诊断和治疗算法。本文受版权保护。保留所有权利。
方法：PubMed，EMBASE,和Cochrane数据库从开始到2022年1月进行了系统审查。评估轨道管理的研究，非鼻窦的头部和颈部,包括AIFS的颅内表现。根据EBRR指南使用了迭代审查过程。生成了有关AIFS管理原则的证据和建议水平。
结果：针对围绕AIFS的十二个主题（体征和症状，实验室和微生物学诊断，内窥镜检查,成像,病理学,手术,医学治疗,extrasinus扩展的管理，逆转免疫抑制，以及结果和生存)。证据的总体质量在审查的领域有所不同。
结论：根据现有证据，明智地利用历史和体检相结合，实验室和组织病理学技术，和内窥镜检查为AIFS的准确诊断提供了基石。此外,AIFS由多学科团队通过手术组合（包括尽可能的切除）进行最佳管理。抗真菌治疗,纠正免疫抑制的来源。更高的质量(即，需要前瞻性)研究来更好地定义每种模式的作用，并确定诊断和治疗算法。本文受版权保护。保留所有权利。
