Medical Treatment of Acute Invasive Fungal Rhinosinusitis

Acute invasive fungal rhinosinusitis (AIFRS) is a rapidly progressing and fatal infection, primarily affecting immunocompromised individuals such as those undergoing hematopoietic stem cell transplantation, organ transplantation, and patients with diabetes. AIFRS is characterized by rapid tissue necrosis and vascular invasion, with a high mortality rate if early treatment is not initiated. Aspergillosis and Mucorales are the main causative pathogens, both of which exist in airborne spores and can infect immunocompromised individuals through the respiratory tract. Treatment requires both potent antifungal therapy and surgical resection of necrotic tissue. In this review, we comprehensively reviewed the latest medical treatment strategies for AIFRS and discuss future research and clinical application directions. According to several literature reviews, liposomal amphotericin B (L-AmB) was the most recommended as the first-line treatment for AIFRS, whereas voriconazole was used as a first-line drug, especially effective for Aspergillus infections. For Mucormycosis, L-AmB was used as the preferred treatment, and posaconazole and isavuconazole can be considered as alternative therapies. However, resistance to antifungal drugs may occur in some patients, necessitating an individualized approach and treatment for each patient. Combination antifungal therapy may be effective in certain cases, but it is generally not recommended as the treatment duration may vary depending on clinical findings and the patient’s condition. To achieve effective treatment for AIFRS in the future, further research on various causative organisms and improvements in treatment strategies are needed, with a multidisciplinary approach being crucial.