Antifungal agent was important to AIFRS patients
As to our experience, once suspicion of AIFRS was raised according to
clinical manifestation,
antifungal treatment should be
initiated as soon as possible, usually Voriconazole for Aspergillus and
amphotericin B for Mucor. In recent years, FDA has approved
isavuconazole, which was effective against Aspergillus and some Mucor,
and it was water-soluble, with less impact on renal function and hepatic
function than amphotericin B [7,8].
Antifungal treatment was equal or
even more important than surgical debridement, as we learned
inflammation could not be fundamentally solved by operation. If the
patients could not tolerate anti-fungal treatment, mainly because of
hepatic and renal dysfunction, their prognosis were usually poor, such
as case3 and case5, though they underwent an extensive debridement,
still died after 1 and 2.5 months after diagnosis. On the contrary, for
case1,2, 4,7, though only administered a part debridement, the results
were not so bad after antifungal treatment. There were also reports
which showed some survival AIFRS cases were managed only by medical
treatment [9].
As for the duration of antifungal treatment, although it was clear that
patients suffered with invasive fungal infection need a long time of
antifungal therapy, however, up to now, there was no consensus on the
optimal duration. We suggested a range of 6-12 months if the patient
could be tolerated with the drug. However, most of them died within
several months. We also have a group of 6 patients with CIFRS (not
provided in the data), who maintained oral antifungal drugs for 6-14m
after operation, and had a good prognosis.
Prognosis mostly up t o underlying disease, we should
focus more emphasizes on comprehensive treatment.
Prognosis of AIFRS is extremely poor. It’s mortality rate was high up to
50-80% [1]. Now with the rapid development of endoscopic
technology, more thorough debridement was possible, and more effective
antifungal drugs could be available, however, compared with 20 years
ago, the mortality rate did not decreased significantly [10]. Why?
The end of AIFRS largely depends on the struggle between the body’s
immunity and fungal invasion, for those patients with severe
neutropenia, poorly controlled DM, immunosuppressive therapy and
insufficient hepatic and renal function, if they infected with fungi,
especial highly invasive Mucor, a disastrous end was almost inevitable,
such as case 3,5,6,8 in our group, so we should focus more emphasizes on
comprehensive treatment.