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.