Invasive Fungal Infections of the Head and Neck: A Tertiary Hospital Experience

TL;DR

This study examines invasive fungal infections in the head and neck, identifying risk factors, common organisms, and treatment approaches over 19 years at a large hospital.

Contribution

The study provides a detailed analysis of invasive fungal infections in the head and neck, highlighting their incidence, risk factors, and outcomes.

Findings

Invasive infections were most common in the sinonasal cavities, with a 15-fold higher incidence compared to other sites.

Mucorales were the most common organism (51%), followed by hyaline molds (29%) and Candida (11%).

Mortality was high in patients with malignancy and/or transplant, and mandibular infections were often linked to osteoradionecrosis.

Abstract

From the existing millions of fungal species, only a few cause disease. In this study, we investigated invasive fungal infections in the head and neck (H&N) over a 19-year period (2005 to 2024) at a large academic healthcare system. Among the 413 documented fungal H&N infections, 336 were noninvasive, and 77 were invasive. The highest incidence of invasive infections occurred in the sinonasal cavities, with a 15-fold difference compared to other sites. Most infections affected adults over 40 years old. The most common organisms were Mucorales (51%), hyaline molds (29%), and Candida (11%). Risk factors included malignancy, transplant, diabetes, and illicit drug use. Mortality was high in patients with malignancy and/or transplant. Infections affecting the mandible were usually a complication of osteoradionecrosis and were associated with the coinfection of Candida and Actinomyces. At other sites, infections were rare and were usually the result of penetrating injuries or immunosuppression. Treatment typically involved a combination of antifungals and surgical procedures.

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