Isavuconazole in the treatment of acute invasive fungal sinusitis: two case reports and literature review

Objective Through the analysis of two successfully treated cases of acute invasive fungal rhino-sinusitis (AIFRS) caused by Mucor in our hospital, to enhance the understanding of this disease and explore improved diagnostic and treatment strategies. This study also conducted a comprehensive literature review of AIFRS. This study also provides a comprehensive literature review of Infections of the mucor and aspergillus genera. Methods The clinical data of two patients with AIFRS admitted to our hospital from 2022 to 2025 were retrospectively analyzed, focusing on risk factors, clinical manifestations, treatment plans, and outcomes. Additionally, we reviewed and analyzed cases of Infections of the Mucor and Aspergillus genera published in PubMed over the past 15 years (2011–2025). Results A total of 387 cases were included in the analyzed studies. The patient cohort was systematically categorized into two main groups: those with Mucor infection and those with Aspergillus infection. Within the Mucor infection group, four subgroups were further identified. The average age of patients infected with Mucor was 41 ± 31.11 years, while that of patients infected with Aspergillus was 32.5 ± 29.99 years. Since the sample size in some subgroups was less than 5 cases, we chose Fisher’s exact test to calculate whether there were significant differences, the efficacy rate of isavuconazole monotherapy (89.47%) was significantly higher than that of amphotericin B monotherapy (59.68%), p < 0.05. Similarly, the efficacy rate of isavuconazole combination therapy (86.67%) was significantly superior to that of amphotericin B monotherapy (59.68%), p < 0.05. Amphotericin B combination therapy demonstrated a marginally better efficacy rate (76.92%) compared to amphotericin B monotherapy (59.68%), p < 0.05. Conclusion In the described cases, ours patients received isavuconazole pre- and post-surgery, achieving favorable prognostic outcomes. Literature comparisons further validate these findings, demonstrating that the efficacy of the new triazole drug isavuconazole in treating invasive aspergillosis and mucormycosis significantly surpasses that of amphotericin B, with efficacy comparable to voriconazole ( p < 0.05). These results provide valuable guidance for clinical medication decisions.