Chronic Granulomatous Invasive Fungal Sinusitis in Patients With Immunocompetence: A Review.

Autor: Rupa V; Department of Otorhinolaryngology, Christian Medical College Hospital, Vellore, India., Peter J; Department of Ophthalmology, Christian Medical College Hospital, Vellore, India., Michael JS; Department of Microbiology, Christian Medical College Hospital, Vellore, India., Thomas M; Department of Pathology, Christian Medical College Hospital, Vellore, India., Irodi A; Department of Radiology, Christian Medical College Hospital, Vellore, India., Rajshekhar V; Department of Neurological Sciences, Christian Medical College Hospital, Vellore, India.
Jazyk: angličtina
Zdroj: Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery [Otolaryngol Head Neck Surg] 2023 Apr; Vol. 168 (4), pp. 669-680. Date of Electronic Publication: 2023 Feb 05.
DOI: 10.1177/01945998221097006
Abstrakt: Objective: We aimed to study the literature on chronic granulomatous invasive fungal sinusitis to elucidate the changing trends in the management of the disease.
Data Sources: Using specific keywords, we searched the PubMed, PubMed Central, and Scopus databases over the past 50 years, which yielded 938 articles in the English language.
Review Methods: Scrutiny of 147 relevant articles revealed 15 homogenous case series (255 cases of histologically proven chronic granulomatous fungal sinusitis alone) and 8 heterogeneous case series (patients with other types of fungal sinusitis included), which were analyzed in detail (all with >5 cases each).
Conclusions: The disease typically affected middle-aged adults with immunocompetence. Most reports were from Sudan, India, and Saudi Arabia. A slowly progressive orbital, cheek, or palatal mass with proptosis (88.2%) or sinonasal symptoms (39.2%) was typical. Ethmoid (57.2%) and maxillary (51.4%) sinuses were chiefly affected with intracranial extension in 35.1%. Aspergillus flavus (64%) was the most frequent isolate reported. Endoscopic excision (78.8%) followed by azole therapy was the preferred treatment in recent reports. Orbital exenteration and craniotomy were infrequently performed. Complete resolution or improvement was reported in 91.3% of patients. Mortality ranged from 5.9% to 22.2%. There is a trend in the literature toward less radical and disfiguring surgery and preferential use of azoles, with good outcomes even in advanced cases.
Implications for Practice: Chronic granulomatous fungal sinusitis should be diagnosed on the basis of well-defined histopathologic features. A combination of endoscopic sinus surgery and azole therapy usually yields good outcomes.
(© 2022 American Academy of Otolaryngology-Head and Neck Surgery Foundation.)
Databáze: MEDLINE
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