A New Classification and Diagnostic Criteria for Invasive Fungal Sinusitis

“…2 Invasive sinusitis can be further subdivided into granulomatous, acute fulminant and chronic invasive types. 1 The diagnostic criteria proposed for invasive fungal sinusitis include radiological confirmation of sinusitis, and histopathological evidence of hyphal forms within sinus mucosa, submucosa, blood vessels or bone. Mucormycosis can manifest as six different syndromes: rhinocerebral, pulmonary, gastrointestinal, central nervous system, subcutaneous and disseminated.…”

Section: Discussionmentioning

confidence: 99%

“…3 Rhinocerebral mucormycosis falls under the category of acute fulminant invasive sinusitis. 1,2 This particular form is characterised by a painless, necrotic septal ulcer, sinusitis and rapid intracranial spread with a high mortality rate. The syndrome develops most commonly in individuals with poorly controlled diabetes, as in our patient.…”

Section: Discussionmentioning

confidence: 99%

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Use of posaconazole in the treatment of infective rhinocerebral mucormycosis

et al. 2010

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Introduction: A patients with undiagnosed type II diabetes mellitus presented with infective rhinocerebral mucormycosis.Investigation results: Initial magnetic resonance imaging scans demonstrated an aggressive disease process involving the left orbit and paranasal sinuses. A repeated scan following treatment excluded intracranial spread or recurrence. Pus from the paranasal sinuses grew Rhizopus arrhizus on microbiological culture.Management: Initial treatment comprised intravenous liposomal amphotericin B, intravenous co-amoxiclav and surgical debridement. The patient's diabetes was managed medically. The development of drug-induced transaminitis required a change of medication. The dose of liposomal amphotericin B was reduced, and then titrated back up as the liver function test results improved. Posaconazole was also introduced and the patient was eventually discharged on this alone, as the maximum recommended cumulative dose of liposomal amphotericin B had been reached.Conclusions: Posaconazole may be used effectively in conjunction with surgical debridement in the treatment of patients with infective rhinocerebral mucormycosis who develop hepatotoxic side effects to liposomal amphotericin B. Posaconazole may also allow a reduction in the dose of liposomal amphotericin B, resulting in better tolerance.

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“…13 The known ability of voriconazole to penetrate bone was an additional theoretical advantage; two diabetic but otherwise immunocompetent patients with skull base fungal bone invasion have been reported to have died of neurological sequelae. 1,5 . Intravenous (IV) amphotericin or voriconazole, with a subsequent IV to oral switch, has been used to treat invasive sinus aspergillosis with extension into the skull base .…”

Section: Discussionmentioning

confidence: 99%

Oral voriconazole for invasive fungal skull base infection

et al. 2009

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Background: Intravenous amphotericin or intravenous voriconazole, both followed by oral voriconazole, have previously been given to treat invasive aspergillosis of the skull base.Case report: Exclusively oral voriconazole was used in an immunocompetent patient with biopsy-proven, invasive aspergillosis. She had a large, erosive lesion extending from the central skull base to the right orbit and ethmoid sinus, and displacing the right internal carotid artery. After four months of oral treatment as an out-patient, a repeated computed tomography scan showed a fully treated infection with post-infectious changes only, and treatment was terminated. Two years later, there had been no recurrence.Conclusion: Substantial cost savings were made by using exclusively oral treatment, compared with the use of intravenous voriconazole or amphotericin, or a switch strategy.

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A New Classification and Diagnostic Criteria for Invasive Fungal Sinusitis

Cited by 296 publications

References 35 publications

Presentation of Invasive Fungal Rhinosinusitis in Sudanese Children: A Report of Four Cases

Presentation of Invasive Fungal Rhinosinusitis in Sudanese Children: A Report of Four Cases

Use of posaconazole in the treatment of infective rhinocerebral mucormycosis

Oral voriconazole for invasive fungal skull base infection

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