An algorithmic approach to aspergillus sinusitis

Abstract

The effective management of paranasal sinus aspergillosis requires early diagnosis, histological classification, surgery and where appropriate, chemotherapy. Fungal sinusitis may be easily missed unless a high index of suspicion is maintained and specific culture and histology requested. The disease is classified into invasive and noninvasive types, each being divided into two subgroups: invasive aspergillosis may be either fulminant or indolent and noninvasive disease localized or allergic. The literature is reviewed and an algorithmic approach to aspergillus sinusitis proposed. The importance of histologically differentiating invasive from noninvasive aspergillosis prior to selecting the appropriate treatment options is stressed. CT scan should precede definitive surgery, and be used in follow-up. Close and prolonged follow-up is essential.

Invasive Aspergillus flavus sinusitis: case report in a patient with biphenotypic acute leukemia

“…In neutropenic patients, as observed in our report, the presentation of an Aspergillus sinusitis is a fulminant invasive disease where rapidly progressive, gangrenous mucoperiosteitis is frequently fatal 1,4,5,10 .…”

“…Therapy is based in surgical remotion of the damaged tissue associated with antifungal therapy, where amphotericin B is the drug of choice 1 . Despite this aggressive treatment the outcome death is common, mainly due to the great period between the beginning of the disease and the therapy start, which permit the infection progress to a severe clinical form.…”

Sinus Aspergillosis and Allergic Fungal Sinusitis

“…The use of the CT scan is recommended during the period of follow-up to detect occult recurrence or incomplete removal. 7 In conclusion, it seems that sinonasal mycosis is increasingly reported all over the world. In endemic areas, such as Sudan and Saudi Arabia, this diagnosis should be kept in mind when facing patients with nasal polyposis.…”

“…2,5,9 Preoperative CT scan determines the extent of the lesion and accordingly helps in the choice of surgical approach. 2,3,7,9,12,15 However, the recommended approaches vary according to the surgeon's experience and preference. Stammberger 4 advocated the use of endoscopic sinus surgery (ESS) for all cases, whereas Kennedy 15 recommended the use of ESS for limited cases without extra sinus extension.…”

“…2) Mucosal or invasive fungal sinusitis may be either chronic indolent or fulminate invasive sinusitis. 5,7 Each of these four forms has its own rather distinctive histopathological findings, as well as clinical and therapeutic implications (Table 1). 5 Fungal sinusitis is commonly reported in Sudan, where the disease is almost endemic.…”