Current therapeutic protocols for chronic granulomatous fungal sinusitis

Abstract

Surgery followed by itraconazole or voriconazole for Stage 1 and 2 disease and voriconazole for stage 3 disease is recommended for a good outcome. Amphotericin B is not recommended as first line therapy for CGFS.

Chronic Granulomatous Invasive Fungal Sinusitis: A Case Series and Literature Review

“…15 With regard to CGIFS, Rupa et al recently published a current therapeutic protocol and reported that azole derivatives (voriconazole or itraconazole) were consistently better than amphotericin B. 2 The duration of oral voriconazole treatment is still debatable; typically, it ranges from 6 to 18 months. 16,17 In the literature, topical antifungal application has no clear role as an adjuvant mode of therapy in CGIFS cases.…”

“…[16][17][18] Recently, Rupa et al have suggested a protocol for CGIFS management based on a staging system using clinical features and radiological findings of the disease extent. 2 In stage 1, the disease is confined to the nose and the PNSs. In stage 2, it extends to the orbit, the palate, or the oral cavity.…”

A Novel Insight into the Immunologic Basis of Chronic Granulomatous Invasive Fungal Rhinosinusitis

“…CGIFS is a rare condition, and, consequently, there is a lack of a management consensus in the literature, 4 although it is generally accepted that any treatment should involve a combination of surgery and antifungal treatment at a minimum. One recent CGIFRS case report proposed a management approach that involves a combination “conservative” surgery and long-term oral antifungals.…”

“…3 CGIFRS poses a significant diagnostic and management challenge for the clinician due to its rarity, unclear pathogenesis, and the lack of agreed management protocols. 4 …”

Invasive fungal rhinosinusitis with palatal erosion in an elderly edentulous patient with uncontrolled diabetes: report of a rare case

“…bone, mucous membrane and vessels. Treatment is generally a combination of antifungal chemotherapy and surgery. New antifungal agents like voriconazole are more effective and reduce the need for extensive surgery; however, the duration of antifungal chemotherapy is debatable as only a few cases have been reported.…”