Paranasal sinus aspergillosis: its categorization to develop a treatment protocol

Abstract

A prospective study was conducted in 25 consecutive patients of paranasal sinus aspergillosis to categorize and treat them based on a fixed treatment protocol. The three types of aspergillosis categorized as per definitive criteria were chronic invasive (six), non-invasive (fungus ball) (seven) and non-invasive destructive (12). Adjuvant chemotherapy was employed in non-invasive destructive and chronic invasive disease. Ketoconazole was used in the first variety and itroconazole in the latter. Only two patients had recurrence after a mean follow-up of 11 months (range: 6-20 months). They belonged to the non-invasive destructive category and the recurrence had progressed to invasive variety. It is suggested that non-invasive destructive disease should be followed up regularly with endoscopic examination, CT and fungal serology to detect recurrence. Categorization of the paranasal sinus aspergillosis helps to institute proper treatment. Adjuvant chemotherapy in the form of ketoconazole along with surgery is effective in non-invasive destructive disease to prevent recurrence and progression to invasive disease. Chronic invasive disease with its propensity to involve orbit and intracranial cavity should be managed at the earliest with surgery and itraconazole.

Aspergillus flavus: human pathogen, allergen and mycotoxin producer

“…Florid granulomatous inflammation is the histological hallmark of this condition. Interestingly, almost all reports come from the Sudan (Milosev et al, 1969;Gumaa et al, 1992;Yagi et al, 1999), Saudi Arabia (Alrajhi et al, 2001) and the Indian subcontinent (Chakrabarti et al, 1992;Ramani et al, 1994;Panda et al, 2004). There are a limited number of reports in the USA, which appear to affect almost exclusively African-Americans (Currens et al, 2002).…”

Entities of Chronic and Granulomatous Invasive Fungal Rhinosinusitis: Separate or Not?

“…Panda et al divided fungal rhinosinusitis into acute and chronic invasive categories for the following reasons: similar histopathological evidence of mucosal invasion, a fixed treatment protocol for both diseases, and similar clinical manifestations, such as involvement of multiple sinuses and orbital or intracranial involvement [14]. We reported 6 deaths in 55 cases, all found in the CIFRS group.…”

Sphenoid sinus aspergillosis simulating pituitary tumor in immunocompetent patient

“…Cultures on Sabouraud Pétri plates are not always positive, 9 except for Panda et al 7 Treatment of sphenoid sinus non-invasive aspergillosis requires excision through endoscopic endonasal transsphenoidal surgery, or microsurgery. Good results have been achieved without antifungal treatment where authors have found no relapse after surgery alone.…”

“…Non-invasive destructive aspergillosis occurs in 2.2% to 63% of cases and leads to systemic antifungal-associated surgical removal in some cases. 7,8 Definite diagnosis is actually based on histopathology 3,8 that excision multiple septated fungal hyphae without tissue invasion.…”