Management of invasive fungal rhino sinusitis in a tertiary health care center
Keywords:Invasive fungal sinusitis, Amphotericin B, Debridement, Mucoraceae, CT para nasal sinuses
Background: Invasive fungal sinusitis, though considered to be rare entity, is nowadays frequently encountered, mostly in immunocompromised patients like uncontrolled diabetes, haematological malignancy and organ transplants on immunosuppressive drugs. There are only a few landmark studies from the Indian subcontinent on invasive fungal rhino sinusitis. The lack of awareness among clinicians regarding the varying clinical presentations of fungal rhino sinusitis prompted us to undertake this study, as our hospital is referral centre we get to see varying presentations and most terminal stages of disease.
Methods: This is a prospective study in which we report 30 cases reported to Gandhi Hospital, Secunderabad, invasive fungal rhino sinusitis. Evaluated in detail the clinical presentation, radiological features, specimens collected were subjected to both microbiology and pathologic examination; data collected and were analysed. Treated medically and surgically.
Results: The most common co-morbid condition is uncontrolled diabetes mellitus. Mucoraceae (53%) and Aspergillus (10%) were the main fungi found. Mucosal biopsy confirmed fungal invasion to the nasal mucosa in all cases. Computed tomography and endoscopic findings showed a predominance of unilateral disease, with various stages of nasal involvement. All patients underwent surgical debridement and systemic antifungal therapy immediately after diagnosis.
Conclusions: Early medical and surgical treatment is essential to improve the prognosis along with better control of comorbidities.
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