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Post-operative responses of paranasal Aspergillus granuloma to itraconazole
S A Gumaa1, E S Mahgoub, R J Hay
1Department of Medical Microbiology, Faculty of Medicine, University of Khartoum, Republic of Sudan.
Abstract:
Paranasal Aspergillus granuloma is an invasive infection, seen mainly in tropical countries, involving the paranasal sinuses, orbit and brain. Previously surgical excision has been followed by a high relapse rate, 80% in some series, and mortality. This study involved the use of post-operative therapy with oral itraconazole in doses of 200-300 mg daily. Twenty-two patients were treated for a mean period of 19.7 weeks. Of 19 patients for whom follow-up data were available, 12 (62%) were rated as being in complete remission in a mean period of 17.2 months after the end of therapy. Only one patient developed progressive disease during itraconazole therapy. No serious adverse effect was seen. Use of itraconazole shows promise as a means of preventing relapse after surgery in this progressive infection.
Insights
Post-operative itraconazole therapy shows promise in preventing relapse of invasive paranasal Aspergillus granuloma, a serious tropical infection. This treatment approach offers a potential solution to high recurrence rates following surgical intervention.
Area of Science:
- Mycology
- Infectious Diseases
- Otolaryngology
Background:
- Paranasal Aspergillus granuloma is an invasive fungal infection prevalent in tropical regions.
- It commonly affects the paranasal sinuses, orbit, and brain.
- Previous treatments involving surgical excision have been associated with high relapse rates (up to 80%) and significant mortality.
Purpose of the Study:
- To evaluate the efficacy of post-operative oral itraconazole in preventing relapse of paranasal Aspergillus granuloma.
- To assess the safety and tolerability of itraconazole in patients treated for this invasive fungal infection.
Main Methods:
- A study involving 22 patients with paranasal Aspergillus granuloma.
- Patients received post-operative oral itraconazole at doses of 200-300 mg daily.
- Treatment duration averaged 19.7 weeks, with follow-up data analyzed.
Main Results:
- Of 19 patients with available follow-up data, 12 (62%) achieved complete remission.
- Remission was observed at a mean of 17.2 months after therapy completion.
- Only one patient experienced disease progression during itraconazole treatment, and no serious adverse effects were reported.
Conclusions:
- Post-operative itraconazole therapy demonstrates potential in reducing relapse rates for paranasal Aspergillus granuloma.
- This antifungal regimen appears safe and effective in managing this invasive fungal infection after surgery.
- Itraconazole offers a promising adjunctive treatment to surgery for improving outcomes in paranasal Aspergillus granuloma.