Related Experiment Videos
Nasosinusal fungal granuloma--clinical profile
G Andrews1, M Kurien, V Anandi
1Department of ENT, Christian Medical College and Hospital, Vellore, South India.
Abstract:
Fifty cases of nasosinusal fungal granuloma were admitted under the ENT Department in a teaching tertiary care hospital in India during a thirteen-year period. Aspergillus species was found to be the most common causative fungus (29) followed by Mucorales (14), Entomophthorales (5) and Fusarium (2) species. There were 13 cases of non-invasive and 16 cases of invasive variants of Aspergillosis. In spite of intravenous amphotericin B therapy and radical surgical debridement, 81% in the invasive group showed relapse and required prolonged oral antifungal drugs and multiple surgical procedures. Among the 14 cases of Mucormycosis, all of the 10 cases who received intravenous amphotericin B and radical surgery showed complete recovery with no relapse over a period of 2 to 10 years. This is contrary to earlier published reports which suggest poor prognosis. The entomophthoromycosis received oral steroids and cotrimoxazole, and oral potassium iodide or intravenous amphotericin in case of relapse. Both the cases of Fusariosis recovered completely with oral ketoconazole.
Insights
Nasosinusal fungal granuloma cases show varied outcomes. Invasive Aspergillosis has high relapse rates, while Mucormycosis treated with amphotericin B and surgery achieved full recovery, challenging previous findings.
Area of Science:
- Otolaryngology
- Mycology
- Infectious Diseases
Background:
- Nasosinusal fungal granulomas are fungal infections affecting the nasal and sinus cavities.
- Fungal infections of the sinonasal region can be caused by various fungi, including Aspergillus, Mucorales, Entomophthorales, and Fusarium species.
- The clinical presentation and treatment outcomes for these infections can vary significantly.
Purpose of the Study:
- To analyze the causative agents, clinical variants, and treatment outcomes of nasosinusal fungal granuloma.
- To compare the treatment responses of different fungal species, particularly Aspergillus and Mucorales.
- To evaluate the long-term prognosis of invasive Aspergillosis and Mucormycosis in the sinonasal region.
Main Methods:
- Retrospective analysis of 50 nasosinusal fungal granuloma cases over 13 years.
- Identification of causative fungal species including Aspergillus, Mucorales, Entomophthorales, and Fusarium.
- Review of treatment modalities such as intravenous amphotericin B, oral antifungals, surgical debridement, steroids, and ketoconazole.
Main Results:
- Aspergillus species were most common (29 cases), with 16 invasive and 13 non-invasive variants. Invasive Aspergillosis showed an 81% relapse rate despite treatment.
- Mucormycosis (14 cases) demonstrated a favorable prognosis, with all 10 treated cases achieving complete recovery and no relapse after amphotericin B and surgery.
- Entomophthoromycosis (5 cases) and Fusariosis (2 cases) showed complete recovery with varied antifungal and steroid treatments.
Conclusions:
- Invasive Aspergillosis of the sinonasal region has a high relapse rate, necessitating prolonged treatment and multiple interventions.
- Mucormycosis in the sinonasal region appears to have a better prognosis than previously reported, with radical surgery and amphotericin B leading to complete recovery.
- Prompt and appropriate management is crucial for improving outcomes in nasosinusal fungal granulomas, with species-specific treatment strategies potentially influencing prognosis.