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Novel methods of antifungal administration
Published in Mahmoud A. Ghannoum, John R. Perfect, Antifungal Therapy, 2019
While isolated reports have described the nasal use of alternative agents, such as fluconazole (100 mg in 500 mL of normal saline solution administered as 5–0.5 mL sprays twice daily) [68] and liposomal amphotericin B [69], adjunctive use of nasal irrigations containing amphotericin B have been reported for the treatment of various forms of fungal sinusitis. Again, lack of adequately-controlled clinical trials makes it difficult to determine its efficacy in these medical settings. However, surgery and (in select cases) systemic antifungal therapy are likely to be mainstays of therapy for most forms of fungal sinusitis.
Acute severe rhinological infection
Published in S. Musheer Hussain, Paul White, Kim W Ah-See, Patrick Spielmann, Mary-Louise Montague, ENT Head & Neck Emergencies, 2018
Management of granulomatous invasive fungal sinusitis includes complete surgical removal of the fibrous fungal mass, which often extends into the orbit and intracranial spaces. Treatment with itraconazole (10 mg/kg/day) helps to prevent recurrence. Chronic invasive fungal sinusitis is managed with a combination of functional endoscopic sinus surgery and antifungal therapy. Surgery aims to remove the unhealthy diseased tissue and ventilate the sinuses.
Invasive Mold Infections
Published in Johan A. Maertens, Kieren A. Marr, Diagnosis of Fungal Infections, 2007
Fernanda P. Silveira, Flavio Queiroz-Telles, Marcio Nucci
The radiological appearance of fungal sinusitis is variable. Often the findings are non-specific, with mucosal thickening and sinus opacification (Fig. 7). The CT scan is helpful to detect bony destruction and extension to surrounding areas, whereas the MRI is useful to demonstrate soft tissue involvement.
HO-1: a new marker for predicting postoperative recurrence of CRSwNP
Published in Acta Oto-Laryngologica, 2023
Min-Jie Gong, Yu-sheng Wang, Miao Lou, Rui-ping Ma, Zhen-zhen Hu, Guo-xi Zheng, Ya Zhang
14 healthy controls, 31 patients with CRSsNP, and 32 patients with CRSwNP were recruited in this study. The controls were other diseases requiring nasal endoscopic treatment such as trauma and cerebrospinal fluid rhinorrhea. The diagnosis of CRSwNP and CRSsNP was determined based on physical symptoms, nasal endoscopy and CT imaging and with reference to the guidelines of the European Position Paper on Rhinosinusitis and Nasal Polyps 2012 [8]. Allergy was determined based on the patient’s history of allergy, skin prick and IgE examination. Patients with fungal sinusitis, aspirin intolerance, severe systemic immune disease and those who had used glucocorticoid or immunosuppressive therapy in the 4 weeks prior to the procedure were not included in this study. All patients with chronic rhinosinusitis were treated with an intranasal corticosteroid spray and nasal saline irrigation for 3 months after surgery. Recurrence of CRSwNP in this study was defined as a recurrence of nasal congestion and runny nose for more than one week after 12 months, and other diseases were excluded. The Medical Ethics Committee of Xi’an Jiaotong University Second Affiliated Hospital approved this study.
A case of mistaken identity: Saksenaea vasiformis of the orbit
Published in Orbit, 2021
Allison J. Chen, Lilangi S. Ediriwickrema, Rohan Verma, Vera Vavinskaya, Solomon Shaftel, Adam S. Deconde, Bobby S. Korn, Don O. Kikkawa, Catherine Y. Liu
The universal agreement for management of invasive fungal sinusitis includes (1) treatment with systemic antifungals, (2) debridement of necrotic tissue, (3) reduction in immune suppression, and (4) correction of metabolic derangement when feasible. The current landscape of orbital management of disease is evolving between the spectrum of exenteration and globe-sparing surgery (e.g. functional endoscopic sinus surgery) in unity with periorbital injections of amphotericin. The largest review to date on exenteration studied 807 patients who failed to demonstrate an improvement in patient survival.8 The past decade, as a result, has led to a shift towards conservative debridement with local irrigation of orbital tissue, and more recently, with off-label peribulbar injection of AmB ranging from daily to weekly treatments with reported excellent postoperative visual acuity.9–15 These injections can be done at bedside, typically do not require general anesthesia, and are less invasive than the other options. Potential disadvantages include the possibility of transient moderate to severe orbital inflammation due to the intrinsic inflammatory properties of amphotericin as well as the reported potential for local cytotoxicity in vitro.16,17 The former is more likely to occur with AmB formulated with deoxycholate that is dose-limited systemically by acute infusion-related reactions and nephrotoxicity. Inflammation occurs less frequently with L-AmB given its smaller size and composition can avoid substantial immune recognition.17,18
Cavernous sinus fungal infection: a rare case
Published in British Journal of Neurosurgery, 2019
Boon Han Kevin Ng, Giat Seng Kho, Sze Kiat Sim, Donald Ngian San Liew, Ing Ping Tang
Symptoms include headache, retro orbital pain, vomiting, fever and blurring of vision. A study by Dubey et al showed that the commonest symptoms are headache followed by vomiting and eye symptoms such as proptosis and blurring of vision3. Fever is not frequently seen on presentation1,3. Clinical examination may reveal anosmia, ptosis, proptosis, chemosis and opthalmoplegia 2,3. Chronic sinusitis can be a presentation of paranasal fungal sinusitis which can manifest with a wide spectrum of the disease ranging from simple colonization to invasive which can be progressive slowly and can be destructive locally. Our patients presented with 6th cranial nerve palsy with subsequent involvement of the 3rd cranial nerve. He denied any nasal symptoms. The author postulates that the source of the disease could be haematogenous.