Invasive fungal sinusitis: Difference between revisions

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==Background==
= Invasive fungal sinusitis =


== Microbiology ==
===Microbiology===


*[[Aspergillus]]
* Mucorales (50%)
*[[Zygomycetes]]: [[Mucor]], [[Rhizopus]]
* Aspergillus (50%)
* Fusarium (rare)
*[[Fusarium]]
*[[Pseudoallescheria boydii]]
*[[Alternaria]]
*[[Bipolaris]]
*[[Cladophialophora]]
*[[Curvularia]]
*Non-invasive:
**Mycetoma: [[Mucor]], [[Rhizopus]], [[Fusarium]], [[Pseudoallescheria bpydii]], [[Alternaria]], [[Bipolaris]], [[Cladophialophora]], [[Curvularia]]
**Allergic fungal sinusitis: [[Aspergillus]], [[Bipolaris]], [[Curvularia]], [[Dreschlera]]


===Risk Factors===
== Clinical Presentation ==


*Immunocompromise, including [[solid organ transplantation]] and [[hematopoietic stem cell transplantation]]
* Difficult to distinguish from bacteria
*[[Diabetes mellitus]]
* Risk factors: DM, solid organ transplant, hematologic transplant
* Edema and paresthesias are common
* NP scope normal in ~30%; black eschar in 50%


==Clinical Manifestations==
== Management ==


*Difficult to distinguish from [[acute bacterial sinusitis]]
* CT for extrasinus invasion
*Edema and paresthesias are common
** MRI is more sensitive
*NP scope normal in ~30%; black eschar in 50%
* Debridement

* Lipsomal amphotericin B 5 mg/kg
==Management==
** Every day of delay increases mortality

** 3 week induction, then switch to posaconazole or isuvaconazole for 3-6 months
*CT for extrasinus invasion
* Decrease immunosuppression
**MRI is more sensitive
*Debridement
*Lipsomal amphotericin B 5 mg/kg
**Every day of delay increases mortality
**3 week induction, then switch to posaconazole or isuvaconazole for 3-6 months
*Decrease immunosuppression

[[Category:Head and neck infections]]

Latest revision as of 00:32, 16 August 2020

Background

Microbiology

Risk Factors

Clinical Manifestations

  • Difficult to distinguish from acute bacterial sinusitis
  • Edema and paresthesias are common
  • NP scope normal in ~30%; black eschar in 50%

Management

  • CT for extrasinus invasion
    • MRI is more sensitive
  • Debridement
  • Lipsomal amphotericin B 5 mg/kg
    • Every day of delay increases mortality
    • 3 week induction, then switch to posaconazole or isuvaconazole for 3-6 months
  • Decrease immunosuppression