Invasive fungal sinusitis: Difference between revisions

Latest revision as of 20:32, 15 August 2020

Background

Microbiology

Aspergillus
Zygomycetes: Mucor, Rhizopus
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

Immunocompromise, including solid organ transplantation and hematopoietic stem cell transplantation
Diabetes mellitus

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

@@ Line 1: / Line 1: @@
+==Background==
-= Microbiology =
+===Microbiology===
-* Mucorales (50%)
-* Aspergillus (50%)
-* Fusarium (rare)
+*[[Aspergillus]]
-= Clinical Presentation =
+*[[Zygomycetes]]: [[Mucor]], [[Rhizopus]]
+*[[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===
-* Difficult to distinguish from bacteria
-* Risk factors: DM, solid organ transplant, hematologic transplant
-* Edema and paresthesias are common
-* NP scope normal in ~30%; black eschar in 50%
+*Immunocompromise, including [[solid organ transplantation]] and [[hematopoietic stem cell transplantation]]
-= Management =
+*[[Diabetes mellitus]]
+==Clinical Manifestations==
-* CT for extrasinus invasion
-** MRI is more sensitive
+*Difficult to distinguish from [[acute bacterial sinusitis]]
-* Debridement
+*Edema and paresthesias are common
-* Lipsomal amphotericin B 5 mg/kg
+*NP scope normal in ~30%; black eschar in 50%
-** Every day of delay increases mortality
-** 3 week induction, then switch to posaconazole or isuvaconazole for 3-6 months
+==Management==
-* Decrease immunosuppression
+*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
 [[Category:Head and neck infections]]