Invasive fungal sinusitis: Difference between revisions
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= Invasive fungal sinusitis = |
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* Mucorales (50%) |
* Mucorales (50%) |
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* Fusarium (rare) |
* Fusarium (rare) |
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= Clinical Presentation = |
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* Difficult to distinguish from bacteria |
* Difficult to distinguish from bacteria |
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* NP scope normal in ~30%; black eschar in 50% |
* NP scope normal in ~30%; black eschar in 50% |
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= Management = |
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* CT for extrasinus invasion |
* CT for extrasinus invasion |
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** 3 week induction, then switch to posaconazole or isuvaconazole for 3-6 months |
** 3 week induction, then switch to posaconazole or isuvaconazole for 3-6 months |
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* Decrease immunosuppression |
* Decrease immunosuppression |
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[[Category:Head and neck infections]] |
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Revision as of 01:08, 15 August 2019
Microbiology
- Mucorales (50%)
- Aspergillus (50%)
- Fusarium (rare)
Clinical Presentation
- 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%
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
