Invasive fungal sinusitis: Difference between revisions
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==Background== |
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===Microbiology=== |
===Microbiology=== |
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*[[Aspergillus]] |
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*[[Zygomycetes]]: [[Mucor]], [[Rhizopus]] |
*[[Zygomycetes]]: [[Mucor]], [[Rhizopus]] |
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*[[Fusarium]] |
*[[Fusarium]] |
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**Allergic fungal sinusitis: [[Aspergillus]], [[Bipolaris]], [[Curvularia]], [[Dreschlera]] |
**Allergic fungal sinusitis: [[Aspergillus]], [[Bipolaris]], [[Curvularia]], [[Dreschlera]] |
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===Risk Factors=== |
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*Immunocompromise, including [[solid organ transplantation]] and [[hematopoietic stem cell transplantation]] |
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*[[Diabetes mellitus]] |
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==Clinical Manifestations== |
==Clinical Manifestations== |
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Latest revision as of 00:32, 16 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
