Invasive fungal sinusitis
From IDWiki
Microbiology
- Mucorales (50%)
- Aspergillus (50%)
- Fusarium (rare)
Clinical Manifestations
- 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
