Invasive Sphenoidal Aspergillosis: Successful Treatment with Sphenoidotomy and Voriconazole

Yoon

Clin Exp Otorhinolaryngol

et al. 2014

ObjectiveThis study was conducted to present the clinical outcome of invasive fungal sinusitis of the sphenoid sinus and to analyze clinical factors influencing patient survival.MethodsA retrospective review of 12 cases of invasive fungal sphenoiditis was conducted.ResultsCases were divided into acute fulminant invasive fungal spheonoidits (n=4) and chronic invasive fungal sphenoiditis (n=8). The most common underlying disease was diabetes mellitus (n=9). The most common presenting symptoms and signs included visual disturbance (100%). Intracranial extension was observed in 8 patients. Endoscopic debridement and intravenous antifungals were given to all patients. Fatal aneurysmal rupture of the internal carotid artery occurred suddenly in two patients. The mortality rate was 100% for patients with acute fulminant invasive fungal sphenoiditis and 25% for patients with chronic invasive fungal sphenoiditis. In survival analysis, intracranial extension was evaluated as a statistically significant factor (P=0.027).ConclusionThe survival rate of chronic invasive fungal sphenoiditis was 75%. However, the prognosis of acute fulminant invasive fungal sphenoiditis was extremely poor despite the application of aggressive treatment, thus, a high index of suspicion should be required and new diagnostic markers need to be developed for early diagnosis of invasive fungal sinusitis of the sphenoid sinus.

Section: Discussionsupporting

confidence: 74%

“…The typical symptoms of IFS of the sphenoid sinus are prolonged diffuse headache and rhinorrhea, followed by sudden visual disturbance or ocular motion impairment resulting from orbital apex syndrome or cavernous sinus syndrome [11]. In our study, the most common associated symptoms and signs were visual disturbance and headache.…”

Section: Discussionmentioning

confidence: 56%

Invasive Fungal Sinusitis of the Sphenoid Sinus

Yoon

Clin Exp Otorhinolaryngol

et al. 2014

An International Journal Clinical Rhinology

“…A treatment of 6 to 12 months is being advocated in skull base aspergillosis these days. 16,17 There were significantly increased number of adverse nephrotoxic and cardiotoxic events in patients on amphotericin as compared to voriconazole in this series. Though 3 patients developed skin rashes on voriconazole, they were transient and did not hamper the administration of voriconazole to the patients and disappeared after the stopping of the drug.…”

Section: Discussionmentioning

confidence: 67%

“…15 The optimum duration of antifungal drug administration for chronic invasive fungal sinusitis is controversial and reports vary widely, depending on the severity of the disease and institution from 2 months to more than 15 months. [16][17][18] In a review by Webb and Vikram on chronic invasive sinus aspergillosis in immunocompetent hosts, they found that treatment failure and mortality were not associated with degree of surgical intervention. But patients receiving azoles with activity against aspergillosis (i.e.…”

Section: Discussionmentioning

confidence: 99%

Should Voriconazole be the Primary Therapy for Chronic Invasive Sinus Aspergillosis (CISA)?

2011

Introduction Invasive sinus aspergillosis infection has been reported with increasing frequency in the last decade, especially, in immunocompromised patients with chronic invasive sinus aspergillosis (CISA). The gold standard for treatment has been wide surgical debridement, intravenous administration of antifungal agents, such as amphotericin B, but the prognosis remains poor. Newer antifungal agents are being tried but no standard treatment option with new antifungal agents has yet been established for chronic invasive fungal sinusitis. Therefore, we undertook this study to evaluate the efficacy of voriconazole in patients of chronic invasive sinus aspergillosis. Materials and methods This study is a prospective randomized unblinded study with primary aim of evaluating the feasibility and effectivity of voriconazole in patients of chronic invasive sinus aspergillosis with intraorbital or intracranial extension, and secondarily to compare voriconazole with amphotericin B therapy in patients with chronic invasive sinus aspergillosis. Observations and results Thirty-three patients who fulfilled the eligibility criteria were included in this study. There were 18 patients enrolled in group I who received amphotericin therapy and 15 patients in group II who received voriconazole therapy. Out of 33 patients, 9 patients had complete response, 10 had partial response, in eight patients disease became stable and there were seven failures. Overall 50% patients had a successful outcome in group I, whereas 60% had a successful outcome in group II receiving oral voriconazole. On comparing only in extradural group, 5/10 had a successful outcome in group I receiving amphotericin B, whereas 8/12 (66.7%) had a successful outcome in group 2 receiving voriconazole. There was significant difference between adverse reactions of the two drugs, with amphotericin B having a significant renal and cardiotoxicity as compared to voriconazole; though patients on voriconazole developed skin rashes which were transient and disappeared on completion of the therapy. Conclusion The present series demonstrates that oral voriconazole can be the primary line of therapy in chronic invasive sinus aspergillosis in carefully monitored immunocompetent cases. Multicentric, randomized studies are required to define disease definition, duration and successful outcome.

An International Journal Clinical Rhinology

“…17 The optimum duration of antifungal drug administration for chronic invasive fungal sinusitis is controversial and reports very widely depending on the severity of the disease and institution from 2 months to more than 15 months. [49][50][51] In a review by Webb and Vikram on chronic invasive sinus aspergillosis in immunocompetent hosts, they found that treatment failure and mortality were not associated with degree of surgical intervention. But patients receiving azoles with activity against aspergillosis (i.e.…”

Section: Aijcrmentioning

confidence: 99%

Invasive Fungal Sinusitis

Lnu¹,

Gupta²

2012

Invasive sinus Aspergillus infection has been reported in the last decade with increased frequency, most commonly in the setting of hematologic malignancy, neutropenia, HIV infection and other states of immunosuppression. Fungal rhinosinusitis can be broadly classified into two varieties-invasive and noninvasive on the basis of tissue invasion. Invasive fungal sinusitis are acute invasive, chronic invasive (both granulomatous and nongranulomatous forms), whereas noninvasive are fungus balls and allergic fungal sinusitis. Invasive fungal sinusitis is one of the most challenging forms of sinonasal pathology to manage, most commonly presenting in immunocompromised individuals. Chronic invasive being sinus aspergillosis (CISA) is being reported in immunocompetent patients at an increasing rate while most of these cases are being reported from the India subcontinent and middle east. Invasive fungal sinusitis is on the rise worldwide and especially in north India as it is endemic in this part of the country. It is affecting immunocompetent young and middle aged population causing a great morbidity and mortality. This entity needs to be picked up early by spreading awareness among the family physicians, internists, otolaryngologists, ophthalmologists, neurosurgeons, pulmonary physicians, critical care specialists so that an early management can initiated to achieve better control over the disease. This review is an attempt to initiate an interdisciplinary approach to achieve a better outcome.