Invasive Fungal Sinusitis

Česká verzia

Authors: P. Čelakovský ¹; J. Vokurka ¹; J. Laco ²; I. Hybášek ¹
Authors place of work: LF UK a FN Hradec Králové Ušní, nosní a krční klinika ¹; LF UK a FN Hradec Králové Fingerlandův ústav patologie ²
Published in the journal: Cesk Slov Neurol N 2011; 74/107(2): 163-167
Category: Přehledný referát

Summary

The invasive form of fungal sinusitis is a rare disease, but it occurs commonly in immunodeficient patients. The fungi most often responsible for these infections are zygomycetes (Absidia, Mucor, and Rhizopus spp.) and Aspergillus spp. The disease is characterized by tissue destruction and rapid spread via vascular and perineural invasion. Typically affected structures are the orbit and central nervous system. The initial signs are often non-specific. The clinician must maintain a high index of suspicion when an immunocompromised patient experiences fever of unknown origin, not responding to antibiotic therapy. The later symptoms are dependent on the type and extent of destruction of the surrounding structures. The rapid spread to the orbit, soft tissue of the face and to the intracranial space, with a high mortality rate, make a prompt and appropriate diagnosis of this infection crucial. Imaging methods demonstrate the invasive process at the skull base and its extension, while histology is critical for determining the invasive form of fungal infection. The recommended treatment is aggressive surgical removal of the fungal material in combination with intravenous antifungal therapy. Especially in recent years, the disease has become worthy of far closer attention because of the increasing number of surviving haemato-oncological patients.

Key words:
invasive fungal sinusitis – intracranial and orbital complications

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