Paranasal sinus mycoses in north India
Paranasal sinus mycoses in north India
复制标题
印度北部的鼻旁窦真菌病
DOI：
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发表时间：
1998
期刊：
影响因子：
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通讯作者：
S. Mann
中科院分区：
文献类型：
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作者：
N. Panda;Suresh C. Sharma;A. Chakrabartu;S. Mann
总结。认识到鼻窦真菌病在印度北部的高发病率，我们回顾性分析178例确诊疾病患者的临床、真菌学和治疗方面的资料。根据临床、放射学、组织病理学和真菌学检查结果，将患者分为过敏性(8)、非侵袭性（92）和侵袭性（78）。在16例非侵袭性疾病患者中观察到无真菌侵袭的骨侵蚀。农村地区的年轻男性最常受影响。鼻息肉（45.8%）和鼻突出（46.4%）是最常见的表现。上颌窦和筛窦同时受累在这些患者中很常见，而孤立的蝶窦和额窦仅在侵袭性病变中受累。眼眶和颅内扩张分别在100%和13.2%的侵袭型疾病患者中被检测到。黄曲霉（79.7%）是最常见的分离物。手术清创和鼻窦通气足以有效地治疗非侵入性疾病。然而，辅助药物治疗包括半侵袭性和侵袭性疾病的治疗。发现伊曲康唑对预防侵袭型复发最有用。接合菌感染患者死亡率最高（33.3%）。侵袭性真菌性肉芽肿与非侵袭性真菌性鼻窦炎相比，其临床病程和治疗方法都不同，需要手术切除和术后伊曲康唑的积极治疗。
Summary. Recognizing the high incidence of paranasal sinus mycoses in north India, we analysed retrospectively the clinical, mycological and management aspects of 178 patients with proven disease attending our institute. On the basis of clinical, radiological, histopathological and mycological findings, the patients could be categorized into those with allergic (8), non‐invasive (92) and invasive (78) disease types. Bony erosion without mucosal invasion by fungi was seen in 16 patients with non‐invasive disease. Young men from rural areas were the most commonly affected. Rhinorrhoea with nasal polyposis (45.8%) and proptosis (46.4%) was the most common presentation. Concurrent involvement of the maxillary and ethmoid sinuses was common in these patients, whereas isolated sphenoid and frontal sinuses were involved in the invasive variety only. Orbital and intracranial extensions were detected in 100% and 13.2%, respectively, of patients with the invasive type of disease. Aspergillus flavus (79.7%) was the most common isolate. Surgical debridement and sinus ventilation were adequate for the effective management of the non‐invasive disease. However, adjuvant medical therapy was included in treatment of the semi‐invasive and invasive varieties of the disease. Itraconazole was found to be most useful in prevention of recurrence in the invasive type. Mortality was highest (33.3%) among patients with zygomycotic infection. Invasive fungal granuloma with orbital and intracranial invasion is a distinct entity in terms of its clinical course and treatment compared with non‐invasive fungal sinusitis, and it needs to be treated aggressively with surgical excision and postoperative itraconazole.