Primary and secondary fungal infections of the paranasal sinuses: clinical features and treatment outcomes.

Doo Hee Han, Soo-Youn An, Si Whan Kim, Dong-Young Kim, Chae-Seo Rhee, Chul Hee Lee, Yang-Gi Min
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引用次数: 19

Abstract

Conclusion: In a retrospective study of 239 cases of fungal sinusitis, noninvasive paranasal sinus aspergillosis was most common and successfully treated by endoscopic sinus surgery (ESS) with postoperative sinus irrigation. For the treatment of fungal sinusitis, ESS with or without antifungal agents and control of predisposing factors for secondary cases are recommended.

Objective: The aim of this study was to investigate the clinical characteristics of fungal sinusitis and evaluate the treatment outcomes of primary and secondary fungal infections of the paranasal sinuses.

Materials and methods: Two hundred thirty-nine cases of fungal infection of the paranasal sinuses seen between January 1997 and December 2006 were retrospectively analyzed by reviewing their medical records. There were 200 cases of primary fungal infection and 39 cases of secondary fungal infection.

Results: The symptoms of chronic rhinosinusitis such as nasal obstruction, purulent rhinorrhea, and postnasal drip were commonly present in both primary and secondary infections, and the sphenoid sinus was commonly involved in secondary infection. The radiological findings in fungal sinusitis included haziness, calcification, and bone destruction of the involved sinuses. CT scans in 80% of the primary and 69% of the secondary cases revealed calcific densities in a paranasal soft tissue mass. Twenty-eight of 38 cases which had MR showed decreased signal intensities on T1-weighted images and markedly reduced signal intensities surrounded by bright signal on T2-weighted images. In secondary cases, the most common concomitant disease was diabetes mellitus. All patients received surgery including biopsy, ESS, and Caldwell-Luc's operation. Mucosal hypertrophy with fungus ball, which was the most common finding in both types, was found in 124 cases (62%) with primary and in 26 cases (67%) with secondary cases, and aspergillosis was most common, followed by unidentifiable colony, and mucormycosis. Eleven cases received amphotericin-B postoperatively. Two hundred thirty-eight cases showed no recurrence during the mean follow-up period of 11 months.

鼻窦的原发性和继发性真菌感染:临床特征和治疗结果。
结论:对239例真菌性鼻窦炎进行回顾性研究,发现非侵入性鼻窦曲霉病最常见,并通过内镜鼻窦手术(ESS)和术后鼻窦冲洗成功治疗。对于真菌性鼻窦炎的治疗,建议联合或不联合抗真菌药物和控制继发性病例的易感因素。目的:探讨真菌性鼻窦炎的临床特点,评价鼻窦原发性和继发性真菌感染的治疗效果。材料与方法:回顾性分析1997年1月至2006年12月收治的239例鼻窦真菌感染病例。原发真菌感染200例,继发真菌感染39例。结果:原发性和继发性感染均以鼻塞、脓性鼻漏、鼻后滴涕等慢性鼻窦炎症状为主,且继发性感染多以蝶窦为主。真菌性鼻窦炎的影像学表现包括受累鼻窦模糊、钙化和骨破坏。在80%的原发性病例和69%的继发性病例中,CT扫描显示鼻旁软组织肿块有钙化密度。38例MR中有28例在t1加权图像上信号强度降低,在t2加权图像上信号强度明显降低,周围有亮信号。在继发性病例中,最常见的伴随疾病是糖尿病。所有患者均接受手术,包括活检、ESS和Caldwell-Luc手术。两种类型中最常见的粘膜肥大伴真菌球,124例(62%)为原发病例,26例(67%)为继发病例,最常见的是曲霉病,其次是无法识别的菌落和毛霉病。11例患者术后接受两性霉素b治疗。238例患者平均随访11个月无复发。
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