Castillo L, Roger P M, Haddad A, Meyer J M, Santini J, Demard F
Service d'ORL et de Chirurgie de la Face et du Cou, Hôpital Pasteur Nice.
Ann Otolaryngol Chir Cervicofac. 1999 Jun;116(3):162-6.
Chronic sinus pathology is a frequently encountered disease in HIV infected patients. The responsible bacterial agents and management are yet to be settled. The authors report the results of a retrospective study led in the unit of Head and Neck Surgery of the University Hospital of Nice. 25 patients where HIV holders and had a sinus pathology which had lasted more than 6 weeks, despite one or several antimicrobial drug administrations. Clinical and CT scan data are detailed as well as pathology results of the samples harvested during sinus surgery (bacteria free 32%, Pseudomonas aeruginosa 32%, Streptococcus pneumoniae 16%, Staphylococcus aureus 16%, Hemophilus influenzae 16%, anaerobic agents 16% and Toxoplasma gondii 4%). All patients underwent surgery (antral puncture with maxillary sinus drainage 17, functional endoscopic sinus surgery 8). Results where gathered at 4 months with 76% of relapse (100% in patients with less than 200/mm3 CD4 cells). In conclusion empiric antimicrobial drug therapy will be expected to be also effective on Pseudomonas aeruginosa, the surgical management being most often deceiving and leading to relapse especially when considering the frequency of bilateral morbidity and the level of CD4 cell below 200/mm3.
慢性鼻窦病变是HIV感染患者中常见的疾病。其致病细菌及治疗方法尚未确定。作者报告了在尼斯大学医院头颈外科进行的一项回顾性研究结果。25名HIV感染者患有鼻窦病变，尽管接受了一种或几种抗菌药物治疗，但病程仍超过6周。详细介绍了临床和CT扫描数据以及鼻窦手术中采集样本的病理结果（无菌32%，铜绿假单胞菌32%，肺炎链球菌16%，金黄色葡萄球菌16%，流感嗜血杆菌16%，厌氧菌16%，弓形虫4%）。所有患者均接受了手术（上颌窦穿刺引流17例，功能性鼻内镜鼻窦手术8例）。4个月时收集结果，复发率为76%（CD4细胞低于200/mm³的患者复发率为100%）。总之，经验性抗菌药物治疗预计对铜绿假单胞菌也有效，手术治疗往往效果不佳并导致复发，尤其是考虑到双侧发病的频率以及CD4细胞水平低于200/mm³时。
