Sungkanuparph S, Sathapatayavongs B, Kunachak S, Luxameechanporn T, Cheewaruangroj W
Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
J Med Assoc Thai. 2001 Apr;84(4):593-601.
Invasive fungal sinusitis increasingly causes significant morbidity and mortality in immunocompromised patients. It is difficult to treat. Despite standard treatment by surgical debridement and intravenous amphotericin B, morbidity and mortality remain high. Conventional amphotericin B is the standard drug but its use is limited by dose-related nephrotoxicity and infusion-related acute toxicity. Liposomal amphotericin B has proven to be as effective as conventional amphotericin B with less nephrotoxicity and infusion reaction. We report four cases of invasive fungal sinusitis who were treated with liposomal amphotericin B after having severe side effects from conventional amphotericin B. There were two cases of mucormycosis and two cases of aspergillosis. All patients had diabetes millitus. One patient had systemic lupus erythematosus and another was receiving immunosuppressive drugs after kidney transplantation. All cases needed multiple operations for sinus surgery. Two cases had acute reaction to amphotericin B infusion, one had active lupus nephritis with renal insufficiency, and one was considered treatment failure from amphotericin B. The patients received liposomal amphotericin B at the total doses of 4.55-8.85 g. Two cases of mucormycosis were considered to be successfully treated. In cases of aspergillosis, one was considered improved and another one with immunocompromised status died with active disease. From our experience, surgery is the main treatment for patients with invasive fungal sinusitis and liposomal amphotericin B is an effective alternative drug for adjuvant medical treatment. However, the degree of immunosuppression of the patients, the extension of fungal sinusitis and perhaps the species of fungus are important factors determining the clinical response.
侵袭性真菌性鼻窦炎在免疫功能低下患者中导致的发病率和死亡率日益增加。该病难以治疗。尽管采用手术清创和静脉注射两性霉素B进行标准治疗，但发病率和死亡率仍然很高。传统的两性霉素B是标准药物，但其使用受到剂量相关肾毒性和输液相关急性毒性的限制。脂质体两性霉素B已被证明与传统两性霉素B疗效相当，但肾毒性和输液反应较小。我们报告了4例侵袭性真菌性鼻窦炎患者，他们在因传统两性霉素B出现严重副作用后接受了脂质体两性霉素B治疗。其中2例为毛霉病，2例为曲霉病。所有患者均患有糖尿病。1例患者患有系统性红斑狼疮，另1例在肾移植后接受免疫抑制药物治疗。所有病例均需要多次进行鼻窦手术。2例患者对两性霉素B输液有急性反应，1例患有活动性狼疮性肾炎并伴有肾功能不全，1例被认为是两性霉素B治疗失败。患者接受的脂质体两性霉素B总剂量为4.55 - 8.85 g。2例毛霉病患者被认为治疗成功。在曲霉病病例中，1例被认为病情有所改善，另1例免疫功能低下患者在疾病活动期死亡。根据我们的经验，手术是侵袭性真菌性鼻窦炎患者的主要治疗方法，脂质体两性霉素B是辅助药物治疗的有效替代药物。然而，患者的免疫抑制程度、真菌性鼻窦炎的范围以及可能的真菌种类是决定临床反应的重要因素。
