Panda N K, Balaji P, Chakrabarti A, Sharma S C, Reddy C E E
Department of Otolaryngology, Postgraduate Institute of Medical Education and Research, Changigarh, India.
Mycoses. 2004 Aug;47(7):277-83. doi: 10.1111/j.1439-0507.2004.00986.x.
A prospective study was conducted in 25 consecutive patients of paranasal sinus aspergillosis to categorize and treat them based on a fixed treatment protocol. The three types of aspergillosis categorized as per definitive criteria were chronic invasive (six), non-invasive (fungus ball) (seven) and non-invasive destructive (12). Adjuvant chemotherapy was employed in non-invasive destructive and chronic invasive disease. Ketoconazole was used in the first variety and itroconazole in the latter. Only two patients had recurrence after a mean follow-up of 11 months (range: 6-20 months). They belonged to the non-invasive destructive category and the recurrence had progressed to invasive variety. It is suggested that non-invasive destructive disease should be followed up regularly with endoscopic examination, CT and fungal serology to detect recurrence. Categorization of the paranasal sinus aspergillosis helps to institute proper treatment. Adjuvant chemotherapy in the form of ketoconazole along with surgery is effective in non-invasive destructive disease to prevent recurrence and progression to invasive disease. Chronic invasive disease with its propensity to involve orbit and intracranial cavity should be managed at the earliest with surgery and itraconazole.
对25例连续性鼻旁窦曲霉菌病患者进行了一项前瞻性研究，以便根据固定的治疗方案对他们进行分类和治疗。根据明确标准分类的三种曲霉菌病类型为慢性侵袭性（6例）、非侵袭性（真菌球）（7例）和非侵袭性破坏性（12例）。非侵袭性破坏性和慢性侵袭性疾病采用辅助化疗。酮康唑用于第一种类型，伊曲康唑用于后一种类型。平均随访11个月（范围：6 - 20个月）后，只有2例患者复发。他们属于非侵袭性破坏性类型，且复发已进展为侵袭性类型。建议对非侵袭性破坏性疾病进行定期内镜检查、CT和真菌血清学随访，以检测复发情况。鼻旁窦曲霉菌病的分类有助于制定恰当的治疗方案。酮康唑形式的辅助化疗联合手术对非侵袭性破坏性疾病有效，可预防复发和进展为侵袭性疾病。慢性侵袭性疾病有累及眼眶和颅内腔的倾向，应尽早通过手术和伊曲康唑进行治疗。
