Netkovski J, Shirgoska B
University Ear, Nose and Throat Clinic, Medical Faculty, Ss. Cyril and Methodius University, Skopje, R. Macedonia.
Prilozi. 2012;33(1):187-97.
Fungi are a major part of the ecosystem. In fact, over 250 fungal species have been reported to produce human infections. More than ever, fungal diseases have emerged as major challenges for physicians and clinical microbiologists. The aim of this study was to summarize the diagnostic procedures and endoscopic surgical treatment of patients with fungal rhinosinusitis. Eleven patients, i.e. 10% of all cases with chronic inflammation of paranasal sinuses, were diagnosed with fungal rhinosinusitis. Ten of them were patients with a noninvasive form, fungus ball, while only one patient was classified in the group of chronic invasive fungal rhinosinusitis which was accompanied with diabetes mellitus. All patients underwent nasal endoscopic examination, skin allergy test and had preoperative computed tomography (CT) scans of the sinuses in axial and coronal plane. Functional endoscopic sinus surgery was performed in 10 patients with fungus ball, while a combined approach, endoscopic and external, was done in the immunocompromised patient with the chronic invasive form of fungal rhinosinusitis. Most cases (9/11) had unilateral infection. In 9 cases infection was restricted to a single sinus, and here the maxillary sinus was most commonly affected (8/9) with infections in other patients being restricted to the sphenoid sinus (1/9). Two patients had infections affecting two or more sinuses. In patients with an invasive form of the fungal disease there was involvement of the periorbital and orbital tissues. In patients with fungus ball the mycelia masses were completely removed from the sinus cavities. Long-term outcome was positive in all the operated patients and no recurrence was detected. The most frequent fungal agent that caused rhinosinusitis was Aspergillus. Mucor was identified in the patient with the invasive form. Endoscopic examination of the nasal cavity and CT scanning of paranasal sinuses followed by endoscopic sinus surgery were represented as valuable diagnostic and therapeutic procedures for fungal rhinosinusitis.
真菌是生态系统的重要组成部分。事实上，已有超过250种真菌被报道可引发人类感染。真菌疾病比以往任何时候都更成为医生和临床微生物学家面临的重大挑战。本研究的目的是总结真菌性鼻窦炎患者的诊断程序和内镜手术治疗情况。11例患者，即所有慢性鼻窦炎病例的10%，被诊断为真菌性鼻窦炎。其中10例为非侵袭性真菌球型，而仅有1例患者被归类为伴有糖尿病的慢性侵袭性真菌性鼻窦炎组。所有患者均接受了鼻内镜检查、皮肤过敏试验，并进行了鼻窦轴位和冠状位的术前计算机断层扫描（CT）。10例真菌球型患者接受了功能性内镜鼻窦手术，而1例患有慢性侵袭性真菌性鼻窦炎的免疫功能低下患者则采用了内镜和外部联合手术方法。大多数病例（9/11）为单侧感染。9例感染局限于单个鼻窦，其中上颌窦最常受累（8/9），其他患者的感染局限于蝶窦（1/9）。2例患者的感染累及两个或更多鼻窦。侵袭性真菌病患者伴有眶周和眼眶组织受累。真菌球型患者的鼻窦腔内菌丝团被完全清除。所有手术患者的长期预后良好，未发现复发。引起鼻窦炎最常见的真菌病原体是曲霉菌。在侵袭性病例的患者中鉴定出毛霉菌。鼻腔内镜检查和鼻窦CT扫描，随后进行内镜鼻窦手术，被认为是真菌性鼻窦炎有价值的诊断和治疗方法。
