Department of Medicine, Baylor College of Medicinegrid.39382.33, Houston, Texas, USA.
Department of Pathology & Immunology, Baylor College of Medicinegrid.39382.33, Houston, Texas, USA.
Antimicrob Agents Chemother. 2021 Oct 18;65(11):e0169721. doi: 10.1128/AAC.01697-21. Epub 2021 Sep 7.
Environmental fungi are etiologically related to chronic rhinosinusitis (CRS) with airway mycosis, but their infectious role remains uncertain, in part because of potentially inadequate methods of disease quantitation. Our objective was to determine objective radiographic and symptomatic outcomes of oral antifungal therapy in adult patients with CRS and airway mycosis by using computer-assisted analysis. We conducted a retrospective study of 65 patients with CRS and culture-proven airway mycosis in a single-center referral-based academic practice, comparing paired sinus computed tomography (CT) scans and symptom scores prior to and during chronic oral antifungal therapy using computer-assisted analysis of sino-mucosal area (CAASMA). A comparator group received standard therapy without antifungals. Administration of antifungals was associated with significantly reduced sinus mucosal thickening as assessed by CAASMA (-6.85% absolute reduction; 95% confidence interval [CI], -11.8283 to -1.8717; < 0.005), but not by Lund-Mackay score. In contrast, standard care alone was linked by CAASMA to enhanced mucosal thickening (4.14% absolute increase; 95% CI, -1.8066 to 10.0866; < 0.005). Thirty of the 41 antifungal-treated patients (73%) showed decreased sinus mucosal burdens, while only 21 patients (43%) receiving standard therapy showed improved imaging (odds ratio [OR], 11.65; 95% CI, 3.2 to 42.2; < 0.05). Nineteen patients (50%) noted improved symptoms at the time of a follow-up CT scan, while only 8 patients (20%) on standard therapy improved (OR, 6.21; 95% CI, 1.7 to 22.7; < 0.05). These retrospective findings indicate that oral antifungals can reduce mucosal thickening and improve symptoms in CRS with airway mycosis. Randomized clinical trials are warranted to verify these findings.
环境真菌与气道真菌病的慢性鼻-鼻窦炎（CRS）有病因学关系，但它们的感染作用仍不确定，部分原因是疾病定量的方法可能不够充分。我们的目的是通过计算机辅助分析，确定口服抗真菌治疗对成人 CRS 和气道真菌病患者的客观放射学和症状结果。我们对单中心转诊的学术实践中 65 例 CRS 和培养证实的气道真菌病患者进行了回顾性研究，使用计算机辅助分析窦黏膜面积（CAASMA）比较了治疗前和治疗期间的配对鼻窦计算机断层扫描（CT）和症状评分。对照组接受标准治疗而未使用抗真菌药。抗真菌药物的使用与 CAASMA 评估的窦黏膜增厚明显减少相关（-6.85%绝对减少；95%置信区间 [CI]，-11.8283 至-1.8717；<0.005），但与 Lund-Mackay 评分无关。相比之下，仅通过 CAASMA 观察到标准治疗与黏膜增厚增加相关（4.14%绝对增加；95%CI，-1.8066 至 10.0866；<0.005）。41 例接受抗真菌治疗的患者中有 30 例（73%）窦黏膜负担减少，而仅 21 例接受标准治疗的患者（43%）影像学改善（比值比 [OR]，11.65；95%CI，3.2 至 42.2；<0.05）。19 例（50%）患者在随访 CT 扫描时注意到症状改善，而仅 8 例（20%）接受标准治疗的患者改善（OR，6.21；95%CI，1.7 至 22.7；<0.05）。这些回顾性发现表明，口服抗真菌药可减少 CRS 伴气道真菌病患者的黏膜增厚并改善症状。需要进行随机临床试验来验证这些发现。
