Rupa Vedantam, Peter Jayanthi, Michael Joy Sarojini, Thomas Meera, Irodi Aparna, Rajshekhar Vedantam
Department of Otorhinolaryngology, Christian Medical College Hospital, Vellore, India.
Department of Ophthalmology, Christian Medical College Hospital, Vellore, India.
Otolaryngol Head Neck Surg. 2023 Apr;168(4):669-680. doi: 10.1177/01945998221097006. Epub 2023 Feb 5.
We aimed to study the literature on chronic granulomatous invasive fungal sinusitis to elucidate the changing trends in the management of the disease.
Using specific keywords, we searched the PubMed, PubMed Central, and Scopus databases over the past 50 years, which yielded 938 articles in the English language.
Scrutiny of 147 relevant articles revealed 15 homogenous case series (255 cases of histologically proven chronic granulomatous fungal sinusitis alone) and 8 heterogeneous case series (patients with other types of fungal sinusitis included), which were analyzed in detail (all with >5 cases each).
The disease typically affected middle-aged adults with immunocompetence. Most reports were from Sudan, India, and Saudi Arabia. A slowly progressive orbital, cheek, or palatal mass with proptosis (88.2%) or sinonasal symptoms (39.2%) was typical. Ethmoid (57.2%) and maxillary (51.4%) sinuses were chiefly affected with intracranial extension in 35.1%. Aspergillus flavus (64%) was the most frequent isolate reported. Endoscopic excision (78.8%) followed by azole therapy was the preferred treatment in recent reports. Orbital exenteration and craniotomy were infrequently performed. Complete resolution or improvement was reported in 91.3% of patients. Mortality ranged from 5.9% to 22.2%. There is a trend in the literature toward less radical and disfiguring surgery and preferential use of azoles, with good outcomes even in advanced cases.
Chronic granulomatous fungal sinusitis should be diagnosed on the basis of well-defined histopathologic features. A combination of endoscopic sinus surgery and azole therapy usually yields good outcomes.
我们旨在研究关于慢性肉芽肿性侵袭性真菌性鼻窦炎的文献，以阐明该疾病治疗方法的变化趋势。
使用特定关键词，我们在过去50年里检索了PubMed、PubMed Central和Scopus数据库，共获得938篇英文文章。
仔细审查147篇相关文章后，发现15个同质病例系列（仅255例经组织学证实的慢性肉芽肿性真菌性鼻窦炎病例）和8个异质病例系列（包括其他类型真菌性鼻窦炎患者），对其进行了详细分析（每个系列均超过5例）。
该疾病通常影响具有免疫能力的中年成年人。大多数报告来自苏丹、印度和沙特阿拉伯。典型表现为缓慢进展的眼眶、面颊或腭部肿物，伴有眼球突出（88.2%）或鼻窦症状（39.2%）。筛窦（57.2%）和上颌窦（51.4%）最常受累，35.1%有颅内扩展。黄曲霉（64%）是最常报告的分离菌株。在近期报告中，首选治疗方法是内镜切除（78.8%），随后进行唑类治疗。眼眶内容物剜除术和开颅手术很少进行。91.3%的患者报告有完全缓解或改善。死亡率在5.9%至22.2%之间。文献中有减少根治性和毁容性手术、优先使用唑类药物的趋势，即使在晚期病例中也有良好疗效。
慢性肉芽肿性真菌性鼻窦炎应根据明确的组织病理学特征进行诊断。内镜鼻窦手术和唑类治疗联合应用通常能取得良好疗效。
