Rowe-Jones J M, Freedman A R
Department of Otolaryngology, St. George's Hospital, London, United Kingdom.
Rhinology. 1994 Dec;32(4):203-7.
Paranasal aspergillosis is a potentially progressive continuum of disease, classically described as having four forms: allergic, non-invasive, invasive, and fulminant. The first two have been considered together as extramucosal disease whilst the latter two are both variants of tissue-invasive disease. Sphenoid aspergillosis, given its anatomical location is a more aggressive disease than that found affecting the other paranasal sinuses, even when non-invasive, and may be fatal. This is compounded by the fact that diagnosis is difficult and so may be made late when aspergillosis is consequently more advanced. Intracranial extension may occur via the direct spread of invasive disease or along communicating veins despite intact sinus walls and lack of fungal mucosal penetration. Once this occurs mortality is high. We have successfully treated three cases of destructive sphenoid aspergillosis, two of which had intracranial extension, with surgery and adjuvant anti-fungal chemotherapy including itraconazole. We recommend the use of post-operative itraconazole in all cases of sphenoid sinus aspergillosis. Additionally, when there is evidence of spread to the brain or other adjacent structures we would advocate an initial course of intravenous amphotericin B followed by long-term oral itraconazole.
鼻旁曲霉病是一种具有潜在进展性的连续疾病，传统上分为四种类型：变应性、非侵袭性、侵袭性和暴发性。前两种类型被视为黏膜外疾病，而后两种类型都是组织侵袭性疾病的变体。鉴于蝶窦曲霉病的解剖位置，即使是非侵袭性的，它也是一种比其他鼻旁窦曲霉病更具侵袭性的疾病，可能会致命。诊断困难这一事实使情况更加复杂，因此当曲霉病病情更严重时，诊断可能会延迟。尽管鼻窦壁完整且真菌未穿透黏膜，但侵袭性疾病仍可能通过直接蔓延或沿交通静脉发生颅内扩展。一旦发生这种情况，死亡率很高。我们成功地治疗了三例破坏性蝶窦曲霉病，其中两例有颅内扩展，采用了手术和包括伊曲康唑在内的辅助抗真菌化疗。我们建议对所有蝶窦曲霉病病例术后使用伊曲康唑。此外，当有扩散至脑部或其他相邻结构的证据时，我们主张先静脉注射两性霉素B，然后长期口服伊曲康唑。
