真菌性鼻窦炎（ X页）.ppt

Allergic Fungal Sinusitis Allergy to Fungi Most patient with AFS will have allergy to fungus causing disease Manning et al Prospective study Compared 8 patients with AFS and (+)culture with Bipolaris 10 controls with chronic rhinosinusitis All 8 patients showed (+) skin testing, RAST, and ELISA to Bipolaris 8 of 10 controls (-) for all tests IgE levels 1000 IU/mL Allergic Fungal Sinusitis Treatment Surgical Remove all mucin Provide permanent drainage and ventilation of affected sinuses Systemic +/- topical steroids Systemic steroids decrease rate of recurrence Course can range from 2-12 months Schubert showed that longer courses had better results, but more side effects 0.5mg/kg Prednisone starting dose and taper over 2-3 months Allergic Fungal Sinusitis Immunotherapy Decrease recurrence Alleviate need for steroids Prospective review All patients had surgery and systemic steroids One group got immunotherapy, the other did not Consisted of fungal and non-fungal antigens to which patients were sensitive After 1 year: No requirement for systemic or topical steroids by patients in immunotherapy group Recurrence of disease significantly less in immunotherapy group Allergic Fungal Sinusitis Immunotherapy Folker et al Retrospective study Compared 11 patients who received immunotherapy post-operatively vs. 11 who did not Recurrence rates did NOT decrease However: Quality of life scores and mucosal edema were much better in those who received immunotherapy Acute Fulminant Invasive Fungal Sinusitis Patient population Most often compromised immune system DM, AIDS, hematologic malignancies, organ transplant, iatrogenic (chemotherapy and steroids) Most common fungi Aspergillus Mucormycosis Mucor, Rhizopus, Absidia Less common fungi Candida Bipolaris Fusarium Acute Fulminant Invasive Fungal Sinusitis Pathogenesis Spores inhaled ? fungus grows in warm, humid sinonasal cavity Fungi invade neural and vascular structures with thrombosis of feeding vessels Necrosis and loss o