Management & Treatment of Invasive Fungal Sinusitis

Invasive fungal sinusitis is an opportunistic infection by aspergilosis and mucoracae, but mucoracae is more common than aspergilosis. Mucormycosis is an acute opportunistic fungal infection mostly seen with an underlying disease. It has different clinical presentations such as rhinocerebral and orbital involvement, which are very aggressive and with high mortality rate. There is no obvious protocol for treatment of invasive fungal sinustis. Due to having lots of these patients it was decided to write a protocol for management and treatment. Patients & In this retrospective case series study, 21 patients who directly came or referred to this center were studied. As soon as taking a biopsy and after documentation and confirmation of pathology proper protocol was selected. The most common site of involvement is nasal and orbit(52.4%) and then involvement of nasal cavity orbit and brain(38.1%) and involvement of nasal cavity alone(9.5%). There were 14 male(66.7%) & 7 female(33.3%). Out of these patients 19 had underlying disease including diabetes(10 cases), diabetes & renal failure(4 cases), ALL(2), end stage renal failure(1 case), SLE with ESRD(1 case) and CML in one case. Twelve patients were alive and 9 patients died. Those with nasal involvement alone were all alive. Of patients with sinonasal involvement only one patient died and those with sinonasal and brain involvement were dead. Treatment consists of early diagnosis, treatment of the underlying disease, debridement and medical therapy. Surgical protocol based on extension of disease consists of 3 groups: A: Surgical management in patients with sinonasal involvement is complete debridment of nasal and sinus. B: In patients with orbit involvement orbital exenteration is added. C: With involvement of brain, prognosis is poor and surgical and medical therapy can not affect the survival.