Invasive fungal sinusitis: an effective combined treatment in five haematological patients |
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Authors: | Vener Claudia Carrabba Maria Fracchiolla Nicola S Costa Antonella Fabio Giovanna Hu Cinzia Sina Clara Guastella Claudio Pignataro Lorenzo Deliliers Giorgio Lambertenghi |
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Affiliation: | U.O. Ematologia I, Centro Trapianti di Midollo, Università degli Studi di Milano & Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Ospedale Policlinico, Mnagiagalli e Regina Elena, Milano, Italy. |
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Abstract: | Invasive fungal rhinosinusitis (IFR) is a life-threatening infection. Its onset is subtle and a late diagnosis leads to severe complications. Death may occur within a few weeks notwithstanding treatment. We describe a comprehensive pre- and post-operative approach to care for haematological patients with IFR. Five haematological patients with IFR were treated with systemic antifungal therapy and endoscopic surgical debridement of infected tissues, followed by amphotericin-B directly instilled in the sinuses by a new type of ethmoidal drainage. The IFR remitted in all cases; after 32 months of follow-up, three patients are still alive, and two have died of other causes. Two of the patients who experienced IFR progression to the brain at the IFR onset are still alive. The pharmacological and surgical approach with the post-operative local therapy by a new ethmoidal drainage system could support radical antifungal sinus treatment, thus improving the overall survival. |
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Keywords: | Invasive fungal rhinosinusitis immunocompromised patients antifungal treatment Mucormycosis Aspergillus |
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