Invasive aspergillosis is commonly noted in immunocompromised patients. We noticed several cases of invasive aspergillosis of the paranasal sinuses in immunocompetent patients. A respective review identified 23 cases of aspergillosis involving the paranasal sinuses between 1991 and 1997. Duration of follow-up ranged between 1 and 103 months (mean of 30 months). All patients were cancer free, recieved no immunosuppressive therapy or steroids, had normal WBC count and differential, and were not diabetic or HIV positive. They were 14 males and nine females. Most cases came from the southwestern region of the country, 65%. The commonest symptom was nasal blockage for several months. Proptosis was noted in 70% of patients. Absence of fever was universal. On CT scan, bone erosion was noted in 14 patients. Intraorbital and intracranial extension were seen in 13 and eight patients respectively. A. flavus was the most common species isolated. Surgical drainage was performed in all patients. One patient was lost to follow-up and one patient died. Antifungal therapy was not given postoperatively to all patients. Relapse was common, 14 patients requiring several admissions average 4.3 admissions (range 2-9). Repeat surgical evacuation was required in these patients average three times (range 1-7 times). Patients who were relapse free tended to have complete surgical evacuation followed by amphotericin B. These findings emphasize the role of complete surgical evacuation and post operative amphotcricin B.
Full conference title:
36th Annual Meeting of the Infectious Diseases Society of America
- IDSA 36th