Invasive sinus aspergillosis in apparently immunocompetent hosts.
OBJECTIVE
to describe the clinical, microbiological and pathological features of invasive sinus aspergillosis affecting immunocompetent hosts, and to identify the risk factors for mortality.


METHODS
we report three apparently immunocompetent patients with invasive sinus aspergillosis, and review all cases reported in the English literature since 1987, the year in which the triazole antifungal agents were introduced.


RESULTS
twenty-nine patients (including three of our own) were identified. The presenting symptoms were non-specific and indistinguishable from viral, bacterial or allergic causes of sinusitis. The findings on computed tomography scan were also non-specific, and histopathology and culture of sinus tissue biopsy had low yield. These factors, along with the mistaken impression that Aspergillus can only affect immunocompromised hosts, frequently delayed the diagnosis. Fifty-nine percent of patients either failed therapy or died. The following factors were associated with a poor prognosis: delayed diagnosis, intracranial extension of infection, and histopathology demonstrating hyphal invasion of blood vessel or tissue. Complete surgical extirpation was the key element of successful therapy; antifungal agents played an adjunctive role.


CONCLUSIONS
invasive sinus aspergillosis carries high morbidity and mortality, even in immunocompetent hosts. To improve outcome, the diagnosis must be recognized early, before the organism can invade the central nervous system or vascular structures. Aggressive surgical resection of the infected areas is of utmost importance in the management of this infection.
Clancy
C J
CJ
University of Florida College of Medicine and the VA Medical Center, Gainesville 32610, USA.
Nguyen
M H
MH
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000935:Antifungal Agents / Q000627:therapeutic use; D001228:Aspergillosis / Q000188:drug therapy / Q000382:microbiology / Q000473:pathology*; D001230:Aspergillus / Q000254:growth & development / Q000302:isolation & purification*; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D007121:Immunocompetence; D008297:Male; D008875:Middle Aged; D010254:Paranasal Sinus Diseases / Q000188:drug therapy / Q000382:microbiology / Q000473:pathology*
D000935:Antifungal Agents