title: Current therapeutic protocols for chronic granulomatous fungal sinusitis.
abstract: The treatment of chronic granulomatous fungal sinusitis (CGFS), a rare form of invasive fungal sinusitis, is controversial.
  
  
  
  To assess the response to postoperative antifungal therapy in patients with CGFS and suggest an effective treatment protocol.
  
  
  
  Clinical records of patients with CGFS who had undergone excisive surgery followed by antifungal therapy were reviewed to assess current disease status.
  
  
  
  Fourteen male and 4 female patients were diagnosed with CGFS, based on typical histopathological and fungal smear/ culture results. Aspergillus flavus was isolated from 88.9% cases. Stage 1 patients had resectable sinonasal disease, stage 2 had additional spread to orbit/palate and stage 3 had extensive disease. Follow-up ranged from 6 months to 8 years. Residual disease was seen in all but one patient who received amphotericin B as first line therapy and in none of those who received itraconazole or voriconazole. Even those who received azoles as second line therapy were disease free at last follow-up.
  
  
  
  Surgery followed by itraconazole or voriconazole for Stage 1 and 2 disease and voriconazole for stage 3 disease is recommended for a good outcome. Amphotericin B is not recommended as first line therapy for CGFS.
authors.forename: V
authors.initials: V
authors.lastname: Rupa
authors.forename: S
authors.initials: S
authors.lastname: Maheswaran
authors.forename: J
authors.initials: J
authors.lastname: Ebenezer
authors.forename: S S
authors.initials: SS
authors.lastname: Mathews
mesh_terms: D000328:Adult; D000368:Aged; D000666:Amphotericin B / Q000627:therapeutic use; D000935:Antifungal Agents / Q000627:therapeutic use*; D002908:Chronic Disease; D003131:Combined Modality Therapy; D005260:Female; D006099:Granuloma / Q000188:drug therapy* / Q000382:microbiology* / Q000601:surgery; D006801:Humans; D017964:Itraconazole / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D009181:Mycoses / Q000188:drug therapy* / Q000382:microbiology* / Q000601:surgery; D012852:Sinusitis / Q000188:drug therapy* / Q000382:microbiology* / Q000601:surgery; D016896:Treatment Outcome; D065819:Voriconazole / Q000627:therapeutic use
chemical_list: D000935:Antifungal Agents; D017964:Itraconazole; D000666:Amphotericin B; D065819:Voriconazole