Postgraduate institute management protocol for invasive Aspergillus flavus sinusitis: is it effective?

Abstract

To analyze the results of a postgraduate institute management protocol for invasive Aspergillus flavus sinusitis. This was a prospective study wherein all patients with a final histopathological diagnosis of invasive sino-orbital aspergillosis were included for the period between January 1998 and December 2005. All the patients were negative for HIV, diabetes, and chronic granulomatous disease. All patients were evaluated clinically, biochemically, and radiologically for the condition, and were classified into four groups on the basis of clinical and radiological findings. All patients were subjected to endonasal endoscopic biopsy and were subjected as per the management protocol. These patients were then followed up clinically, endoscopically, and radiologically for a period ranging from 9 months to 7 years. A total of 74 patients were enrolled in the study, 52 males and 22 females, ranging in age from 26 to 53 years. The most common sign was proptosis. The patients in each group were subjected to the treatment protocol decided for the group. Overall, residual disease was seen in 14 patients (18.9%) and recurrence was seen in six patients (8.1%). Twenty-four (32.4%) patients died of the disease in our series. Residual disease and recurrent disease were seen more often in the advanced cases. Invasive sino-orbital aspergillosis is associated with significant mortality. By following our management protocol we were able to reduce the mortality to 32.4% in our series.