Document Detail


Combination antifungal therapy for invasive aspergillosis: can it replace high-risk surgery at the skull base?
MedLine Citation:
PMID:  18061828     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: The increasing volume of literature on Aspergillus sinus infection is confusing because different authors stress different aspects of the disease. It is generally accepted that standard therapy consists of surgical debridement and medication with systemic amphotericin B. Patients who fail the standard therapy or those who cannot tolerate amphotericin B pose a dilemma. This study attempted to address the issues concerning combination therapy in invasive aspergillosis. MATERIALS AND METHODS: We conducted a prospective randomized study on 6 apparently immunocompetent patients with invasive aspergillosis complicated by orbital and intracranial spread. All the patients were treated with a combination of amphotericin B (2.5 g) and itraconazole (6 months). They were monitored clinically and radiologically before, during, and after their combined antifungal therapy management. RESULTS: Among the 6 immunocompetent patients, orbital involvement was seen in 5, skull base erosion with intracranial extension was seen in 2, and infratemporal fossa extension was seen in 2. After completion of treatment with 1.5 g of amphotericin, the paranasal sinus part of the lesion disappeared. However, there was residual lesion in the intracranial part that completely disappeared only after treatment with 2.5 g of amphotericin and 6 months of itraconazole therapy. CONCLUSIONS: Invasive aspergillosis has been increasingly reported among immunocompetent patients. No single surgical or medical maneuver, including orbital exenteration, guarantees cure. The combination of amphotericin B and itraconazole for skull base aspergillosis represents a real step forward in the treatment of invasive aspergillosis.
Authors:
Naresh K Panda; Karuppiah Saravanan; Arunaloke Chakrabarti
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Publication Detail:
Type:  Journal Article; Randomized Controlled Trial    
Journal Detail:
Title:  American journal of otolaryngology     Volume:  29     ISSN:  0196-0709     ISO Abbreviation:  Am J Otolaryngol     Publication Date:    2008 Jan-Feb
Date Detail:
Created Date:  2007-12-06     Completed Date:  2008-02-07     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8000029     Medline TA:  Am J Otolaryngol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  24-30     Citation Subset:  IM    
Affiliation:
Department of Otolaryngology and Head and Neck Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India. npanda59@yahoo.co.in
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MeSH Terms
Descriptor/Qualifier:
Adult
Antifungal Agents / therapeutic use*
Aspergillosis / diagnosis,  drug therapy*,  surgery
Biopsy
Debridement / methods*
Endoscopy
Female
Follow-Up Studies
Humans
Magnetic Resonance Imaging
Male
Middle Aged
Prospective Studies
Sinusitis / diagnosis,  drug therapy*,  surgery
Skull Base / surgery*
Tomography, X-Ray Computed
Treatment Outcome
Chemical
Reg. No./Substance:
0/Antifungal Agents

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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