摘要
黴菌性鼻及鼻竇炎可分為非侵犯性和侵犯性兩大類：非侵犯性包括過敏性黴菌鼻及鼻竇炎和黴菌球兩種，侵犯性黴菌鼻及鼻竇炎可依病程區分為急性、慢性和肉芽型慢性三種，或簡單分為急性或慢性。黴菌鼻及鼻竇炎的分類是依據患者免疫狀況、臨床表現、影像學、病理和微生物檢查的結果判斷。宿主的免疫狀況是影響疾病表現的主因：過敏性黴菌鼻及鼻竇炎發生於過敏體質者，表現為困難治療的鼻及鼻竇炎併息肉；黴菌球發生在免疫力正常或稍有減弱者身上，菌絲堆積於單一鼻竇；侵犯性黴菌鼻及鼻竇炎發生在免疫不全者，如嗜中性球不足、糖尿病、移植患者、長期使用類固醇者，除了感染鼻腔鼻竇，常有眼及中樞的侵犯，除造成功能損傷，亦可能發生致命性的感染。黴菌球透過手術徹底清除黴菌堆積可以治癒，過敏性黴菌鼻及鼻竇炎和侵犯性黴菌鼻及鼻竇炎則需積極手術加上藥物治療。近年，黴菌鼻及鼻竇炎的盛行率有增加趨勢，本文介紹其分類和治療，希望臨床醫師能熟悉黴菌鼻及鼻竇炎的診斷與治療。
並列摘要
Fungal rhinosinusitis is classified into invasive and non-invasive forms. There are two non-invasive forms: allergic fungal rhinosinusitis and fungal ball. Invasive forms are divided into acute, chronic, and granulomatous chronic fungal rhinosinusitis, or just acute and chronic invasive fungal rhinosinusitis. The host immune status usually determines the clinical presentation. Allergic fungal rhinosinusitis is caused by type I allergic reactions which lead to a polypoid rhinosinusitis phenotype. Patients with fungal ball are usually immunocompetent and present with fungal debris within a single sinusitis. Hosts with neutropenia, diabetes, or hematological malignancy, as well as patients taking immunosuppressants, are at greater risk of invasive fungal infection. In addition to sinus symptoms, orbital and central nervous system involvement is not uncommon in invasive fungal rhinosinusitis. The morbidity and mortality of invasive fungal rhinosinusitis are both high. However, fungal ball can usually be cured by surgery alone. Other forms of fungal rhinosinusitis need aggressive treatment with a combination of surgery and medication. With the increased survival of immunocompromised hosts, there is a rising prevalence of fungal infection so it is important to better understand the characteristics of fungal rhinosinusitis.
延伸閱讀
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