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Have fungal sinusitis. Surgery done to remove fungus from the swollen face. Alternate treatment?

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Hello Doctor,
We live in Coimbatore. My colleague's father is affected by some kind of Fungal Sinus. Last month there was a heavy swelling in the face. A surgery was done to remove the fungus from the swelling areas. But that was temporary and it is continuing. The medicines given are not completely stopping the growth of fungus. In turn it is affecting the kidney functionality and every 3 days dialysis is done. For surgery only means suggested is to remove all flesh from the cheeks and do some kind of plastic surgery. Is there any alternate for this? Also please suggest if any hospitals specialize such kind of fungus treatment in Chennai (OR) Bangalore.
Thanks a lot for your help.

With Regards,
Posted Sun, 24 Feb 2013 in Ear, Nose and Throat Problems
Answered by Dr. Sumit Bhatti 3 hours later

Thank you for your query.

1. From your description, he seems to have developed Invasive Fungal Sinusitis. The most common fungus is Mucor (Mucormycosis), followed by Aspergillus (Aspergillosis).Which is the exact fungus involved?

2. There are three types of Amphotericin B available. See to it that he is given the best Liposomal Amphotericin B such as Fungisome. Fungisome is a liposomal complex of Amphotericin B, and being the latest addition to the lipid formulations of Amphotericin B, it has many advantages.
a. It has more miscelles per volume which causes less toxicity (such as kidney).
b. As the dose is reduced (1 mg/kg), cost is also less.
c. a process known as Sonication is used to make the particles smaller.
d. It is marketed by Lifecare Innovations in India

3. Mucormycosis can spread rapidly into the eye and brain, resulting in a fatal infection. Is there any spread to the eye or brain? Does he have spread into the skin of the cheek? Do you have any Scan images?

4. The following principles help improve the chances of survival:
a. Step by step thorough debridement. Even the dead fungus destroys the tissue (flesh). Hence repeat, thorough surgeries are necessary.
b. Quick intervention is the key.
c. Local instillation (non-toxic). Fungisome Gel is available.
d. Plain v/s Liposomal Amphotericin B. (Liposomal is better)
e. Extended use of antifungals
f. Control of the Diabetes.

5. Best for invasive Aspergillosis are Azole group of drugs such as Voriconazole, Posaconazole, Ravuconazole

6. If he has a resistant Mucormycosis infection not responding to maximum dosage of Amphotericin B, Echinocandins such as Caspofungin may help. (Cancidas-Merck/MSD), Canducid (Zyphar) 70 mg/day loading followed by 50 mg/day. Dilute in NS, not in 5% Dextrose. It is Hepatotoxic (Liver Toxicity).

7. Any major Institutional Hospital will be able to treat him. You may discuss the above points with his doctors.

I hope that I have answered your query. If you have any further questions, I will be available to answer them.

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