Protocolo de detecção precoce de rinossinusite fúngica invasiva aguda
DOI:
https://doi.org/10.34631/sporl.555Palavras-chave:
detecção precoce, rinossinusite fúngica invasiva aguda, protocoloResumo
Introdução: A Rinossinusite Fúngica Invasiva é uma entidade nosológica cada vez mais frequente, devido principalmente ao aumento de doentes imunodeprimidos. Apesar do progresso no tratamento médico e cirúrgico a taxa de mortalidade desta entidade permanece elevada, entre 20-80%. Os autores propõem um protocolo multidisciplinar para uma intervenção precoce em doentes imunodeprimidos com suspeita de Rinossinusite Fúngica Invasiva Aguda.
Material e Métodos: Os artigos analisados nesta revisão foram identificados através de uma pesquisa sistemática, realizada no PubMed. Foram selecionados 18 artigos publicados entre Setembro de 1993 e Janeiro de 2014. Foram incluídos artigos passiveis de analisar os fatores do hospedeiro que predispõe à RSFIA, e os sinais e sintomas precoces que levam à suspeição da doença. Para o diagnóstico e tratamento foram utilizadas “guidelines” e consensos internacionais.
Resultados: A disfunção neutrofílica parece ser um fator predisponente transversal a praticamente todos os doentes que desenvolveram RSFIA. A febre e/ou os sintomas locais (edema e dor facial, obstrução nasal, rinorreia, cefaleias) são considerados os sintomas mais precoces de RSFIA, assim como mucosa pálida, pouco friável, edema, granulações e crostas são considerados os sinais mais precoces. O exame de imagem mais utilizado para a avaliação inicial de doentes com suspeita de RSFI é a TAC SPN. Os critérios de diagnóstico de RSFIA são definidos pelos grupos ISHAM e EORTC/MSG-NIAID. O tratamento inclui a correção da imunodeficiência de base, a terapêutica médica com antifúngicos sistémicos e o desbridamento cirúrgico.
Conclusões: Os autores apresentam um protocolo de identificação e tratamento de doentes com rinossinusite fúngica invasiva aguda. Palavras chave:
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