Fungal Sinusitis: Current Trends in Diagnosis and Treatment

In This Article

Abstract and Introduction

Abstract

There are currently 4 diagnostic categories of fungal infections affecting the paranasal sinuses. They are acute or fulminant invasive fungal sinusitis, chronic or indolent invasive fungal sinusitis, fungus ball (mycetoma) and allergic fungal sinusitis. Patients at highest risk for acute invasive fungal sinusitis are poorly controlled diabetics and those with conditions that predispose to metabolic acidosis such as chronic renal failure or diarrhea. The offending fungi originate from the classes zygomycetes (Mucor spp) and Ascomycetes (Aspergillus spp). Chronic or indolent invasive fungal sinusitis is a slowly progressive disease characterized by granulomatous chronic infection that extends beyond the sinus walls. This disease occurs predominantly outside of the United States. Mycetoma, more properly called fungus ball, expands within the confines of an immunocompetent, nonatopic host sinus and does not invade or penetrate the sinus mucosa. Aspergillus is the primary causative organism. It usually involves a single sinus; most often the maxillary sinus. Allergic fungal sinusitis (AFS) colonizes the sinuses of an atopic immunocompetent patient and acts as an allergen, eliciting an immune response. Once diagnosed, surgical debridement of all devitalized tissues is necessary because the fungus proliferates in necrotic tissue. Diagnostic criteria for allergic fungal sinusitis include type 1 hypersensitivity, nasal polyposis, characteristic CT scan, histologic evidence of eosinophilic mucus without evidence of fungal invasion into sinus tissue, and positive fungal stain or culture of the sinus.

Introduction

There are currently four diagnostic categories of fungal infections affecting the paranasal sinuses: (1) acute or fulminant invasive fungal sinusitis, (2) chronic or indolent invasive fungal sinusitis, (3) fungus ball (mycetoma), and (4) allergic fungal sinusitis. Each type of infection has its own distinct presentation and therapy.

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