Abstract
Fungal Rhinosinusitis (FRS) is a well known entity, but only in more recent times have the types of FRS been more fully defined. In this study, we evaluate the diagnosis of FRS in a single medical center. Cases were divided into 2 main categories, non-invasive and invasive. Non-invasive FRS included fungus ball (FB) and allergic fungal rhinosinusitis (AFRS). Invasive FRS included acute invasive fungal rhinosinusitis (AIFRS), chronic invasive fungal rhinosinusitis (CIFRS), and chronic invasive granulomatous fungal rhinosinusitis (CGFRS). Fungal culture data, if available was reviewed. 400 patients with FRS were identified. 87.25% were non-invasive (45% AFRS, 40% FB, and 2% combined AFRS and FB and 12.5% were invasive 11% AIFRS 1.2% CIFRS 0.5% CGFRS. One patient (0.25%) had combined FB/CGFRS. Aspergillus sp. or dematiaceous species were the most common fungi isolated in AFS while Aspergillus sp. was most common in FB and AIFRS. In our experience, most FRS is non-invasive. In our patient population, invasive FRS is rare with AIFRS representing >90% of cases. Culture data supports that a variety of fungal agents are responsible for FRS, but Aspergillus sp. appears to be one of the most common organisms in patients with FRS.
Highlights
Fungal rhinosinusitis (FRS) has been a known medical entity for several hundred years but only in more recent times the entity has been further defined
Entities which are considered non-invasive FRS include fungal ball (FB and allergic fungal rhinosinusitis (AFRS)
The patients were classified as non-invasive (FB; Allergic Fungal Rhinosinusitis (AFRS) and mixed Fungus ball (FB)/AFRS), invasive (AIFRS, chronic invasive FRS (CIFRS), and chronic granulomatous FRS (CGFRS)), or mixed invasive/noninvasive based on known clinical and histologic criteria (Table 1)
Summary
Fungal rhinosinusitis (FRS) has been a known medical entity for several hundred years but only in more recent times the entity has been further defined. Invasive disease is characterized as either acute or chronic based on the length the time symptoms are present before presentation. Patients with acute invasive disease (AIFRS) are usually immunosuppressed and, by definition, present with symptoms of less than one-month duration. This entity is characterized by the presence of fungal forms invading into the sinonasal submucosal with frequent angioinvasion and rapid intervention is necessary. Two forms of chronic invasive disease, chronic invasive FRS (CIFRS), and chronic granulomatous FRS (CGFRS), have been described and like AIFRS both are serious, often requiring surgical and medical therapy.
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