Form Of Fungal Sinusitis Research Articles

Fungal sinusitis: Sinuses and beyond

Fungal sinusitis poses a great diagnostic and treatment challenge to the otorhinolaryngologist. The increasing incidence of the disease, wide spectrum of clinical features, possibility of recurrence, invasion to vital structures such as orbit and brain, and treatment challenges make it a major health burden today. Often attributed to an immunoglobulin E-specific reaction or cell-mediated immune response to the fungal filaments, fungal sinusitis can be diagnosed by fungal stain and culture and histopathology (gold standard). Radiological studies help in assessing the disease extent and in planning management. We present our series of various forms of fungal sinusitis and the difficulties we faced in the management and the outcome. Each form of fungal sinusitis has distinctly different medical and surgical treatment which needs to be individualized, most often requiring radical surgical debridement along with adjunct long-term antifungals (polyene and triazole) playing an equally important role.

Fungal sinusitis clinical presentation, latest management: A Review Update

Fungal sinusitis is a relatively common, often misdiagnosed disease process involving the paranasal sinuses. It is a serious condition, as certain forms of fungal sinusitis are associated with a high rate of mortality. Successful treatment requires a prompt diagnosis and frequently relies on radiologic imaging, specifically computed tomography (CT) and magnetic resonance (MR) imaging. The classification of fungal sinusitis is ever changing, but under the most current and widely accepted classification fungal sinusitis is broadly categorized as either invasive or noninvasive. Invasive fungal sinusitis is defined by the presence of fungal hyphae within the mucosa, submucosa, bone, or blood vessels of the paranasal sinuses. Invasive fungal sinusitis is subdivided into acute invasive fungal sinusitis, chronic invasive fungal sinusitis, and chronic granulomatous invasive fungal sinusitis. Conversely, noninvasive fungal sinusitis is defined by the absence of hyphae within the mucosal and other tissues of the paranasal sinuses. Noninvasive fungal sinusitis is subdivided into allergic fungal sinusitis and fungus ball (fungal mycetoma).Journal of Science Foundation, 2014;12(1):16-19

Radiologic characteristics of sinonasal fungus ball: an analysis of 119 cases

It is important to differentiate sinonasal fungus ball from non-fungal sinusitis and other forms of fungal sinusitis in order to determine the optimal treatment. In particular, a sinonasal fungus ball, a non-invasive fungal sinusitis, can be characterized by radiologic findings before surgery. To differentiate a sinonasal fungus ball from other types of sinusitis and determine optimal treatment on the basis of radiologic findings before surgery. We studied 119 patients with clinically and pathologically proven sinonasal fungus balls. Their condition was evaluated radiologically with contrast-enhanced CT (99 patients), non-contrast CT (18 patients) and/or MRI (17 patients) prior to sinonasal surgery. Calcifications were found in 78 of 116 (67.2%) patients who underwent CT scans for fungus ball. As opposed to non-contrast CT scans, contrast CT scans revealed hyperattenuating fungal ball in 82.8% and enhanced inflamed mucosa in 65.5% of the patients, respectively. On MRI, most sinonasal fungal balls showed iso- or hypointensity on T1-weighted images and marked hypointensity on T2-weighted images. Inflamed mucosal membranes were noted and appeared as hypointense on T1-weighted images (64.7%) and hyperintense on T2-weighted images (88.2%). When there are no calcifications visible on the CT scan, a hyperattenuating fungal ball located in the central area of the sinus with mucosal thickening on enhanced CT scans is an important feature of a non-invasive sinonasal fungus ball. On MRI, a sinonasal fungus ball has typical features of a marked hypointense fungus ball with a hyperintense mucosal membrane in T2-weighted images. A contrast-enhanced CT scan or MRI provides sufficient information for the preoperative differentiation of a sinonasal fungus ball from other forms of sinusitis.

Agent fongique et pathologie rhinosinusienne

The aim of this review is to describe the different forms of fungal rhinosinusitis. The interaction between fungi and the nasosinusital cavities results in numerous conditions that have different clinical presentations according to the fungus and to the immune status of the patient. The fungi will be either in the mucus or on the mucosa in its noninvasive form; invasive forms infiltrate bone, blood vessels and mucosa. The diagnostic and therapeutic characteristics of these conditions are described in this review. The newly described forms of fungal sinusitis with eosinophils are also described.

ALLERGIC FUNGAL SINUSITIS

Allergic fungal sinusitis is a recently recognized form of fungal sinusitis that both clinically and histopathologically resembles allergic bronchopulmonary aspergillosis (ABPA). Allergic fungal sinusitis (AFS) is increasingly diagnosed as an important type of chronic sinusitis. Reviews in the otolaryngologic literature have found between 5% and 10% of patients with chronic sinusitis meet the criteria for allergic fungal sinusitis. 13,16,29 AFS must be distinguished not only from chronic bacterial sinusitis but also from other forms of fungal sinusitis. Although fungal infections of the paranasal sinuses have been a diagnosed clinical entity for the past 100 years, it is only recently that there has been an attempt to classify the different manifestations of fungal sinusitis. Fungal sinusitis can be categorized as invasive and noninvasive and subdivided into four distinct clinicopathologic entities (Table 1): (1) acute/fulminant, (2) chronic/indolent, (3) mycetoma, and (4) allergic fungal sinusitis. 11,26 Invasive sinus disease includes acute/fulminant and chronic/indolent sinusitis. Acute fulminant sinusitis is most commonly seen in immunocompromised individuals and diabetics; it is rapidly progressive and without treatment can frequently result in death. Fungi belonging to the Mucoraceae family, which includes Rhizopus, Mucor, and Absidia , are most frequently involved. Chronic or indolent sinusitis is most commonly seen in immunocompetent, nonatopic individuals with a history of chronic sinusitis. It is a slowly progressive disease characterized by granulomatous changes that on histologic examination show tissue invasion. Fungi belonging to either the Dematiaceae family or Aspergillus genus are the main pathogens. Chronic indolent sinusitis clinically resembles allergic fungal sinusitis but can be differentiated from it by histologic examination, demonstrating tissue invasion and the absence of eosinophils. AFS and mycetomas (fungal balls) are noninvasive. Mycetomas typically present with mild-to-moderate nasal obstruction and facial pain that is unresponsive to antibiotics. Patients are immunocompetent and nonatopic. The fungal ball consists of a tightly packed conglomeration of hyphae in a dense clay-like material that lacks eosinophils and tissue invasion. Mycetomas most frequently involve one of the maxillary sinuses and are usually caused by Aspergillus fumigatus. AFS is the most recently described and probably the least understood fungal sinus disease. It is a noninvasive form of fungal sinusitis and is seen in immunocompetent atopic hosts. Failure to recognize and diagnose allergic fungal sinusitis is common and is related to both the lack of widely accepted diagnostic criteria and lack of awareness by clinicians.

Diagnosis of Allergic Fungal Sinusitis

Allergic fungal sinusitis is a noninvasive disease first recognized approximately one decade ago. It accounts for approximately 6% to 8% of all chronic sinusitis requiring surgical intervention and has become a subject of increasing interest to otolaryngologists and related specialists. Although certain signs and symptoms, as well as radiographic, intraoperative, and pathologic findings, may cause the physician to suspect allergic fungal sinusitis, no standards have been defined for establishing the diagnosis. It is extremely important to recognize allergic fungal sinusitis and differentiate it from chronic bacterial sinusitis and other forms of fungal sinusitis because the treatments and prognoses for these disorders vary significantly. To delineate a set of diagnostic criteria, we prospectively evaluated our most recent 15 patients with allergic fungal sinusitis. An allergy evaluation confirmed atopy through a strong history of inhalant mold allergies, an elevated total immunoglobulin E level, or a positive result of a skin test or radioallergosorbent test to fungal antigens in 100% of patients. All 15 patients had nasal polyposis, and 8 of 15 had asthma. There was a unilateral predominance in 13 of 15 cases. A characteristic computerized tomography finding of serpiginous areas of high attenuation in affected sinuses was seen in all patients, and 12 of 15 patients had some degree of radiographic bone erosion. Pathologic examination uniformly revealed eosinophilic mucus without fungal invasion into soft tissue; Charcot-Leyden crystals and peripheral eosinophilia were each observed in 6 of 15 patients. Every patient had fungus identified on fungal smear, although only 11 of 15 fungal cultures were positive.(ABSTRACT TRUNCATED AT 250 WORDS)