Granulomatous Invasive Fungal Sinusitis Research Articles

Allergic Fungal Rhinosinusitis and Contralateral Chronic Granulomatous Invasive Fungal Sinusitis: A Case Report.

This case report describes rare concomitant allergic fungal rhinosinusitis (AFRS) and chronic granulomatous invasive fungal sinusitis (CGIFS) in a 34-year-old woman with acute lymphoblastic leukemia and graft-versus-host disease (GVHD) post bone marrow transplantation. Initially presenting with rhinorrhea and nasal obstruction, the patient was diagnosed with AFRS in the right maxillary sinus, followed by a postoperative course of CGIFS in the left nasal cavity, showcasing the unique occurrence. She was not immunocompromised during diagnosis. CGIFS may have occurred because of surgery; however, voriconazole led to significant improvement. This case highlights noninvasive and invasive fungal infections in patients with chronic rhinosinusitis and a history of GVHD and underscores the complexity of diagnosing and managing such cases.

Persistent Severe Headache After Removal of Fungus Ball From the Sphenoid Sinus: A Case Report.

Granulomatous invasive fungal sinusitis (GIFS) is a rare and life-threatening disease, whereas fungus ball (FB) is the most common form of noninvasive fungal sinusitis. Both GIFS and FB primarily develop in immunocompetent patients, with the former associated with higher mortality and morbidity. A chart review and review of the literature. We present the case of a 77-year-old woman with mixed fungal sinusitis who was successfully treated with voriconazole. GIFS and FB can coexist in extremely rare cases, known as mixed fungal sinusitis; however, the diagnosis and subsequent treatment of mixed fungal sinusitis can be delayed because of a lack of awareness of the underlying concept. Therefore, it is crucial for clinicians to recognize the concept of mixed fungal sinusitis.

Non-surgical management of chronic granulomatous invasive fungal sinusitis with intracranial extension a case report and literature review

Chronic granulomatous invasive fungal sinusitis (CGIFS) is a rare manifestation of the heterogeneous disease process of fungal rhinosinusitis that is traditionally managed with some form of resective or debulking surgery. Historically, these were invasive transfacial resections. With the development of endoscopic surgery this treatment has become less invasive, but surgery still forms a major component of management. It is a rare disease that usually only occurs in dry subtropical areas. We describe the case of a female in her 30’s who presented with progressive headache and facial paresthesia. Workup demonstrated a large destructive lesion centred on the left sphenoid sinus invading the orbit and middle cranial fossa. The patient underwent urgent biopsies with a presumed diagnosis of an invasive malignancy. Upon identifying fungal organisms on culture the patient was commenced on anti-fungal treatment. We describe the first medically managed case of CGIFS with orbital and intracranial extension and perform a review of the contemporary literature to better understand this rare and challenging condition.

Hronični granulomatozni invazivni gljivični sinusitis - pregled literature i prikaz slučaja netipičnog za balkansku regiju

Introduction. Chronic granulomatous invasive fungal rhinosinusitis (CGIFRS) is an extremely rare form of invasive fungal sinusitis. The disease has a long-lasting and indolent course, so the invasion and destruction in the sinonasal and adjacent regions is progressing slowly. This disease has been reported primarily in Middle East, North Africa, India and Pakistan; however, it is very rare in western countries. It is primarily caused by Aspergillus flavus. Case Report. A 40-year-old man, who was repeatedly surgically treated for chronic rhinosinusitis with nasal polyps, was presented to our Otorhinolaryngology Department with a progressive, sudden right-sided proptosis. Contrast-enhanced paranasal sinus computed tomography (CT) showed almost complete soft tissue opacification of the sinonasal region, eroded bone structures and expansion into the right orbit. Erosion of the walls of the right frontal sinus was also seen but without intracranial propagation. Histopathological examination was necessary for the final diagnosis. The finding of granulomatous response along with fibrosis and strong inflammatory infiltrate was typical for chronic granulomatous invasive fungal sinusitis. The patient was successfully treated with a combination of surgery and postoperative medical therapy with voriconazole. To our knowledge, this is the first case of CGIFRS presented in Serbia. In addition, we reviewed the literature concerning this rare form of fungal sinusitis, especially for the Balkan region. Conclusion. Although we reported an extremely rare case of fungal sinusitis for the Balkan region, it is important to suspect on it in all cases where chronic inflammation of the paranasal sinuses does not respond to conventional treatment.

Corrigendum to "Chronic Granulomatous Invasive Fungal Sinusitis in Patients With Immunocompetence: A Review".

Corrigendum to "Chronic Granulomatous Invasive Fungal Sinusitis in Patients With Immunocompetence: A Review".

Radiological Imaging in Diagnosis and Management of Fungal Rhinosinusitis

Fungal sinusitis has been increasing in number throughout the world off lately. The classification of fungal rhinosinusitis has evolved drastically. Broadly it is classified in two groups that is invasive fungal rhinosinusitis and non-invasive fungal rhinosinusitis. There are five subgroups to these. The invasive group comprises of acute invasive fungal sinusitis (AIFS), chronic invasive fungal sinusitis (CIFS), chronic granulomatous invasive fungal sinusitis (CGIFS) whereas the non-invasive group consists of fungal ball and allergic fungal rhinosinusitis (AFRS). These five subtypes have specific radiological and clinical features. The treatment strategies and prognoses for the subtypes are also different, and depends on their characteristics features. It is important to understand the different types of fungal sinusitis and knowledge of their particular radiologic features are important for the clinician to use appropriate diagnostic techniques for confirmation. Relevant diagnosis and initiation of adequate therapy are essential to avoid any adverse consequence.

Mass-forming chronic invasive fungal sinusitis; an uncommon mimicker of head & neck malignancy

Abstract Introduction/Objective Invasive fungal sinusitis is a progressive infection affecting the nasal cavity and associated sinus spaces. Acute forms affect immunocompromised patients with debilitating systemic diseases while chronic forms usually occur in immunocompetent individuals. Methods/Case Report A 26-year-old immunocompetent male with daily Marijuana smoking consulted for acute swelling of the right eye with dull pain, photophobia, loss of vision and pressure of 4 day duration. He reported nasal congestion for approximately one year and over the previous 2 months developed exophthalmos. Imaging demonstrated a 4.9 x 4.3 x 4.1 cm invasive soft tissue mass in the right lamina papyracea with involvement of the paranasal sinus, right orbit, and intracranial space. The mass was presumed to represent a high-grade malignancy. Biopsy was performed and demonstrated granulomatous invasive fungal sinusitis. The patient underwent right orbitotomy and right extranasal ethmoidectomy. He was begun on empiric amphotericin B. After culture and sequencing identification of Curvularia species, voriconazole was added. Follow up imaging studies after two month of treatment still demonstrated residual mass forming lesion with 10-20% decrease in size. The patient has regained his vision after 4 month of treatment and he is expected to complete a six months course. If the mass forming lesion persists, a second round of surgical debridement will be performed. Results (if a Case Study enter NA) N/A Conclusion Curvularia is a dematiaceous fungus most commonly associated with allergic sinusitis, but can rarely become invasive in immunocompetent individuals. Histopathologically large fungal elements are easily recognizable but specific identification requires culture or ribosomal DNA sequencing by PCR. Mass-forming chronic fungal sinusitis overlaps clinically and radiologically with head and neck malignancies. Our report brings attention to this uncommon clinical variant of invasive fungal sinusitis that affects immunocompetent individuals.

Efficacy of Different Modalities of Treatment in Management of Different Types of Fungal Sinusits

Abstract Background Fungal sinusitis is generally classified into invasive and non invasive fungal sinusitis based on histological features, invasive fungal sinusitis divided into acute, chronic and chronic granulomatous invasive fungal sinusitis. While non invasive fungal sinusitis include saprophytic fungal infestation, fungal ball, and fungus-related eosinophilic. Distinguishing invasive disease from noninvasive disease is important because the treatment and prognosis are different for each. AIM A systemic review of effective and safe method in management of different types of fungal sinusitis either by medical or surgical approaches or even combined. Be up to date with the different upcoming new modalities. Methodology A meta-analysis study is done to evaluate the medical and surgical outcomes of patients with invasive and noninvasive Fungal Sinusits. Results Finally, forty-five studies were included in the present systematic review and metaanalysis. Fifteen included studies (No = 539 patients) assessed different modalities for management of fungal ball, via classic endoscopic technique, Canine-fossa approach, gauze technique and osteoplastic approach for FB of the maxillary sinus. The results showed that functional endoscopic sinus surgery has led to success rate of 98.1%. Twenty included studies (No = 806 patients) have assessed the efficacy and safety of different modalities for the management of allergic fungal sinusitis via,Endoscopic Sinus Surgery, Post-ESS Systemic steroids, Antifungals and immunotherapy. The results showed that ESS represents the firstline management strategy of AFRS, followed by aggressive medical therapies, the recurrence rate after postoperative steroids was 20.6%, postoperative antifungals was 40% and after immunotherapy was 9.1%. Ten studies (No = 327 patients) for Invasive Fungal Sinusitis.the results showed that combination of systematic antifungal therapy and aggressive surgical debridement are the treatment of choice. Conclusion FESS is the treatment of choice of fungal ball via classic endoscopic technique, Canine-fossa approach, gauze technique and osteoplastic approach. AFS treatment consists of surgical extirpation of the allergic mucin and polyps with maintenance of adequate sinus drainage followed by medical therapy consists of topical steroids, anti fungal therapy, Immunotherapy, and systemic corticosteroids. Treatment of invasive fungal sinusitis includes surgical resection of necrotic tissues, systemic antifungal therapy and reversal of immune dysfunction.

Concurrent diagnosis of sinus fungus ball and invasive fungal sinusitis: A retrospective case series.

Sinus fungal ball (SFB) is the most common type of non-invasive fungal sinusitis and develops mostly in immunocompetent individuals, whereas invasive fungal sinusitis (IFS), with high mortality, develops mostly in immunocompromised patients. SFB may progress to IFS depending on the patient's immune status and underlying diseases. To investigate the possibility of SFB progressing to IFS. A total of 10 patients histopathologically diagnosed with concurrent IFS and SFB from January 2013 to December 2019 were enrolled. Their clinical characteristics, histopathology and clinical course information were obtained and compared with those of 56 patients with IFS alone and 617 patients with SFB alone. Acute, chronic and chronic granulomatous IFS was diagnosed in two (20%), five (50%) and three (30%) patients, respectively. All patients had severe facial pain and/or headache, with the most common comorbidity being diabetes (n=5, 50%). SFB was identified in the maxillary (60%) and sphenoid (40%) sinuses. The tissue culture was positive for Aspergillus species in five (50%) patients. Eight patients with chronic or chronic granulomatous IFS were successfully treated by debridement with voriconazole, and the two patients with acute IFS and severe neutropenia due to haematologic malignancy died. Compared to patients with IFS alone, patients with combined SFB and IFS were older, female dominant, and commonly had chronic or chronic granulomatous IFS. In addition, they were older and more commonly diabetic and immunocompromised than patients with SFB alone. SFB may progress to IFS particularly in elderly and immunocompromised patients.

Image findings in patients with chronic invasive fungal infection of paranasal sinuses

ObjectivesMore clear classification of chronic invasive fungal infection of paranasal sinuses in the clinical presentation, radiologic findings, and pathology is needed. To describe the imaging findings of patients with chronic invasive fungal sinusitis (CIFS) and chronic granulomatous invasive fungal sinusitis (CGIFS). MethodsEleven patients with CIFS or CGIFS between January 2014 and July 2019 were included in this retrospective study. The demographic, pathologic, and imaging characteristics of the included patients were reviewed by rhinologist, pathologist, and radiologist, respectively. In terms of imaging analysis, overall lesions were categorized as diffuse infiltrative and mass-forming patterns. ResultsAmong eleven patients, ten patients were aged ≥ 60 years (mean age 74.2 years) and nine had hypertension and/or diabetes mellitus. Aspergillus species were the most common pathogens (82%). Of the seven patients with CIFS, five (71%) had diffuse infiltrative patterns and two (29%) had mass-forming patterns, whereas all four patients (100%) with CGIFS had a mass forming pattern. All 11 patients showed both bony erosion and sclerosis. Almost all proven pathologic sites showed predominantly intermediate to high signal intensity on T1WI. ConclusionsCIFS or CFIFS showed chronic course of rhinosinusitis in the patients with old age, imaging findings of bone erosion and sclerosis, and imaging patterns of diffuse infiltration or mass formation.

Demographic profile of fungal rhinosinusitis at a tertiary care centre

<p class="abstract"><strong>Background: </strong>Fungal rhino sinusitis is rampant in the North Indian state of Punjab. The demographic profile, presentation and comorbidities have been analysed.</p><p class="abstract"><strong>Methods: </strong>110 samples from the nasal cavity were collected in Oto-rhino-Laryngology services and processed in the Microbiology services of Dayanand Medical College and Hospital, Ludhiana. Nasal secretions and surgically excised tissue were processed and subjected to direct microscopy by potassium hydroxide (KOH) preparation as well as inoculated on Sabrouraud’s dextrose agar. Identification of fungal isolates was done as per standard procedures.</p><p class="abstract"><strong>Results:</strong> Fungal sinusitis was most common followed by acute invasive sinusitis, chronic invasive, granuloma (fungal ball) and granulomatous invasive fungal sinusitis. Males were affected more than females and the majority of the patients were from urban background. Allergic form of disease was commonly seen in younger age group as compared to the invasive form of the disease which was seen more in older patients. Nasal discharge was common presentation followed by nasal obstruction. Bronchial asthma and diabetes mellitus were co-morbidities. KOH positivity was 44.5% and fungal culture positivity was 33.6%. The common fungal isolate in this group was Aspergillus flavus (22.7%). The most common fungal isolate in the invasive group was Rhizopus spp. (4.5%) and Mucor spp. (3.6%).</p><p class="abstract"><strong>Conclusions: </strong>Elderly diabetic and asthmatic males are more susceptible to invasive fungal rhino sinusitis while the young males are vulnerable to the allergic fungal rhino sinusitis. Thereby control of diabetic status and appropriate allergy testing and desensitization is emphasised.</p>

Frequency of Granulomatous Invasive Fungal Sinusitis in Patients with Clinical Suspicion of Chronic Fungal Rhinosinusitis.

IntroductionOne of the common causes of chronic sinusitis is a fungal infection, and there are various types of fungal rhinosinusitis (FRS). Missed diagnosis of occasional granulomatous invasion of fungal sinusitis can lead to involvement in the central nervous system. The aim of this study is to determine the frequency of granulomatous invasive fungal sinusitis (GIFS) in patients with clinical suspicion of chronic FRS.MethodsWe conducted a descriptive cross-sectional study in the Department of Ear, Nose and Throat (ENT), Nishtar Hospital, Multan from January 1, 2017 to July 1, 2018. Eighty-one patients with chronic FRS participated in the study. After informed consent, nasal tissue was biopsied for granulomatous fungal invasion.ResultsThe frequency of GIFS was 29.6% (n=24) in this study. The significant risk factors included duration of chronic FRS for more than 12 weeks, history of diabetes mellitus, and living status as rural.ConclusionGIFS is a common complication in patients with clinical suspicion of chronic FRS. Nasal biopsy should be a common practice among patients of chronic FRS who have a long duration of disease and a history of diabetes mellitus.

Fungal Rhinosinusitis: Microbiological and Histopathological Perspective.

On the basis of histopathology Fungal Rhinosinusitis (FRS) is categorized into non-invasive (allergic fungal rhinosinusitis, fungal ball) and invasive (acute invasive, chronic invasive and granulomatous invasive fungal sinusitis). This differentiation helps to decide the treatment. Role of latest molecular methods such as PCR and conventional methods such as KOH microscopy and culture also needs to be evaluated. Therefore, in this study we planned to categorise fungal rhinosinusitis on the basis of histopathology and compare it with other methods such as PCR, culture and KOH microscopy. To analyse fungal rhinosinusitis cases by both histopathologically and microbiologically. A total of 76 clinically suspected fungal rhinosinusitis cases were included in the study. The tissue of suspected cases were processed and examined by KOH microscopy, histopathologically, culture and PCR. Histopathological examination was done by PAS, GMS and H&E stain. FRS was diagnosed in 37 (48.68%) cases out of 76 clinically suspected cases of FRS. In which 17 (22.3%) cases were positive by direct microscopy, 21 (27.6%) by culture, 27 (35.5%) by PCR and 14 (18.42%) by histopathology. Approximately 14 cases of FRS were classified according to histopathology; 10 (71.3%) as non-invasive FRS. Out of these 10, 9 (64.2%) were classified as AFRS and 1 (7.14%) as fungal ball. Only 4 cases (28.5%) were diagnosed with invasive FRS. Out of these 4 cases, 2 (14.2%) were of chronic invasive fungal rhinosinusitis, 1 (7.14%) was of granulomatous invasive fungal rhinosinusitis and 1 (7.14%) was of acute fulminant invasive fungal rhinosinusitis. Allergic Fungal Rhinosinusitis (AFRS) is the most common type of FRS. Aspergillus flavus was found to be the most common fungi causing FRS. Diagnosis should not be based on the single method. It should be done by both histopathological and microbiological methods, especially for those cases which are difficult to diagnose.

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

Orbital proptosis in a young immunocompetent female patient

Invasive fungal infections of the nasal and paranasal sinuses are emerging health care problems and are increasingly being reported in healthy immunocompetent persons. Fungal rhinosinusitis (FRS) broadly encompass a wide spectrum of immune and pathological responses that include invasive, chronic, granulomatous and allergic disease. A wide range of fungal species are involved but Aspergillus species is the most common etiological agent. Granulomatous invasive FRS is one of the variants particularly prevalent in Sudan, India, Pakistan and Saudi Arabia. Herein we report a case of chronic granulomatous invasive fungal sinusitis in an immunocompetent adult female.1, 2, 3

Chronic granulomatous invasive fungal sinusitis: an evolving approach to management

Chronic granulomatous invasive fungal sinusitis (CGIFS) is rare and a consensus on ideal management is lacking. We present an extensive case managed successfully with a conservative approach. Case report and literature review. The patient presented with unilateral proptosis, papilledema, and headache. Imaging revealed an infiltrative process with extensive intracranial and intraorbital involvement. Biopsy showed fungal elements and granulomatous reaction consistent with CGIFS. The patient was managed with conservative surgery and long-term oral voriconazole. This case supports a conservative surgical approach in some patients with extensive CGIFS. Oral voriconazole is effective and has significant advantages over more toxic agents administered intravenously.

New treatment for invasive fungal sinusitis: Three cases of chronic invasive fungal sinusitis treated with surgery and voriconazole

Invasive fungal sinusitis is a relatively rare disease and can be divided into acute fulminant, chronic, and granulomatous invasive fungal sinusitis. The conventional treatment is radical surgery combined with systemic amphotericin B administration, but the poor prognosis and unestablished treatment options require a better therapeutic strategy. We report three cases of chronic invasive fungal sinusitis successfully treated with a combination of surgery and voriconazole, a new antifungal agent, with good responses in all patients. Voriconazole administration could form the basis for a new standard treatment for invasive fungal sinusitis.

Syndromes of invasive fungal sinusitis

Invasive fungal sinusitis should be suspected in immunocompromised or diabetic patients who present with acute sinusitis, inflammation of nasal septal mucosa, unexplained fever or cough, or the orbital apex syndrome. Histopathological studies are required to differentiate among these syndromes. Acute (fulminant) invasive fungal sinusitis has been called mucormycosis, zygomycosis and fulminant invasive sinusitis. Fever, cough, crusting of nasal mucosa, epistaxis, and headache are the most common presenting symptoms. Histopathological studies show hyphal invasion of blood vessels, vasculitis with thrombosis, and tissue infarction. Reports of granulomatous invasive fungal sinusitis come primarily from Sudan, but also from India, Pakistan, and the United States. Patients usually present with proptosis, appear to be immunocompetent and are infected almost exclusively with A. flavus. Chronic invasive fungal sinusitis can be distinguished from the two other forms of invasive fungal sinusitis by its chronic course, dense accumulation of hyphae resembling a mycetoma, and association with the orbital apex syndrome, diabetes mellitus, and corticosteroid treatment. Biopsy and orbital exploration show vascular invasion by fungal elements and only a sparse chronic inflammatory infiltrate.

Imaging Features of Invasive and Noninvasive Fungal Sinusitis: A Review

Fungal sinusitis was once considered a rare disorder but is now reported with increasing frequency throughout the world. The classification of fungal sinusitis has evolved in the past two decades, and this entity is now thought to comprise five subtypes. Acute invasive fungal sinusitis, chronic invasive fungal sinusitis, and chronic granulomatous invasive fungal sinusitis make up the invasive group, whereas noninvasive fungal sinusitis is composed of allergic fungal sinusitis and fungus ball (fungal mycetoma). These five subtypes are distinct entities with different clinical and radiologic features. The treatment strategies for the subtypes are also different, as are their prognoses. An understanding of the different types of fungal sinusitis and knowledge of their particular radiologic features allow the radiologist to play a crucial role in alerting the clinician to use appropriate diagnostic techniques for confirmation. Prompt diagnosis and initiation of appropriate therapy are essential to avoid a protracted or fatal outcome.