Type Of Fungal Rhinosinusitis Research Articles

Unraveling a rare medical anomaly: a case report on the incidental discovery of a mixed fungal ball with parasitic elements

Fungal ball is a type of fungal rhinosinusitis (FRS) that is chronic, non-invasive, and extramucosal. A fungal ball is a non-invasive accumulation of dense conglomeration of fungal hyphae in one sinus cavity Sinonasal fungal ball is known to be the most common form of fungal sinusiti. It typically affects immunocompetent individuals and appears as a unilateral lesion between the fourth and sixth decades of life. The most commonly involved sinus is the maxillary sinus. Patients are often asymptomatic, but some patients develop chronic mucopurulent rhinorrhea. Treatment is surgical, with removal of the fungal contents of the involved sinus, and no subsequent treatment is indicated, given the process is noninvasive. Here in we report the case of a 64-year-old gentleman diagnosed with fungal ball of maxillary sinus. Patient was asymptomatic and the fungal ball was identified as an incidental finding on imaging for stroke. The histopathological examination necrotizing lesion showing entangled septate, aseptate and pigmented fungal structures and non-viable parasitic structures noted. No viable tissue was seen.

Histopathological Examination in the Categorization of fungal Rhinosinusitis - a Retrospective Study

Introduction: Fungal Rhinosinusitis is broadly defined as any sinonasal pathology related to the presence of fungi and is increasingly recognized worldwide. This study aimed to assess and ascertain the need for histopathological examination in the management of fungal Rhinosinusitis. Materials and Methods: This study was performed over two years, from April 2019 to April 2021, in the Department of Pathology, Vinayaka Missions KirupanandaVariyar Medical College and Hospital, Salem. A total of 383 cases of rhinosinusitis/nasal polyps were studied. Histopathological examination and categorization were done and compared with clinical diagnosis. Results: Only 4/18 cases of acute fungal Rhinosinusitis were correctly diagnosed(22.22%). Nineteen cases of the fungal ball were diagnosed, but none was correctly categorized. Clinical suspicion of fungal sinusitis was present in 10 cases of Rhinosinusitis, which turned out to be chronic Rhinosinusitis in histopathology. In AFRS, fungal elements were overlooked in Hematoxylin and Eosin stained slides and identified only by Grocottmethenamine silver in one-fourth of the cases. Conclusions: Though clinical diagnosis was made in 86% of fungal rhinosinusitis cases, correct categorization was done only in one-third of cases. CT scan could diagnose 60% of cases, but none was categorized. As treatment depends on the type of fungal Rhinosinusitis, histopathological examination is the gold standard for diagnosing and treating fungal Rhinosinusitis.

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: Unravelling the Disease Spectrum.

Fungal rhinosinusitis (FRS), once considered a rare disease, has seen a steep rise in incidence in recent times. This global rise in the burden of fungal disease is a consequence of an increment in the population with weakened immune systems. Increased life expectancy with rise in conditions like diabetes mellitus, medical advancements with invasive interventions, use of immunosuppressive drugs and chemo-radiotherapy all lead to unique risk situations. The situation becomes more alarming with the fact that there has been a significant rise in cases in immune-competent hosts with no predisposing factors. FRS represents a wide spectrum of disease ranging from the mild form of superficial colonization, allergic manifestations to life threatening extensive invasive disease. The categorization of disease into acute and chronic and invasive or noninvasive is important factor with implications in disease management and prognosis and this has been emphasized greatly in recent years. Diagnosis of FRS has been a challenge as the presenting clinical signs and symptoms and radiographic manifestations are often nonspecific. Definitive diagnosis requires direct fungi identification and hence culture and microscopic examination remain the gold standard. Availability of advanced and rapid diagnostic techniques is rare in majority of developing nations. Therapeutic dilemmas are another aspect of the management of FRS as in spite of the availability of new antifungal drugs, treatment is often empirical due to non-availability of early diagnosis, rapid disease progression and high costs of antifungal drugs. A description of the different types of FRS, their diagnosis and management has been presented in this review.

Evaluation of Conventional and Molecular Techniques in the Diagnosis of Fungal Rhinosinusitis

Introduction: Fungal infection of the nose and paranasal sinuses is increasing in both immunocompetent and immunocompromised patients. Limited studies on spectrum of fungi causing fungal rhinosinusitis (FRS) and the types of FRS are scarce from this region of India. We therefore analyzed the suspected cases of FRS by clinical, radiological, histopathological, mycological and molecular methods and categorized them in to non-invasive and invasive forms. Objective: To evaluate laboratory methods in the diagnosis of fungal rhinosinusitis and to find out the spectrum of fungi causing various forms of FRS Methods: 44 patients of chronic rhinosinusitis were enrolled on the basis of history, clinical examination, and radiological findings from the E.N.T. department after obtaining their consent. Functional endoscopic sinus surgery was performed and tissues were examined histopathologically, by fungal culture and PCR. Antimicrobial susceptibility testing of the fungal isolates were done by disk diffusion (M51-A) & broth micro dilution (M38-A2) methods of CLSI. Result: Out of 44 clinically and radiologically suspected patients of chronic rhinosinusits, 23 (52%) were positive for fungal rhinosinuistis. In 44 cases, 18 (40.9%) cases were PCR positive, 12 (27%) were culture positive, 8(18%) were positive by KOH microscopy and 4 (9%) were positive on histopathology. Aspergillus flavus was found to be the most common fungal isolate causing fungal rhinosinusitis Conclusion: We found laboratory methods are essential in confirming the diagnosis of FRS. Among all the laboratory methods, though culture is an important diagnostic tool, PCR were found to be more significant than other methods.

Allergen Immunotherapy in an HIV+ Patient with Allergic Fungal Rhinosinusitis.

Patients with HIV/AIDS can present with multiple types of fungal rhinosinusitis, fungal balls, granulomatous invasive fungal rhinosinusitis, acute or chronic invasive fungal rhinosinusitis, or allergic fungal rhinosinusitis (AFRS). Given the variable spectrum of immune status and susceptibility to severe infection from opportunistic pathogens it is extremely important that clinicians distinguish aggressive fungal invasive fungal disease from the much milder forms such as AFRS. Here we describe a patient with HIV and AFRS to both remind providers of the importance of ruling out invasive fungal disease and outline the other unique features of fungal sinusitis treatment in the HIV-positive population. Additionally we discuss the evidence for and against use of allergen immunotherapy (AIT) for fungal disease in general, as well as the evidence for AIT in the HIV population.

Fungal Rhinosinusitis: A Retrospective Microbiologic and Pathologic Review of 400 Patients at a Single University Medical Center

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.

Controversies surrounding the categorization of fungal sinusitis

Though rhinosinusitis is a common disorder, controversies surround the categorization of chronic rhinosinusitis (CRS) and the role of fungus in CRS. The diagnosis of each category is important for optimum therapy and predicting the course. Based on histopathological findings, fungal rhinosinusitis (FRS) can be broadly divided into two categories: the invasive and non-invasive depending on invasion of the mucosal layer. Three types of FRS are tissue-invasive: acute invasive, chronic invasive, & granulomatous. The two non-invasive FRS disorders are fungal ball, and fungus related eosinophilic rhinosinusitis including allergic fungal rhinosinusitis (AFRS). The distinction of granulomatous from chronic invasive type is not beyond controversy as both types have a chronic course and predominant orbital involvement. Maximum confusion surrounds the entity of fungus-related eosinophilic rhinosinusitis, and the definition of AFRS. In the diagnosis of AFRS, the detection of fungi in allergic mucin is considered important, although hyphae are sparse in sinus content. This leads to confusion in definition of this entity, especially with the description of two more closely related entities--eosinophilic fungal rhinosinusitis (EFRS) and eosinophilic mucin rhinosinusitis (EMRS). Recently reports of histologic invasion in possible cases of AFRS were also documented. Currently, there are more questions than answers concerning the categorization of FRS.