Fungal sinusitis

Editor-In-Chief: Prab R Tumpati, MD
Obesity, Sleep & Internal medicine
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Fungal sinusitis
Synonyms	Fungal rhinosinusitis
Pronounce	N/A
Specialty	N/A
Symptoms	Nasal congestion, facial pain, headache, fever, nasal discharge
Complications	Orbital cellulitis, intracranial complications, bone erosion
Onset	Varies depending on type (acute or chronic)
Duration	Can be acute or chronic
Types	Allergic fungal sinusitis, chronic indolent sinusitis, fungal ball, acute invasive fungal sinusitis
Causes	Fungal infection by species such as Aspergillus, Mucor, Rhizopus
Risks	Immunocompromised state, diabetes mellitus, chronic sinusitis
Diagnosis	CT scan, MRI, nasal endoscopy, biopsy
Differential diagnosis	Bacterial sinusitis, viral sinusitis, nasal polyps
Prevention	N/A
Treatment	Antifungal medication, surgery, corticosteroids
Medication	Amphotericin B, voriconazole, itraconazole
Prognosis	Varies; better with early diagnosis and treatment
Frequency	Rare, but more common in immunocompromised individuals
Deaths	N/A

Fungal sinusitis is a condition characterized by the inflammation of the sinus lining due to a fungal infection. It is a relatively uncommon form of sinusitis and can be classified into two main categories: invasive and non-invasive. Invasive fungal sinusitis is a serious condition that typically affects individuals with weakened immune systems, such as those with diabetes mellitus, cancer, or HIV/AIDS. Non-invasive fungal sinusitis, on the other hand, generally occurs in individuals with normal immune systems and is further divided into allergic fungal sinusitis (AFS) and fungal ball.

Causes and Risk Factors

Fungal sinusitis is caused by the inhalation of fungal spores, which can then infect the sinus cavities. The most common fungi associated with this condition include species from the genera Aspergillus, Fusarium, and Mucor. Risk factors for developing fungal sinusitis include a weakened immune system, living in environments with high levels of fungal spores, previous sinus surgery, and the use of immunosuppressive medications.

Symptoms

Symptoms of fungal sinusitis can vary depending on the type of infection but generally include chronic nasal congestion, nasal discharge (which may be thick and contain black material in cases of invasive fungal sinusitis), facial pain or pressure, reduced sense of smell, and headaches. In severe cases of invasive fungal sinusitis, symptoms may also include fever, eye swelling, and vision changes.

Diagnosis

Diagnosis of fungal sinusitis involves a combination of medical history, physical examination, imaging studies such as CT scans or MRI, and laboratory tests. Nasal endoscopy may be performed to obtain samples for fungal cultures and histopathological examination. Identifying the specific type of fungus is crucial for determining the appropriate treatment plan.

Treatment

Treatment for fungal sinusitis depends on the type and severity of the infection. Non-invasive forms, such as allergic fungal sinusitis and fungal ball, are typically treated with surgery to remove the fungal mass and antifungal medications. Invasive fungal sinusitis requires aggressive treatment with intravenous antifungal medications and, in some cases, surgery to remove infected tissue. Long-term management may include the use of oral antifungal medications to prevent recurrence.

Prevention

Preventive measures for fungal sinusitis include avoiding environments with high concentrations of fungal spores, such as compost piles and moldy spaces. Individuals with weakened immune systems should take additional precautions, such as wearing masks in potentially contaminated areas and ensuring that indoor air is clean and well-filtered.

Gallery

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  Granuloma formation in fungal sinusitis

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  MRI scan showing fungal sinusitis

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  Voriconazole, an antifungal medication used in treatment

See Also

• Sinusitis
• Immunocompromised host
• Aspergillosis
• Mucormycosis

References

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