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* Fungal Sinusitis

Classifications, Epidemiology and Etiology

By : May Ahmed Aly Hussein 1195

Fungal sinusitis is a relatively common but

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 upon
radiologic imaging, specifically computed
tomography and magnetic resonance



Acute Invasive Fungal Sinusitis

Chronic Invasive Fungal Sinusitis
Chronic Granulomatous Invasive
Fungal Sinusitis


Allergic Fungal Sinusitis

Fungus Ball (fungus mycetoma)

*Invasive fungal Sinusitis

*Acute Invasive Fungal


Epidemiology and Etiology:

*Most lethal form of fungal sinusitis

mortality 50-80%

*Rare in immunocompetent patients

*Two clinical populations:

Poorly controlled Diabetics : ususally

caused by fungi of order Zymocycetes
(Rhizopus, Rhizomucor, Absidia, and Mucor)


Immunocompromised with severe

neutropenia (chemotheraphy patients, BMT,
organ transplants, AIDS) Aspergillus
accounts for 80% of infection in this group.

* Common causes of underlying immunosuppression include:

diabetes mellitus: especially those with ketoacidosis
neutropaenic patients

haematologic malignancies
solid organ transplants
bone marrow transplantation
chemotherapy-induced neutropaenia


Fungal Sinusitis in a diabetic patient

*Chronic Invasive fungal


Epidemiology and Etiology

* Inhaled fungal organisms deposited in nasal passageways

and paranasal sinuses
* Chronic invasive FRS is a slowly destructive process that
most commonly affects the ethmoid and sphenoid
sinuses but may involve any paranasal sinus. The disease
typically has a time course of more than 12 weeks.
* Progression over months to years with fungal organisms
invading mucosa, submucosa, blood vessels, and bony
* Organisms Mucor, Rhizopus, Aspergillus, Bipolaris, and

*Chronic Granulomatous

invasive fungal sinusitis

Epidemiology and Etiology:

* primary paranasal granuloma

and indolent fungal sinusitis
* Primarily found in Africa
(Sudan) and Southeast Asia,
only few case reports in US
* Immunocompetent
* Caused by Aspergillus flavus
* Characterized by non
caseating granulomas in the

*Non Invasive Fungal

Sinusitis :

*Allergic Fungal Sinusitis

* Most common form of fungal sinusitis

* Common in warm, humid climates of Southern US

* Hypersensitivity reaction to inhaled fungal organisms resulting in

chronic noninfectious inflammatory reaction - IgE type I immediate

hypersensitivity and type III hypersensitivity are involved
* Common organisms implicated Bipolaris, Curvularia, Alternaria,
Aspergillus, and Fusarium
* Allergic mucin within affected sinus which is inspissated mucous
the consistency of peanut butter with eosinophils on histology
* Younger individuals, third decade, immunocompetent
* Often associated history of atopy with allergic rhinitis or asthma
* Chronic headaches, nasal congestion, and chronic sinusitis for years

*Fungus Ball
*Older individuals, (60-70 years)
* female>male
*The causative fungi include Aspergillus

fumigatus, Aspergillus flavus, Alternaria Sp and

P Boydii. Only 23- 50% cultures result in fungal

*Thank You

* American Academy of Otolaryngology-Head and
neck surgery
* Cade Martin, MD
* Fungal-Sinusitis-NXPowerLite