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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
.imaging

*Classification:

Invasive

Acute Invasive Fungal Sinusitis


Chronic Invasive Fungal Sinusitis
Chronic Granulomatous Invasive
Fungal Sinusitis

Noninvasive

Allergic Fungal Sinusitis


Fungus Ball (fungus mycetoma)

*Invasive fungal Sinusitis

*Acute Invasive Fungal


Sinusitis:

Epidemiology and Etiology:

*Most lethal form of fungal sinusitis


mortality 50-80%

*Rare in immunocompetent patients


*Two clinical populations:
a)

Poorly controlled Diabetics : ususally


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

b)

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

Advanced AIDSAIDS

Fungal Sinusitis in a diabetic patient

*Chronic Invasive fungal


sinusitis

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
walls
* Organisms Mucor, Rhizopus, Aspergillus, Bipolaris, and
Candida

*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
tissues

*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
*Immunocompetent
*The causative fungi include Aspergillus

fumigatus, Aspergillus flavus, Alternaria Sp and


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

*Thank You

*References
* https://www.entnet.org/content/fungal-sinusiti
s
* American Academy of Otolaryngology-Head and
neck surgery
* Cade Martin, MD
* Fungal-Sinusitis-NXPowerLite
* www.ncbi.nlm.nih.gov
* www.drtbalu.com
* www.jaypeebrothers.com
* Radiology.uthscsa.edu