Abstract

Fungal sinusitis is the inflammation of the lining mucosa of the paranasal sinuses due to fungal infection. It occurs in people with reduced immunity. The maxillary sinus is the most commonly involved. Fungi responsible for fungal sinusitis are "Aspergillus fumigatus" (90%), "Aspergillus flavus", and "Aspergillus niger". Fungal sinusitis occurs most commonly in middle-aged populations. Diabetes mellitus is the most common risk factor involved.

Types

The types of fungal sinusitis are based on "invasive" and "non-invasive" as follows:

- Invasive

- Non Invasive

Signs/symptoms

Individuals with the condition of fungal sinusitis mostly present with features that include facial pain and pain around the eyes, nasal congestion, rhinorrhea(running nose), headache, later there may be ophthalmoplegia (paralysis of ocular muscles).

Pathophysiology

The mechanism of fungal sinusitis depends on which form, such as:

- "Acute fulminant form" – the fungus invades into vessels causing thrombosis, necrosis with minimum inflammation

- "Chronic invasive" – fungal hyphae invades tissue leaving necrosis with minimal inflammation

- "Granulomatous form" – invasive hyphae invades tissue with inflammation and non-caseating granuloma (with foreign bodies).

- "Saprophytic infection" – growth of fungus seen on mucous crusts within sinus cavity.

- "Sinus fungal ball" – sequestration of fungal hyphae as densely tangled, and has "gritty matted" appearance.

- "Eosinophil related Allergic fungal sinusitis" – though not completely understood, a possible mechanism sees the protein component of fungus elicits IgE mediated allergic mucosal inflammation.

Diagnosis

In terms of diagnosis, the clinical examination gives an idea about fungal sinusitis, as well as:

Treatment

Treatment for fungal sinusitis can include surgical debridement; helps by slowing progression of disease thus allowing time for recovery additionally we see the options below:

- In the case of invasive fungal sinusitis, echinocandins, voriconazole, and amphoterecin (via IV) may be used

- For allergic fungal sinusitis, systemic corticosteroids like prednisolone, methylprednisolone are added for their anti-inflammatory effect, bronchodilators and expectorants help to clear secretions in the sinuses.

Epidemiology

Though it is widely held that fungal infections of the nose and paranasal sinuses are not common, most agree that their frequency has been increasing over past decades.