Fungal sinusitis or fungal rhinosinusitis is the

inflammation Inflammation (from ) is part of the biological response of body tissues to harmful stimuli, such as pathogens, damaged cells, or irritants. The five cardinal signs are heat, pain, redness, swelling, and loss of function (Latin ''calor'', '' ...

of the lining

mucosa A mucous membrane or mucosa is a membrane that lines various cavities in the body of an organism and covers the surface of internal organs. It consists of one or more layers of epithelial cells overlying a layer of loose connective tissue. It ...

of the

paranasal sinuses Paranasal sinuses are a group of four paired air-filled spaces that surround the nasal cavity. The maxillary sinuses are located under the eyes; the frontal sinuses are above the eyes; the ethmoidal sinuses are between the eyes and the sphe ...

due to a

fungal infection Fungal infection, also known as mycosis, is a disease caused by fungi. Different types are traditionally divided according to the part of the body affected: superficial, subcutaneous, and systemic. Superficial fungal infections include common ...

. It occurs in people with reduced immunity. The maxillary sinus is the most commonly involved. Fungi responsible for fungal sinusitis are ''

Aspergillus fumigatus ''Aspergillus fumigatus'' is a species of fungus in the genus ''Aspergillus'', and is one of the most common ''Aspergillus'' species to cause disease in individuals with an immunodeficiency. ''Aspergillus fumigatus'', a saprotroph widespread in ...

'' (90%), ''

Aspergillus flavus ''Aspergillus flavus'' is a saprotrophic and pathogenic fungus with a cosmopolitan distribution. It is best known for its colonization of cereal grains, legumes, and tree nuts. Postharvest rot typically develops during harvest, storage, and/or ...

'', and ''

Aspergillus niger ''Aspergillus niger'' is a mold classified within the ''Nigri'' section of the ''Aspergillus'' genus. The ''Aspergillus'' genus consists of common molds found throughout the environment within soil and water, on vegetation, in fecal matter, on de ...

''. Fungal sinusitis occurs most commonly in middle-aged populations.

Diabetes mellitus Diabetes mellitus, commonly known as diabetes, is a group of common endocrine diseases characterized by sustained hyperglycemia, high blood sugar levels. Diabetes is due to either the pancreas not producing enough of the hormone insulin, or th ...

is the most common risk factor involved.subscription needed

Types

The types of fungal sinusitis are based on ''invasive'' and ''non-invasive'' as follows: * ''Invasive'' :*Acute fulminant :*Chronic invasive :*

Granulomatous A granuloma is an aggregation of macrophages (along with other cells) that forms in response to chronic inflammation. This occurs when the immune system attempts to isolate foreign substances that it is otherwise unable to eliminate. Such subst ...

* ''Non Invasive'' :*

Saprophytic Saprotrophic nutrition or lysotrophic nutrition is a process of chemoheterotrophic extracellular digestion involved in the processing of decayed (dead or waste) organic matter. It occurs in saprotrophs, and is most often associated with fungi ...

infection :*Sinus fungal ball :*

Eosinophil Eosinophils, sometimes called eosinophiles or, less commonly, acidophils, are a variety of white blood cells and one of the immune system components responsible for combating multicellular parasites and certain infections in vertebrates. Along wi ...

related FRS including AFRS * Fulminant

Difference between non-invasive, invasive and fulminant fungal sinusitis

The type of fungal disease highly depends on the immunity of the patient. When a person has low immunity, they can get non-invasive fungal sinusitis, where the fungus will infect only the skin lining of the nasal and sinus cavity. When the immunity gets lowered, it will turn into invasive fungal sinusitis, and the infection can seep into the tissues making the infection dangerous. A person can have both non-invasive and invasive fungal sinusitis at the same time at different locations. Fulminant is the rarest and the most dangerous infection that can occur when immunity is too low. In this type of disease, the infection will not only seep into the tissues but also into blood vessels. Although it comes under invasive technically, when we say invasive fungal sinusitis we often refer to non-fulminant invasive fungal sinusitis as we can clearly distinguish both irrespective of the fact that symptoms are the same. The differentiating factor between invasive and fulminant infections is that the progress of the disease is very rapid in fulminant. The progress of the disease is so quick that it can kill a person in a month if not treated. One of the most common type of fulminant fungal infection is

mucormycosis Mucormycosis, also known as black fungus, is a severe fungal infection that comes under fulminant fungal sinusitis, usually in people who are immunocompromised. It is curable only when diagnosed early. Symptoms depend on where in the body the ...

Signs and symptoms

Individuals with the condition of fungal sinusitis mostly present with features that include

facial A facial is a family of skin care treatments for the face, including steam, exfoliation (physical and chemical), extraction, creams, lotions, facial masks, peels, and massage. They are normally performed in beauty salons, but are also a c ...

pain and pain around the eyes,

nasal congestion Nasal congestion is the partial or complete blockage of nasal passages, leading to impaired nasal breathing, usually due to membranes lining the nose becoming swollen from inflammation of blood vessels. Background In about 85% of cases, nasal ...

rhinorrhea Rhinorrhea (American English), also spelled rhinorrhoea or rhinorrhœa (British English), or informally runny nose is the free discharge of a thin mucus fluid from the nose; it is an extremely common condition. It is a common symptom of allergie ...

(running nose),

headache A headache, also known as cephalalgia, is the symptom of pain in the face, head, or neck. It can occur as a migraine, tension-type headache, or cluster headache. There is an increased risk of Depression (mood), depression in those with severe ...

, later there may be

ophthalmoplegia Ophthalmoparesis refers to weakness (-paresis) or paralysis (-plegia) of one or more extraocular muscles which are responsible for eye movements. It is a physical finding in certain neurologic, ophthalmologic, and endocrine disease. Internal ...

(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 * ''

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

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 Immunoglobulin E (IgE) is a type of antibody (or immunoglobulin (Ig) " isoform") that has been found only in mammals. IgE is synthesised by plasma cells. Monomers of IgE consist of two heavy chains (ε chain) and two light chains, with the ε ...

mediated allergic mucosal inflammation.

Diagnosis

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

:::::::*Suggestive clinical features include - multiple recurrent episodes, persistent

pathology Pathology is the study of disease. The word ''pathology'' also refers to the study of disease in general, incorporating a wide range of biology research fields and medical practices. However, when used in the context of modern medical treatme ...

, and absent ability to smell (the Eustachian tube may also be affected). :::::::*

X-Ray An X-ray (also known in many languages as Röntgen radiation) is a form of high-energy electromagnetic radiation with a wavelength shorter than those of ultraviolet rays and longer than those of gamma rays. Roughly, X-rays have a wavelength ran ...

- can be done if the diagnosis is not certain. :::::::* CT – can document the presence of sinusitis, in the coronal views :::::::*

MRI Magnetic resonance imaging (MRI) is a medical imaging technique used in radiology to generate pictures of the anatomy and the physiological processes inside the body. MRI scanners use strong magnetic fields, magnetic field gradients, and rad ...

– used to find the CNS spread (extent of the disease), to evaluate individuals who demonstrate signs of invasive fungal sinusitis :::::::*

Histology Histology, also known as microscopic anatomy or microanatomy, is the branch of biology that studies the microscopic anatomy of biological tissue (biology), tissues. Histology is the microscopic counterpart to gross anatomy, which looks at large ...

studies

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 cases where the fungus has invaded the sinus tissue,

echinocandin Echinocandins are a class of antifungal drugs that inhibit the synthesis of β-glucan in the fungal cell wall via noncompetitive inhibition of the enzyme 1,3-β glucan synthase. The class has been dubbed the "penicillin of antifungals," along w ...

s, oral

voriconazole Voriconazole, sold under the brand name Vfend among others, is an antifungal medication used to treat a number of fungal infections. This includes aspergillosis, candidiasis, coccidioidomycosis, histoplasmosis, penicilliosis, and infections b ...

, and I.V

amphotericin Amphotericin B is an antifungal medication used for serious fungal infections and leishmaniasis. The fungal infections it is used to treat include mucormycosis, aspergillosis, blastomycosis, candidiasis, coccidioidomycosis, and cryptococcosis. ...

may be used * For allergic fungal sinusitis, systemic corticosteroids like

prednisolone Prednisolone is a corticosteroid, a steroid hormone used to treat certain types of allergies, inflammation, inflammatory conditions, autoimmune disorders, and cancers, Electrolyte imbalance, electrolyte imbalances and skin conditions. Some of ...

methylprednisolone Methylprednisolone (Depo-Medrol, Medrol, Solu-Medrol) is a synthetic glucocorticoid, primarily prescribed for its anti-inflammatory and immunosuppressive effects. It is either used at low doses for chronic illnesses or used at high doses durin ...

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.

References

External links

{{Medicine, state=collapsed Nose disorders