Invasive Fungal Sinusitis

ABSTRACT Invasive sinus Aspergillus infection has been reported in the last decade with increased frequency, most commonly in the setting of hematologic malignancy, neutropenia, HIV infection and other states of immunosuppression. Fungal rhinosinusitis can be broadly classified into two varieties-invasive and noninvasive on the basis of tissue invasion. Invasive fungal sinusitis are acute invasive, chronic invasive (both granulomatous and nongranulomatous forms), whereas noninvasive are fungus balls and allergic fungal sinusitis. Invasive fungal sinusitis is one of the most challenging forms of sinonasal pathology to manage, most commonly presenting in immunocompromised individuals. Chronic invasive being sinus aspergillosis (CISA) is being reported in immunocompetent patients at an increasing rate while most of these cases are being reported from the India subcontinent and middle east. Invasive fungal sinusitis is on the rise worldwide and especially in north India as it is endemic in this part of the country. It is affecting immunocompetent young and middle aged population causing a great morbidity and mortality. This entity needs to be picked up early by spreading awareness among the family physicians, internists, otolaryngologists, ophthalmologists, neurosurgeons, pulmonary physicians, critical care specialists so that an early management can initiated to achieve better control over the disease. This review is an attempt to initiate an interdisciplinary approach to achieve a better outcome. How to cite this article Gupta AK, Bansal S, Rijuneeta, Gupta B. Invasive Fungal Sinusitis. Clin Rhinol An Int J 2012;5(2): 63-71.

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Fungal sinusitis clinical presentation, latest management: A Review Update

Journal of Science Foundation ◽

10.3329/jsf.v12i1.23460 ◽

2015 ◽

Vol 12 (1) ◽

pp. 16-19

Author(s):

Bithi Bhowmik

Keyword(s):

Paranasal Sinuses ◽

Disease Process ◽

High Rate ◽

Fungus Ball ◽

Fungal Sinusitis ◽

Allergic Fungal Sinusitis ◽

Invasive Fungal Sinusitis ◽

Radiologic Imaging ◽

Chronic Invasive

Fungal sinusitis is a relatively common, 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 on radiologic imaging, specifically computed tomography (CT) and magnetic resonance (MR) imaging. The classification of fungal sinusitis is ever changing, but under the most current and widely accepted classification fungal sinusitis is broadly categorized as either invasive or noninvasive. Invasive fungal sinusitis is defined by the presence of fungal hyphae within the mucosa, submucosa, bone, or blood vessels of the paranasal sinuses. Invasive fungal sinusitis is subdivided into acute invasive fungal sinusitis, chronic invasive fungal sinusitis, and chronic granulomatous invasive fungal sinusitis. Conversely, noninvasive fungal sinusitis is defined by the absence of hyphae within the mucosal and other tissues of the paranasal sinuses. Noninvasive fungal sinusitis is subdivided into allergic fungal sinusitis and fungus ball (fungal mycetoma).Journal of Science Foundation, 2014;12(1):16-19

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Conversion to Chronic Invasive Fungal Sinusitis From Allergic Fungal Sinusitis in Immunocompetence

The Laryngoscope ◽

10.1002/lary.27884 ◽

2019 ◽

Vol 129 (11) ◽

pp. 2447-2450 ◽

Cited By ~ 6

Author(s):

Luke Edelmayer ◽

Christopher Ito ◽

Won Sok Lee ◽

James Kimbrough ◽

Stilianos E. Kountakis ◽

...

Keyword(s):

Fungal Sinusitis ◽

Allergic Fungal Sinusitis ◽

Invasive Fungal Sinusitis ◽

Chronic Invasive

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Imaging of granulomatous and chronic invasive fungal sinusitis: Comparison with allergic fungal sinusitis

Otolaryngology ◽

10.1016/j.otohns.2010.02.027 ◽

2010 ◽

Vol 143 (2) ◽

pp. 294-300 ◽

Cited By ~ 28

Author(s):

C. Ekambar Eshwara Reddy ◽

Ashok K. Gupta ◽

Paramjit Singh ◽

Sher B. S. Mann

Keyword(s):

Fungal Sinusitis ◽

Allergic Fungal Sinusitis ◽

Invasive Fungal Sinusitis ◽

Chronic Invasive

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Chronic Invasive Fungal Sinusitis With Negative Histopathology: A Diagnostic Challenge

Ear Nose & Throat Journal ◽

10.1177/0145561320973773 ◽

2021 ◽

pp. 014556132097377

Author(s):

Anne Ning ◽

Arminé Kocharyan ◽

W Colby Brown ◽

Brian D’Anza

Keyword(s):

Definitive Diagnosis ◽

Fungal Sinusitis ◽

Chain Reaction ◽

Diagnostic Challenge ◽

Invasive Fungal Sinusitis ◽

Fungal Organisms ◽

Fungal Dna ◽

Polymerase Chain ◽

Histopathologic Findings ◽

Chronic Invasive

Although the diagnosis of chronic invasive fungal sinusitis relies chiefly on identification of invasive fungi on histology, the insidious nature of the disease can preclude detection of fungal organisms. Here, we present a case of chronic invasive fungal sinusitis with negative histopathologic findings and a definitive diagnosis made through fungal DNA detection. Clinicians should consider polymerase chain reaction an important complement to histology and culture in the diagnosis of chronic invasive fungal sinusitis.

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1740. Title: Outcomes of a Clinical Algorithm for the Early Diagnosis and Treatment of Invasive Fungal Sinusitis among Children with Hematologic Malignancy or Prior Hematopoietic Stem Cell Transplantation

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.1603 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S637-S637

Author(s):

Gohar Warraich ◽

Naomi Winick ◽

Tamra Slone ◽

Victor M Aquino ◽

Kimberly Donner ◽

...

Keyword(s):

Stem Cell ◽

Absolute Neutrophil Count ◽

Neutrophil Count ◽

Hematologic Malignancy ◽

Morbidity And Mortality ◽

Fungal Sinusitis ◽

Significant Morbidity ◽

Hematopoietic Stem ◽

Clinical Algorithm ◽

Invasive Fungal Sinusitis

Abstract Background Invasive fungal sinusitis (IFS) is a cause of significant morbidity and mortality among children with hematologic malignancy and hematopoietic stem cell transplant (HSCT) recipients, with an estimated mortality of 18–80%. Since 2007, our center has employed a clinical algorithm for the early detection and treatment of IFS among children with prolonged febrile neutropenia. Methods We reviewed all EORTC defined cases of proven IFS among children with underlying hematologic malignancy or prior HSCT admitted to our institution between July 1, 2004 and December 31, 2018, and compared clinical characteristics and outcomes (including underlying malignancy, chemotherapy regimen at the time of viremia, absolute neutrophil count, absolute lymphocyte count, treatment regimens, and 6 month mortality) between the pre (July 1, 2004–December 31, 2006) and post-protocol (January 1, /2007–December 31, 2018) periods. Results We identified 33 cases of proven IFS during the study period, with 6 in the pre-protocol and 27 in the post-protocol period. The most common underlying primary diagnosis was acute lymphoblastic leukemia (ALL) at > 50% with 8% of individuals with prior HSCT. Twenty-five cases (92%) during the protocol period were diagnosed via nasal endoscopy per protocol, with 17 (63%) reporting no clinical complaints of sinusitis. Median absolute neutrophil count (ANC) at the time of IFS diagnosis was 155/mm3 (IQR 0 – 375/ mm3; n = 12) with median duration of neutropenia 16.5 days (IQR 10.5–18.25, n = 12) at the time of diagnosis. Most individuals required one definitive debridement. Isolated fungal specimens included Bipolaris spp. (24%), Aspergillus spp. (20%), Curvularia spp. (20%), with Fusarium and Exserohilum spp. each at 12%, and Rhizopus spp. At least one patient had a co-infection with more than one fungal species. Pre-protocol cause-specific mortality at 6 months was 33.3% compared with 14.8% (P = 0.29) in the post- protocol period. Conclusion IFS is a cause of significant morbidity and mortality among children with hematologic malignancy or prior HSCT. An aggressive protocol with early nasal endoscopy and targeted debridement may help decrease morbidity and mortality associated with this entity. Additional well-designed studies are needed to assess the potential benefits of this approach in the diagnosis and management of IFS among high-risk children. Disclosures All authors: No reported disclosures.

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A Case of Chronic Invasive Fungal Sinusitis with Invasion of the Nasolacrimal Duct

Practica oto-rhino-laryngologica Suppl ◽

10.5631/jibirinsuppl.148.40 ◽

2017 ◽

Vol 148 (0) ◽

pp. 40-41

Author(s):

Shuta Tomisato ◽

Sayuri Yamamoto ◽

Taiji Kawasaki ◽

Koichirou Wasano

Keyword(s):

Nasolacrimal Duct ◽

Fungal Sinusitis ◽

Invasive Fungal Sinusitis ◽

Chronic Invasive

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Chronic Invasive Fungal Sinusitis Presenting as Inferior Altitudinal Visual Field Defect

Neuro-Ophthalmology ◽

10.1080/01658107.2017.1292296 ◽

2017 ◽

Vol 41 (3) ◽

pp. 144-148

Author(s):

Reema Bansal ◽

Aastha Takkar ◽

Vivek Lal ◽

Amanjit Bal ◽

Sandeep Bansal

Keyword(s):

Visual Field ◽

Visual Field Defect ◽

Fungal Sinusitis ◽

Invasive Fungal Sinusitis ◽

Field Defect ◽

Chronic Invasive

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Fungal sinusitis diagnostic management and classification

Acta chirurgica iugoslavica ◽

10.2298/aci0903145p ◽

2009 ◽

Vol 56 (3) ◽

pp. 145-148

Author(s):

I. Pendjer ◽

I. Boricic ◽

V. Arsic ◽

Z. Dudvarski ◽

J. Dotlic ◽

...

Keyword(s):

Elevated Serum ◽

Diagnostic Procedures ◽

Specific Ige ◽

Topical Steroids ◽

Positive Staining ◽

Fungal Sinusitis ◽

Allergic Fungal Sinusitis ◽

Positive Skin ◽

Non Invasive ◽

Invasive Fungal Sinusitis

The aim of this paper is to present the current classification of fungal sinusitis and share our experiences in diagnostic procedures and treatment outcomes. The study includes 31 patients operated since 2000-2009. in whome some form of fungal infection had been diagnosed. There were 10 patients with mycetoma, and 16 patients with chronic non-invasive fungal sinusitis, while in five patients allergic fungal sinusitis was proven. All patients were treated postoperatively with topical steroids and irrigation with saline solution, without use of fungicides. Characteristics of chronic non-invasive funga sinusitis and mycetoma are CT with specific opacification and calcification with involement of maxillary sinus unilaterally or bilateral together with pathohistological finding of positive staining by Grocott with the identification of fungi from secret or tissue. Allergic fungal sinusitis is characterized by eosinophilia, positive skin test to fungal allergens, elevated serum level of both specific IgE antibodies to causal fungus and total IgE, as well as, pathohistological finding of allergic mucus which include non-invasive hifa. Fungal sinusitis in immunocompetent patients is classified into the following categories: mycetoma, chronic non-invasive fungal sinusitis, chronic indolent sinusitis (which does not occur in our population) and allergic fungal sinusitis.

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