Fungal rhinosinusitis refers to a broad group of conditions caused by fungal infections of the paranasal sinuses.
In this condition, an isolated paranasal sinus is completed filled with a ball of fungal debris. The maxillary sinus is the most site. Patient symptoms include fullness, pressure and discharge. Treatment requires surgery for complete removal of all fungal elements. The prognosis is good.
Allergic fungal rhinosinusitis (AFRS) is characterized by thick sinus secretions, which have a characteristic golden-yellow color and have a consistency like rubber cement. These secretions contain proteins from degranulated eosinophils (a type of inflammatory cell) plus some fungal elements. Patients often will have received multiple treatments (including steroids) for chronic rhinosinusitis before the diagnosis of AFRS is confirmed. Many AFRS patients also have asthma. Endoscopic sinus surgery is required for diagnosis and mechanical cleansing of the sinuses, but surgery must be combined with long-term medical management. Medical treatments include systemic and topical corticosteroids and antifungals as well as antibiotics for bacterial infection.
Acute fulminant invasive rhinosinusitis (also known as rhinocerebral mucormycosis or simply “mucor”) occurs when fungal organisms invade the sinus tissues in patients who are immunosuppressed. Classically, these patients have suppressed immune systems due to chemotherapy administered for cancer treatment, or they have diabetes which leads to immune suppression. In the early stages, patients have an area of necrotic tissue (i.e., dead tissue due to invasion by the fungus) within the sinuses, but within hours, it can rapidly progress to eye and brain involvement. Prognosis is poor. Emergency surgery is necessary to confirm the diagnosis and to mechanically remove all dead tissue. Systemic antifungal treatment is also provided. If possible, the efforts to reverse the underlying immune suppression should be initiated.
In chronic invasive fungal rhinosinusitis, the process of invasion of the sinus tissues occurs over a period of weeks or months, rather than hours. Many patients with this relatively rare condition have subtle abnormalities in their immune system due to diabetes or chronic steroid use. Patients can present with eye swelling and blindness. Urgent surgery is necessary to confirm the diagnosis and to remove all involved tissues. Again, systemic antifungal treatments are also critically important.
The onset of granulomatous fungal rhinosinusitis is also gradual. This condition is characterized by a specific long-term inflammatory response, known as granulomatous inflammation to fungal organisms that have invaded the sinus tissues. Almost all cases occur in the Sudan and neighboring countries.