Fungal Sinusitis Fungal sinusitis is relatively uncommon, but should be considered in patients with chronic sinusitis because of its potentially serious complications. Aspergillus species are the most common causes of fungal sinusitis, and fungi of the order Mucorales are the most dangerous (rhinocerebral mucormycosis). Various widely distributed pigmented fungi that are collectively known as dematiaceous molds can cause a variety of syndromes that include life-threatening disease; examples of these organisms include Alternaria, Bipolaris, Cladosporium, Curvularia, and Exserohilum. Numerous other fungi sometimes cause sinusitis. Five syndromes are currently recognized. Simple colonization of the paranasal sinuses by fungi may be relatively common, although the incidence is unknown. Sinus mycetoma (fungus ball) presents most often as a mass in the maxillary sinus. Underlying disease is usually not present although some patients have nasal polyps and chronic bacterial sinusitis. Patients usually seek medical attention for nasal obstruction, facial pain, symptoms of chronic sinusitis, or fetid breath (cacosmia). Seizures have been reported as a presenting manifestation. Allergic fungal sinusitis usually presents as intractable sinusitis with nasal polyposis in patients with atopy. Some patients also have allergic bronchopulmonary aspergillosis. Children with allergic sinusitis may develop hypertelorism or proptosis when the frontal or ethmoid sinuses are involved. As mentioned above, some investigators believe that allergic fungal sinusitis is present in a majority of patients who carry the diagnosis of chronic rhinosinusitis. Acute (fulminant) invasive fungal sinusitis is essentially synonymous with rhinocerebral mucormycosis, which usually occurs in patients with diabetes mellitus or severe immunosuppression from other causes. The sinuses have been called way stations to the brain in this medical emergency, which classically presents as a painless black eschar on the palate or a nasal turbinate followed by epistaxis, headache, changes in mental status, and focal neurologic symptoms and signs (such as diplopia). Other fungi including Aspergillus species, Fusarium species, and Pseudallescheria boydii can cause an identical syndrome, typically in patients who are severely immunosuppressed from disease (including AIDS) or chemotherapy for cancer or organ transplantation. Chronic invasive fungal sinusitis can occur not only in immunocompromised patients but also in patients who are immunologically normal. Most of these latter patients have chronic sinusitis and nasal polyposis. Causative organisms include the dematiaceous molds noted above; the condition is known as phaeohyphomycosis. Dense masses of fungal elements resembling mycetoma are found, but there is also invasion into the mucosa and then into bone. Patients present with headache and localizing symptoms such as decreased vision and loss of eye movement (orbital apex syndrome) or behavioral changes (mycetoma of the frontal lobe).
Posted on: Tue, 22 Oct 2013 00:59:39 +0000
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