Fungal Rhinosinusitis: Unravelling the Disease Spectrum

Abstract

Fungal rhinosinusitis (FRS), once considered a rare disease, has seen a steep rise in incidence in recent times. This global rise in the burden of fungal disease is a consequence of an increment in the population with weakened immune systems. Increased life expectancy with rise in conditions like diabetes mellitus, medical advancements with invasive interventions, use of immunosuppressive drugs and chemo-radiotherapy all lead to unique risk situations. The situation becomes more alarming with the fact that there has been a significant rise in cases in immune-competent hosts with no predisposing factors. FRS represents a wide spectrum of disease ranging from the mild form of superficial colonization, allergic manifestations to life threatening extensive invasive disease. The categorization of disease into acute and chronic and invasive or noninvasive is important factor with implications in disease management and prognosis and this has been emphasized greatly in recent years. Diagnosis of FRS has been a challenge as the presenting clinical signs and symptoms and radiographic manifestations are often nonspecific. Definitive diagnosis requires direct fungi identification and hence culture and microscopic examination remain the gold standard. Availability of advanced and rapid diagnostic techniques is rare in majority of developing nations. Therapeutic dilemmas are another aspect of the management of FRS as in spite of the availability of new antifungal drugs, treatment is often empirical due to non-availability of early diagnosis, rapid disease progression and high costs of antifungal drugs. A description of the different types of FRS, their diagnosis and management has been presented in this review.

Fungal sinusitis: a spectrum of disease

“…Finally, chronic granulomatous fungal sinusitis (CGIFS), hallmarked by its indolent course and granulomatous immunologic response of the host, is not associated with immune abnormalities. 4,5 The distinction between noninvasive and invasive disease is recognized as an important prognostic factor and guides treatment. 5 Rare cases of conversion or progression from noninvasive AFS to IFS have been reported in the literature and observed at our institution.…”

Patient with nasal congestion, purulent discharge, facial pain and hyposmia

“…is one that should be considered 1 . This infection is particularly frequent in people with weakened immune systems, such as those using immunosuppressive drugs and corticoid therapy, those undergoing chemo and radiotherapy, and those with acquired immunodeficiency syndrome and uncontrolled diabetes mellitus among others 2 …”

Chronic Invasive Fungal Sinusitis With Negative Histopathology: A Diagnostic Challenge

“…[1][2][3][4][5] Globally, rates of fungal rhinosinusitis in immunocompetent individuals are uptrending. 6 Diagnosis of CIFS is challenging. Symptoms are nonspecific and range from facial pain to vision loss.…”