Fungal Sinusitis

• Most commonly occurs in immunocompromised pts (hematologic malignancies, BMT, solid organ transplant recipients, chemo-induced neutropenia, advanced HIV, DM)

• Immunosuppression is also the major risk factor for invasive fungal infections outside of the sinuses

• Clinical presentation is acutely with fever, facial pain, nasal congestion, epistaxis, and changes in vision or mental status.

• Facial numbness or diplopia may occur in the setting of CN involvement. (many patients already have extension of the infection outside the sinuses at the time of presentation)

• CT shows sinus involvement, and may reveal bony erosions; however, none of the CT findings are specific enough to allow for a diagnosis. MRI should be performed to assess intracranial and cavernous sinus involvement (especially in patients with focal neurologic deficits

• Most common species are mucor, rhizopus and aspergillus (Candida less commonly and less virulent) 

• Normal hosts can be colonized with fungal spores (especially aspergillous), but not clinically infected

• Treatment is primarily emergency surgical debridement and, if possible, correction of the underlying immunologic derangement. Secondary treatment includes systemic anti-fungal therapy.

• Despite timely surgical debridement, and appropriate adjuvant medical treatment, mortality rates remain upwards of 50 percent

Overview of antifungal agents:

(Victoria Kelly MD, 12/20/10)