Fungal sinusitis

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Fungal sinusitis is defined as the infection of the sinuses caused by fungi. Fungal infection of sinuses has recently been blamed being the most common cause of cases of chronic rhinosinusitis.

Fungal infections of the paranasal sinuses are uncommon and usually occur in individuals who are immunocompromised. The cases of fungal sinusitis are increased in the immunocompetent population.

[/expand]Classification of Fungal sinusitis

There are different types of fungal sinusitis and different types have different pathologies are given as under:-

Mycetoma fungal sinusitis

In this type of sinus infection by fungi there is production of clumps of spores, fungal ball within the cavity of sinus most commonly maxillary sinuses. In this type fungus does not cause a significant inflammatory response but there occur sinus discomfort.

Allergic fungal sinusitis

This type of fungal sinusitis is believed to be an allergic reaction to environmental fungi which are dispersed into the air. In this type thick fungal debris and mucin are developed in the sinus cavities.

Chronic indolent sinusitis

This type of fungal sinusitis is an invasive form of fungal sinusitis especially in patients who are immune deficiency. Chronic indolent sinusitis is characterized by a granulomatous inflammatory infiltrate.

Fulminant sinusitis

This type of sinusitis is mostly seen immunocompromised patient. This type leads to destruction of the sinuses and can invade the body cavities containing the eyeball and brain. Chronic sinus infections are the results of fungus exposure.

Age/Sex of Fungal sinusitis

Individuals of any age and of any sex can be affected by fungal sinusitis.

Race of Fungal sinusitis

Individuals of any race can be affected by fungal sinusitis.

Causes of Fungal sinusitis

Common organisms that cause different types of fungal sinusitis are given below according to the type of fungal sinusitis they produce

Non invasive type of fungal sinusitis

Allergic fungal sinusitis are caused by following organisms:-

•Curvularia lunata.

•Aspergillus fumigates.

•Bipolaris.

•Drechslera.

Sinus mycetoma are caused by following organisms :-

•Fumigates.

•Dematiaceous fungi.

Invasive type of fungal sinusitis

Acute fulminant type, the chronic and granulomatous types are caused by following types of fungi

•Rhizopus.

•Rhizomucor.

•Absidia.

•Mucor.

•Cunninghamella.

•Mortierella.

•Saksenaea.

•Apophysomyces species.

Fumigates is the only fungus type which is associated with chronic invasive fungal sinusitis.

Granulomatous invasive fungal sinusitis is caused mainly by the aspergillus flavus fungi.

Fungal sinusitis Signs and Symptoms
 

Different type of fungal sinusitis gives different type of signs and symptoms and are explained below:-

Allergic fungal sinusitis presents the following symptoms:-

•Facial pressure.

•Headache.

•Nasal stuffiness.

•Discharge.

•Cough.

•Proptosis or eye muscle entrapment is seen in some patients.

Acute invasive fungal sinusitis show the following symptoms:-

•Patient is very sick with fever.

•Cough.

•Nasal discharge.

•Headache.

•Mental status changes.

•There are dark ulcers present on the septum, turbinates or palate.

Chronic invasive fungal sinusitis include following symptoms

•There are symptoms of chronic sinusitis along with proptosis.

Investigation for Fungal sinusitis
 

Following test will indicate the presence of fungal infection in sinuses:-

•Elevated levels of total fungus-specific IgE concentrations.

•Enzyme linked immunoabsorbent assays are helpful in diagnosis.

Other imaging techniques help in diagnosis are as follows

•CT scan of paranasal sinuses.

•MRI helps in seeing the spread of infection.

Histological findings are also help to confirm diagnosis of type of fungal sinusitis affecting the patient.

Complication of Fungal sinusitis

•There occur complications if the sinusitis is not treated at right time.

•Complications involve orbit and CNS.

•Necrosis and damage to the adjacent structures.

•Cavernous sinus thrombosis.

•Erosions in the orbit.

Treatment for Fungal sinusitis

Treatment given in fungal sinusitis is given below:-

Medications to be given are as follows-

•Systemic steroids.

•Immune therapy in specific allergens.

•Systemic antifungals.

•Antifungal medications.

Surgical treatment is more helpful

Removing of the fungal balls with surgery is very helpful.

Endoscopic lesion removal is performed when the lesion is accessible.

Surgical debridement is another procedure to treat the case of fungal sinusitis.

Prognosis of Fungal sinusitis

Prognosis of fungal sinusitis is not complicated or worse, if treated at right time with proper medication that is antifungal medications then results are very good.Prognosis is good but tendency to reoccur is very common in such individuals.

Differential diagnosis of Fungal sinusitis

Rhinosporidiosis is taken as the differential diagnosis of fungal sinusitis.

Homeopathic Treatment for Fungal sinusitis

Hydrastis

•Well indicated medicine for patients suffering from fungal sinusitis.

•Patient complaints of ozaena with ulceration of septum.

•Patient tends to blow nose all the time.

•There is thick tenacious discharge from posterior nares to throat.

•Discharge from nose is watery and excoriating.

Mercurius solibus

•Very well indicated medicine for fungal sinusitis.

•Itching in nose.

•Given to dirty nose children.

•There is putrid smell from nose.

•Painful pustule in nose.

•Discharge from nose is greenish fetid and corrosive pus from the nostrils.

•Frequent and profuse bleeding from nose, even during sleep and sometimes when coughing.

•Dry coryza with obstruction in nose or fluent coryza with copious discharge of corrosive serum.

Cuprum mettalicum

•Very well indicated medicine for fungal sinusitis.

•Nose gets stopped up every time person goes out into cold air.

•Nose is sore and ulcerated.

•Soreness of nostrils with catarrhal troubles.

Hepar sulphuris 

•Nose is sore and ulcerated.

•Soreness of nostrils with catarrhal troubles.

•Nose stopped up every time he goes out into cold air.

•Patient sneezes every time he goes into a cold, dry wind with running from nose, later discharge become thick and offensive.

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