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Sinusitis: viral, bacterial, or fungal and what is the role of Staph?

Raymond G Slavin1

  • 1Department of Internal Medicine/Allergy and Immunology, St. Louis University School of Medicine, 1402 South Grand Avenue, Room R209, St. Louis, MO 63104, USA. slavinrg@slu.edu

Allergy and Asthma Proceedings
|December 21, 2006
PubMed

Insights

Fungi are increasingly recognized as a cause of chronic rhinosinusitis (CRS), particularly allergic fungal sinusitis in young adults. Treatment involves surgery and steroids, with ongoing research into antifungal agents.

Area of Science:

  • Otolaryngology
  • Immunology
  • Mycology

Background:

  • Inflammation, not bacterial infection, is now considered the primary driver of chronic rhinosinusitis (CRS).
  • Fungal pathogens are emerging as significant contributors to CRS development.
  • Allergic fungal sinusitis is a common form, typically affecting atopic individuals.

Purpose of the Study:

  • To review the role of fungi in chronic rhinosinusitis (CRS).
  • To discuss the presentation, diagnosis, and treatment of allergic fungal sinusitis.
  • To explore emerging evidence on fungal involvement in other CRS subtypes and potential therapies.

Main Methods:

  • Review of current literature on fungal sinusitis and CRS.
  • Description of clinical presentation, diagnostic imaging (CT scans), and histopathology (allergic mucin).
  • Summary of treatment outcomes for allergic fungal sinusitis and emerging therapies for other fungal-related CRS.

Main Results:

  • Allergic fungal sinusitis presents with nasal polyps and allergic mucin containing eosinophils and fungal hyphae.
  • Computer tomographic imaging often reveals sinus opacification with hyperdense areas.
  • Successful treatment for allergic fungal sinusitis includes surgery and oral prednisone; intranasal antifungals show promise for other fungal CRS types.

Conclusions:

  • Fungi play a crucial role in CRS pathogenesis, especially allergic fungal sinusitis.
  • While surgery and steroids are effective for allergic fungal sinusitis, further research is needed for other fungal-mediated CRS.
  • The role of Staphylococcus-derived enterotoxins in CRS requires further investigation.

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