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Sinus aspergillosis and allergic fungal sinusitis
1Dept of Pathology, University of Texas M.D. Anderson Cancer Center, Houston 77030.
Abstract:
Aspergillosis of the sinonasal tract has four basic clinicopathologic presentations depending on the mucosal or extramucosal involvement by the fungus. Two are saprophytic (aspergilloma and allergic Aspergillus sinusitis) and two are infectious (chronic indolent and invasive fulminant sinusitis). Tissue-invasive and angioinvasive aspergillosis can be a rapidly lethal disease, particularly in the immune-compromised host. The allergic form of paranasal sinus aspergillosis is presumed to be initiated by hyperreactivity to fungal antigens. Not all allergic fungal sinusitis is associated with Aspergillus species, and culture confirmation is necessary to distinguish the fungal agent. Surgical removal of the offending fungus is the mainstay of therapy in all forms of sinonasal aspergillosis and other fungal sinusitis. Antifungal agents and steroids complement surgical removal, depending on the form of the sinusitis.
Insights
This study outlines four types of sinonasal aspergillosis, differentiating between saprophytic and infectious forms. Surgical removal is key for treating all fungal sinusitis types, often with antifungal medications and steroids.
Area of Science:
- Otolaryngology
- Mycology
- Infectious Diseases
Background:
- Sinonasal aspergillosis presents in four clinicopathologic forms based on fungal involvement (mucosal vs. extramucosal).
- These forms include saprophytic (aspergilloma, allergic Aspergillus sinusitis) and infectious (chronic indolent, invasive fulminant sinusitis) types.
- Invasive fungal sinusitis can be rapidly fatal, especially in immunocompromised individuals.
Purpose of the Study:
- To categorize the clinicopathologic presentations of sinonasal aspergillosis.
- To highlight the role of fungal antigens in allergic forms.
- To emphasize diagnostic confirmation and therapeutic strategies.
Main Methods:
- Review of clinicopathologic presentations of sinonasal aspergillosis.
- Discussion of diagnostic considerations, including culture confirmation for fungal agents.
- Outline of therapeutic mainstays and adjunctive treatments.
Main Results:
- Four distinct clinicopathologic presentations of sinonasal aspergillosis are identified.
- Allergic fungal sinusitis is linked to hypersensitivity to fungal antigens, requiring specific fungal identification.
- Tissue-invasive and angioinvasive forms pose significant mortality risks.
Conclusions:
- Surgical extirpation of the fungus is the primary treatment for all sinonasal fungal sinusitis.
- Antifungal agents and corticosteroids serve as crucial adjuncts to surgical management.
- Accurate diagnosis, including fungal species identification, is essential for effective treatment of sinonasal aspergillosis.