Chronic Granulomatous Invasive Fungal Sinusitis in Patients With Immunocompetence: A Review

Area of Science:

• Otorhinolaryngology
• Mycology
• Infectious Diseases

Background:

• Chronic granulomatous invasive fungal sinusitis (CGIFS) is a rare condition affecting immunocompetent adults, often presenting with orbital or sinonasal masses.
• Historically, management has involved radical surgical interventions, but evolving treatment strategies are being explored.
• Geographical distribution of reported cases highlights prevalence in regions like Sudan, India, and Saudi Arabia.

Approach:

• A comprehensive literature review was conducted using PubMed, PubMed Central, and Scopus databases, spanning 50 years.
• 147 relevant articles were analyzed, focusing on 15 homogenous and 8 heterogeneous case series of CGIFS.
• Data extraction included patient demographics, clinical presentation, microbiological findings, treatment modalities, and outcomes.

Key Points:

• Aspergillus flavus is the most common fungal isolate in CGIFS.
• Typical presentation involves slowly progressive masses with proptosis and sinonasal symptoms, frequently affecting ethmoid and maxillary sinuses.
• Intracranial extension occurs in over a third of cases.

Conclusions:

• There is a discernible trend towards less invasive surgical techniques, primarily endoscopic excision, combined with azole antifungal therapy.
• This shift in management has led to favorable outcomes, with high rates of complete resolution or improvement.
• Mortality rates, though variable, underscore the importance of timely and effective treatment.