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Global distribution of fungal rhinosinusitis

S Zhou1, R Kwizera2, F Bongomin3

  • 1Key Laboratory of Environmental Pollution Monitoring and Disease Control, Ministry of Education of Guizhou, Key Laboratory of Microbiology and Parasitology of Education Department of Guizhou, School of Public Health, School of Basic Medical Science, Guizhou Medical University, Guiyang, China; Department of Medical Microbiology, Radboudumc, Nijmegen, The Netherlands; Radboudumc-CWZ Center of Expertise for Mycology, Radboudumc, Nijmegen, The Netherlands.

Rhinology
|March 5, 2026
PubMed
Abstract

Insights

Fungal rhinosinusitis (FRS) is a global health issue, with non-invasive forms common and invasive types causing significant harm, especially in tropical areas. Aspergillus species show distinct geographic preferences, impacting diagnosis and treatment strategies.

Area of Science:

  • Infectious Diseases
  • Mycology
  • Epidemiology

Background:

  • Fungal rhinosinusitis (FRS) encompasses diverse subtypes with limited global comparative data.
  • Understanding regional variations in FRS epidemiology and outcomes is crucial.

Purpose of the Study:

  • To conduct a systematic review and meta-analysis of fungal rhinosinusitis (FRS) cases globally.
  • To categorize FRS subtypes and assess variations across different geographic regions.

Main Methods:

  • Adherence to PRISMA guidelines for systematic review and meta-analysis.
  • Inclusion of 2,031 studies encompassing 40,860 cases from 77 countries.
  • Categorization of cases into seven distinct subtypes for regional analysis.

Main Results:

  • Non-invasive FRS (fungal ball, allergic) constituted 60% of cases.
  • Invasive FRS subtypes were more prevalent in tropical climates, notably hyperacute rhino-orbito-cerebral mucormycosis.
  • Aspergillus species distribution varied geographically: A. fumigatus in temperate zones, A. flavus in tropical regions. Invasive FRS exhibited significant morbidity and mortality.

Conclusions:

  • Fungal rhinosinusitis (FRS) is a significant global health concern, with non-invasive forms predominating.
  • Invasive FRS subtypes pose substantial morbidity and mortality risks, particularly in tropical regions.
  • Distinct geographic and climatic preferences of Aspergillus species necessitate climate-informed diagnostic and surveillance strategies.

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