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Speciality Spotlight
Invasive
Fungal Rhinosinusitis
- The
patient who is immunocomprimized is susceptible to
invasive fungal rhinosinusitis. Acute or fulminant
also have been termed for this entity. Fulminant
conveys the meaning fatal outcomes are seen with
rapid destruction, if such patients remain untreated
or else immuno-compromised status is severe or
irreversible.
In this, vascular invasion is prominent histopathologically and the time course is less than 4 weeks duration.
The definition of chronic invasive is denoted to those findings where duration is more than 4 weeks and the vascular invasion is less or absent.
De Shazo et al has subdivided chronic invasive fungal disease into granulomatous and non-granulomatous histopathology but no difference in prognosis or therapy is seen.
The source of immunocompromisation can range from severe neutropenia (bone marrow transplant patient), organ transplant patients, Diabetes or HIV infection.
Diagnosis of Invasive Fungal Rhinosinusitis:
1) Clinical symptoms of Rhinosinusitis
2) Inability to raise a WBC count
3) Presence of actual hyphae present.
4) Culture – This may take days or weeks to grow.
5) Biopsy specimens by frozen section to show vascular involvement.
The goal of the clinician is to suspect and diagnose invasive fungal rhinosinusitis as early as possible to institute appropriate therapy.
Systemic antifungal therapy is not required in noninvasive form of fungal rhinosinusitis.
Although, Aspergillus species and Mucormycosis, especially in diabetes, are the most common infective invasive fungal organisms, rarely and occasionally nonpathogenic fungal species can cause invasive fungal rhinosinusitis.
Out of 20000 fungal species identified in the world, 250 fungal species have been reported to produce human infection.
