1. RANGEEN CHANDRAN R

2.  Fungal sinusitis is a clinical entity characterized by
inflammation of sinus mucosa due to fungal infection.
 Seen in immunocompetent/immunocompromised
hosts.

3. CAUSATIVE AGENTS
 Aspergillus
 Mucormycosis
 Paecilomyces
 Candida
 Penicillium species

4. CAUSATIVE FACTORS
 Diabetics and immunocompromised patients.
 Patients with chronic renal failure.
 Prolonged systemic steroids.
 Chemotherapy.
 Prolonged use of steroid nasal spray.

5. Classification
 Non invasive fungal sinusitis
o Allergic fungal rhinosinusitis(AFRS).
o Mycetoma.
 Invasive fungal sinusitis.
o Acute invasive fungal sinusitis.
o Chronic invasive sinusitis.

6. CHRONIC INVASIVE FUNGAL
SINUSITIS
 Slowly progressive fungal infection with a low-
grade invasive process.
 Diabetic patients.
 Presents with symptoms of long standing sinusitis.
 Persistent and recurrent.
 Orbital apex syndrome,occular immobility.
 Bipolaris and aspergillus.

8. Treatment
 Surgical treatment-mandatory.
 Antifungal therapy.
o Amphotericin B(2-3g)
o Replaced by itroconazole/ketoconazole.
 Long term follow up care is required.

9. ACUTE FULMINANT FUNGAL
SINUSITIS
 Most lethal form of fungal sinusitis.
 Seen in immunocompromised ,diabetics and
advanced AIDS.
 Symptoms include fever, facial pain or numbness,
nasal congestion, serosanguineous nasal
discharge, and epistaxis
 Intraorbital, intracranial, and maxillofacial
extension is common.

10.  Characterised by a painless, necrotic nasal septal ulcer
,sinusitis, and rapid orbital and intracranial spread
leading to death.

11. Treatment
 Emergency surgery required.
 Radical debridement of necrotic tissue.
 Antifungal treatment.
 Long term follow up care required.
 Has a poor prognosis.

12. Complications
Once untreated
cavernous sinus
thrombosis and
invasion of CNS
develops.

13. FUNGAL BALL
 Implantation of fungus into
sinus cavity.
 Usually unilateral.
 Maxillary sinus commonly
involved.
 Seen in immunocompetent.
 Commonest cause-Aspergillus
species.

15. TREATMENT
 Recommended treatment is surgical.
 No antifungal treatment is necessary.

16. ALLERGIC FUNGAL
RHINOSINUSITIS

17.  Most common form of fungal sinusitis.
 Recognised as IgE mediated response to dematiaceous
fungi.
 Aspergillus spp,
 Bipolaris
 Curvularia
 Alternaria

18. Criteria for diagnosis
1. Type 1 hypersensitivity.
2. Nasal polyposis.
3. Characteristic CT scan appearance.
4. Thick eosinophilic mucin.

19. Presentation
 Atopic
 Present with signs and symptoms of nasal airway
obstruction, chronic sinusitis that includes nasal
congestion, purulent rhinorrhea, postnasal drainage.

20. Nasal polyposis

21. Coronal CT scan showing typical unilateral
appearance of allergic fungal sinusitis with
hyperintense areas and inhomogeneity of
the sinus opacification; the hyperintense
areas appear whitish in the center of the
allergic mucin.

23. A 15-year-old boy with allergic fungal
sinusitis causing right proptosis,
telecanthus, and malar flattening; the
position of his eyes is asymmetrical, and his
nasal ala on the right is pushed inferiorly
compared to the left

24. ALLERGIC MUCIN
 Reliable indicator.
 Appears
thick,tenacious,peanut
butter like brown green
mucus containing
eosinophils,charcot
laden crystals and
hyphae.

26. IgE levels
 Total IgE values generally are elevated in AFS(90%)
 Total IgE level traditionally has been used to monitor
the clinical activity of allergic bronchopulmonary fungal
disease.
 IgE levels have been proposed as a useful indicator of
AFS clinical activity.

27. TREATMENT
 Surgical debridement of mucin and polyps.
 Administration of systemic steroids.
 Topical nasal steroid are helpful postoperatively.
 Aggressive nasal salt-water washes are
recommended.

28. Coronal MRI showing
expansion of the sinuses
with allergic mucin and
polypoid disease; the
hypointense black areas in
the nasal cavities are the
actual fungal elements and
debris. The density above
the right eye is the
mucocele. The fungal
elements and allergic
mucin in allergic fungal
sinusitis always look
hypointense on MRI
scanning and can be
mistaken for absence of
disease.

29. COMPLICATIONS OF FUNGAL
SINUSITIS
 Orbital cellulitis.
 Orbital abscess.
 Intracranial invasion causing meningitis.
 Cavernous sinus invasion.