fungal rhinosinusitis Flashcards
broadly what are the types of fungal rhinosinusitis ?
non invasive and invasive
what are the types of non invasive fungal rhinosinusitis ?
allergic fungal sinusitis
sinus mycetoball
what are the types of invasive fungal rhinosinusitis ?
acute invasive fungal sinusitis
chronic invasive fungal sinusitis
granulomatous invasive fungal sinusitis
what type of patient are commonly affected by allergic fungal sinusitis ?
immunocompetent patients who have asthma and high levels of fungi specific IgE and eosinophilia
what is allergic fungal sinusitis a reaction to ?
reaction to aerosolized environmental fungi
what is the usual presentation of allergic fungal rhinitis ?
unilateral nasal polyps
what is the imaging used for the diagnosis of allergic fungal sinusitis ?
CT
shows opaccification with concretions
what is the treatment for allergic fungal rhinitis ?
FESS
topical steroids +/- S steroids
what is diagnostically found during surgery in allergic fungal sinusitis ?
peanut butter mixed with sand and glue
allergic mucin
what is the immunity status of patients with invasive vs non invasive fungal rrhinosinusitis ?
only one highly associated with immunocompromised is acute invasive fungal sinusitis
what structures arw affected in mycetoma ball ?
maxillary sinus
what is often the presentation of mycetoma ball ?
often asymptomatic
involves the maxillary sinus
patient may complain of blowing gravel like material from the nose
what is the treatment for mycetoma ball ?
FESS
at the time of surgery in mycetoma ball what is present ?
cheesy or clay like material is present at the time of surgery
what are the organisms responsible for acute invasive fungal sinusitis ?
rhizomucor
rhizopus
how does spread happen in invasive acute fungal sinusitis ?
vascular invasion
vasculitis into the orbit and the CNS
what are the pathognomonic changes seen in active fungal sinusitis ?
blackk ulcers sen on the septum on the turbinates or the palate
what is the treatment for acute invasive fungal sinusitis ?
hospitalization
correct blood sugar
systemic antifungals
surgical deb may be needed
what is the presentation associated with acute invasive fungal sinusitis ?
altered mental status
fever
cough
nasal discharge
headache
what type of patients can get chronic inv fungal sinusitis ?
both immunocompromised and immunocompetent
what is the presentation of chronic inv fungal sinusitis ?
not acute
not as aggressive as acute form
no altered mental status
nasal examination can be minimal
what is the trreatment for chronic inv fungal sinusitis
surgical debridement
systemic antifungals
what kind of patient gets granulomatous invasive fungal sinusitis ?
immunocompeteent
what is a common finding associated with granulomatous invasive fungal sinusitis ?
proptosis
examination of the nasal cavity is often non revealing
what is the treatment for granulomatous invasive fungal sinusitis ?
systemic antifungals and surgical debridement
