PATIENTS' DEMOGRAPHIC DATA IN DIFFERENT TYPES OF FUNGAL SINUSITIS

Abstract

Fungal rhinosinusitis (FRS) has been a known medical entity for several hundred years but only in more recent times the entity has been further defined. FRS comprises a variety of different disease processes which vary in presentation, histologic appearances, and clinical significance. Disease is most commonly classified as being non-invasive or invasive based on whether the fungi have invaded into the sinonasal submucosal tissue resulting in tissue necrosis and destruction. Entities which are considered non-invasive FRS include fungal ball (an entangled mass of fungus without significant surrounding sinonasal inflammatory reaction) and allergic fungal rhinosinusitis (AFRS) (a complex entity characterized by the presence of allergic mucin). Non-invasive FRS often requires surgical intervention and/or medical therapy. Invasive disease is characterized as either acute or chronic based on the length the time symptoms are present before presentation. Patients with acute invasive disease (AFIFS) are usually immunosuppressed and, by definition, present with symptoms of less than one-month duration. This entity is characterized by the presence of fungal forms invading into the sinonasal submucosal with frequent angioinvasion and rapid intervention is necessary. Patients with chronic invasive disease present with symptoms of greater than three month duration. Two forms of chronic invasive disease, non granulomatous chronic invasive FRS (CIFS), and chronic granulomatous FRS (GIFS), have been described and like AFIFS both are also serious, often requiring surgical and medical therapy. Although fungal sinusitis is a well-documented disease in the immunocompromised patient, but many reports have indicated an increased prevalence of fungal sinusitis in otherwise healthy. This higher incidence is probably due to environmental factors and a high index of suspicion among clinicians, microbiologists and pathologists.