Reviews and feature article
Fungal disease of the nose and paranasal sinuses

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Fungal infections of the nose and paranasal sinuses represent a spectrum of diseases ranging from colonization to invasive rhinosinusitis. Clinical manifestations are largely dependent on the immune status of the host, and given the ubiquitous nature of these organisms, exposure is unavoidable. Noninvasive disease includes asymptomatic fungal colonization, fungus balls, and allergic fungal rhinosinusitis. Invasive disease includes indolent chronic rhinosinusitis, granulomatous fungal sinusitis, and acute fulminant fungal rhinosinusitis. A differentiation of these somewhat overlapping syndromes and the disparate treatment regimens required for effective management are the focus of this review.

Section snippets

Saprophytic fungal infestation/fungal colonization

Anatomic abnormalities of the paranasal sinuses impair drainage and predispose the patient to fungal colonization of these areas. Mucosal injury from comorbidities also can cause pooling of mucus and colonization by fungi; however, colonization is seldom of clinical consequence, patients are typically asymptomatic, and fungi identified during procedures performed for other reasons should not be treated because numerous species, including Aspergillus species, are commonly found in the sinonasal

Chronic invasive fungal sinusitis

In patients with chronic invasive fungal rhinosinusitis, the process of invasion of the sinus tissues occurs over a period of weeks or months rather than hours. Many patients with this relatively rare condition have subtle abnormalities in their immune system caused by diabetes mellitus, chronic low-dose corticosteroid use, or other ongoing immunosuppression. This indolent infection is most commonly caused by dematiaceous molds, such as Bipolaris, Curvularia, and Alternaria species, followed by

Summary

Fungal rhinosinusitis encompasses a wide range of fungal infections that range from asymptomatic colonization of the sinus passages to rapidly progressing and ultimately fatal infection. Colonization is exceedingly common, and isolation of potential pathogens from the nasosinal passages requires an understanding of host risk factors and disease syndromes given the vastly different treatment options for these overlapping conditions.

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    Disclosure of potential conflict of interest: G. R. Thompson has received research support from Pfizer. T. F. Patterson has consultant arrangements with Pfizer, Viamet Pharmaceuticals, Toyama, Merck, and Astellas Pharma US and has received research support from Astellas Pharma US, Merck, and Pfizer.

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