Invasive fungal sinusitis

Background

Microbiology

• Aspergillus
• Zygomycetes: Mucor, Rhizopus
• Fusarium
• Pseudoallescheria boydii
• Alternaria
• Bipolaris
• Cladophialophora
• Curvularia
• Non-invasive:
  • Mycetoma: Mucor, Rhizopus, Fusarium, Pseudoallescheria bpydii, Alternaria, Bipolaris, Cladophialophora, Curvularia
  • Allergic fungal sinusitis: Aspergillus, Bipolaris, Curvularia, Dreschlera

Risk Factors

• Immunocompromise, including solid organ transplantation and hematopoietic stem cell transplantation
• Diabetes mellitus

Clinical Manifestations

• Difficult to distinguish from acute bacterial sinusitis
• Edema and paresthesias are common
• NP scope normal in ~30%; black eschar in 50%

Management

• CT for extrasinus invasion
  • MRI is more sensitive
• Debridement
• Lipsomal amphotericin B 5 mg/kg
  • Every day of delay increases mortality
  • 3 week induction, then switch to posaconazole or isuvaconazole for 3-6 months
• Decrease immunosuppression