From the Guidelines
Immunocompromised states, such as neutropenia, hematologic malignancies, poorly controlled diabetes, acquired immunodeficiency syndrome, and organ transplantation, are significant risk factors for fungal sinusitis, particularly acute invasive fungal sinusitis, which has a high mortality rate of 50% to 80% 1.
Key Risk Factors
- Immunocompromised states, including neutropenia, hematologic malignancies, and acquired immunodeficiency syndrome
- Poorly controlled diabetes
- Organ transplantation
- Patients on immunosuppressive therapy, including systemic steroids and chemotherapy
- Previous sinus surgery or anatomical abnormalities that obstruct normal sinus drainage
Clinical Considerations
- Symptoms of fungal sinusitis can be nonspecific and similar to those of acute bacterial rhinosinusitis, including fever, rhinorrhea, and diplopia
- Clinicians should maintain a high index of suspicion for fungal sinusitis in immunocompromised patients with symptoms of acute rhinosinusitis, orbital symptoms, and/or headache 1
- Definitive diagnosis is made on biopsy with the identification of invasive fungi in the sinonasal mucosa, vessels, and bone
- Treatment typically includes both systemic antifungal medication and surgical debridement 1
From the Research
Risk Factors for Fungal Sinusitis
- Immunocompromised conditions, such as malignancy, chemotherapy, transplantation, acquired immunodeficiency syndrome, and usage of immunosuppressant drugs, increase the risk of fungal infections, including fungal sinusitis 2
- Individuals with immunosuppression caused by HIV infection or organ transplantation are at increased risk of various infections, which may include fungal sinusitis 3
- People with compromised immunity due to cytotoxic cancer treatments, biological therapies, organ transplants, inherited and acquired immunodeficiencies, and other immune disorders are at increased risk for developing infectious diseases, including potentially fungal sinusitis 4
- The exact role of immunosuppression in conferring increased risk of fungal sinusitis is not specified in the provided studies, but it is known that immunosuppression increases the risk of various infections 3, 4
- Environmental fungi such as Aspergillus species and mucormycetes can cause invasive fungal infections, including potentially fungal sinusitis, in immunocompromised individuals 2