Fungal sinusitis: a spectrum of disease

Ma, Connie; Ryan, Matthew W.; Marple, Bradley F.; Halderman, Ashleigh A.

doi:10.1002/alr.22736

Cited by 5 publications

(4 citation statements)

References 10 publications

(18 reference statements)

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“…As a result, fungal sinusitis has been described as a possible spectrum of disease, whereby non-invasive forms may mimic invasive forms or even become invasive. 8,19,20 Our finding that 4 (50%) patients were found to have fungus balls is consistent with recently reported evidence that non-invasive may progress to invasive disease in rare circumstances. In a review of 372 patients with fungus balls found on mucosal biopsies, Seo et al 21 identified thirteen patients that displayed mucosal invasion.…”

Section: Discussionsupporting

confidence: 90%

“…As a result, fungal sinusitis has been described as a possible spectrum of disease, whereby non-invasive forms may mimic invasive forms or even become invasive. 8,19,20…”

Section: Discussionmentioning

confidence: 99%

“…[13][14][15][16] Recently, the transformation of non-invasive to invasive forms of fungal sinusitis has been reported. [17][18][19] Ma et al 19 demonstrated in a case series that 5 patients with allergic fungal sinusitis converted to cIFS, and 2 converted to aIFS. As a result, fungal sinusitis has been described as a possible spectrum of disease, whereby non-invasive forms may mimic invasive forms or even become invasive.…”

Section: Discussionmentioning

confidence: 99%

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Intermediate Invasive Fungal Sinusitis, a Distinct Entity From Acute Fulminant and Chronic Invasive Fungal Sinusitis

Burnham

Magliocca

Pettitt-Schieber

et al. 2021

Ann Otol Rhinol Laryngol

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Background: The current classification system of invasive fungal sinusitis (IFS) includes acute (aIFS) and chronic (cIFS) phenotypes. Both phenotypes display histopathologic evidence of tissue necrosis, but differ by presence of angioinvasion, extent of necrosis, and disease progression. aIFS is defined by a rapid onset of symptoms, while cIFS slowly progresses over ≥12 weeks. However, a subset of IFS patients do not fit into the clinical presentation and histopathologic characteristics of either aIFS or cIFS. Objectives: To investigate the demographic, clinical, and histopathologic characteristics of a distinct subset of IFS. Methods: Retrospective review of patients with IFS from a single tertiary-care institution (2010-2020). Patients with symptoms for ≤4 weeks were classified as aIFS if they displayed endoscopic evidence of mucosal necrosis or fungal angioinvasion on pathology. Patients with slowly progressive IFS for ≥12 weeks were classified as cIFS. Patients with symptom duration between 4 and 12 weeks with evidence of invasive fungal disease were classified as a new entity and were further investigated. Results: Of the 8 patients identified, 50% were immunosuppressed at presentation. The mean symptom duration prior to presentation was 50.5 days (SD 16.8), and common symptoms included facial pain (100%), vision change (87.5%), and blindness (37.5%). Two patients (25%) died of their disease. Sites of fungal involvement confirmed by histopathology included sphenoid (62.5%) and ethmoid sinuses (12.5%), orbital apex (25%), optic nerve (12.5%), pterygopalatine fossa (12.5%), and clivus (12.5%). Fungal elements but without obvious angioinvasion, were identified in all specimens, and fungus balls (50%), granulomas (37.5%), and giant cells (25%) were also observed on histopathology. CT and MRI radiographic imaging showed findings consistent with orbital, intracranial, or skull base involvement in all patients. Conclusion: We propose intermediate IFS as a new subgroup of patients with IFS who do not fit into the standard classification of aIFS or cIFS.

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Section: Discussionsupporting

confidence: 90%

“…As a result, fungal sinusitis has been described as a possible spectrum of disease, whereby non-invasive forms may mimic invasive forms or even become invasive. 8,19,20…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Intermediate Invasive Fungal Sinusitis, a Distinct Entity From Acute Fulminant and Chronic Invasive Fungal Sinusitis

Burnham

Magliocca

Pettitt-Schieber

et al. 2021

Ann Otol Rhinol Laryngol

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“…2 Recent case series have suggested the possibility that fungal sinusitis could be a spectrum of disease. 3,4 The possibility of progression from non-invasive fungal sinusitis to invasive disease is concerning given our lack of understanding of specific risk factors for disease development.…”

Section: Introductionmentioning

confidence: 99%

RNA Sequencing and Gene Ontology Analysis in Acute Invasive Fungal Sinusitis

David

Loftus

Russell

et al. 2022

Am J Rhinol�Allergy

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Background Acute invasive fungal sinusitis (AIFS) is an aggressive and dangerous disease of the paranasal sinuses with high morbidity and mortality. The immune response at the level of the nasal mucosa, the site of entry, has not been previously evaluated. Objective To evaluate differential gene expression in the sinonasal mucosa of AIFS patients as compared to control patients using RNA sequencing. Methods Sinonasal tissue samples were prospectively obtained from consenting patients undergoing surgery between November, 2020 and November, 2021. RNA extraction and sequencing were performed and differential expression was analyzed to detect transcriptional differences between patient groups. Results Tissue samples were collected from 4 patients with active AIFS diagnoses, 2 patients with recovered AIFS, 1 patient with a diagnosis of non-invasive fungal ball, and 4 healthy controls. 255 genes were differentially expressed in AIFS patients as compared to control patients. Specific Gene Ontology (GO) biological processes that were identified as differentially expressed in AIFS patients as compared to controls included the following: 1. GO:0007155 (cell adhesion), 2. GO:0030199 (collagen fibril organization) and 3. GO:0001525 (angiogenesis). Conclusion Transcriptional differences were noted between AIFS and control patients in sinonasal tissue samples. Future work is necessary to determine causes of the differential gene expressions between AIFS and control patients, specifically those who are immunosuppressed, or with preexisting non-invasive forms of fungal sinusitis, to guide treatment and prevention strategies.

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