Fungi: The Unusual Sinus Infection Suspects

Talking about sinus infection, you could be thinking bacterial invasion is what causes it. You are partly correct. Most bouts with sinusitis emerge as a result of bacterial infection. However, bacteria aren’t the ONLY organisms that can cause sinus infections. Other organisms could cause sinus infections too. One of these groups for instance, are the fungi.

Why Me?
Fungi that cause sinusitis are among the most common types that live abundantly almost everywhere. However, fungal sinusitis is much rarer. Not everyone with exposure to these fungi would automatically develop sinus infection, or any other fungal infection for that matter. This is because most people with a sound immune system can tolerate fungi. People who are at greater risk to these fungi are those who elicit an allergic reaction to the offending mold; or those with weak immune system such as cancer patients on chemotherapy or those with diseases like HIV-AIDS in which the immune system is not functioning properly.

Traces of Evidence (Types of Fungal Sinusitis)
The treatment plan largely depends on the organisms and the type of sinusitis, so classifying the infection and identifying the organisms is important. Fortunately, this shouldn’t be guesswork since diagnostic imaging techniques can enable clinicians to visualize the sinuses and nasal cavity to aid them in identification. Each type of fungal sinusitis presents with its own clinical picture, facilitating differentiation.

In the first type of infection called fungal ball, an overgrowth of fungal elements is usually noted in the maxillary sinus. The fungal growth blocks the affected sinus/es, but causes no damage to the surrounding structures. The organism which often causes this infection is Aspergillus. Treatment consists of removing the fungal elements, usually through a surgical procedure called functional endoscopic sinus surgery.

Fungi from the Dematiaceous family, including species of Bipolaris, Curvularia, and Alternaria, are often the culprits of the most common type - allergic fungal sinusitis. In this type, it is not unusual to see nasal polyps and thick drainage upon examination of the nose. Allergic fungal sinusitis causes blockage of the affected sinuses and sometimes, notable bone thinning. The goal of treatment is to surgically remove the fungal elements to relieve the blockage and to re-establish sinus drainage.

Both the acute and chronic invasive types are considered to be the most serious types of fungal sinusitis. In acute invasive fungal sinusitis, the invading fungi quickly grow deeply into the sinus tissues and bones, thus the term, invasive. The pathophysiology in chronic invasive fungal sinusitis is similar, but occurs much slower. These types are the least common; in fact, acute invasive fungal sinusitis usually occurs only to people with compromised immune system. Chronic invasive fungal sinusitis, on the other hand, can occur even to patients with healthy immune systems. Species of Rhizopus, Mucor, and Aspergillus are frequently identified as the causative agents. These two types are associated with the worst prognosis because they cause extensive damage - facial swelling, blockage of involved sinuses and destruction of the surrounding bones and tissues.

Arresting the Infection
Compared to bacterial sinusitis, fungal sinusitis requires a longer, and sometimes more aggressive (surgery) treatment course. Two of the most promising sinus treatment regimens for after-surgery care are medicated irrigation and sinus nebulization. Sinus Dynamics is a pharmaceutical company which specializes in these effective and revolutionary treatments.