Which among the following is true regarding fungal sinusitis -a) Surgery is required for treatmentb) Most common organism is Aspergillus nigerc) Amphoterecin B i.v is used for invasive fungal sinusitisd) Hazy appearance on X-ray with radio-opaquee) Seen only in immunodeficient conditions

Fungal Sinusitis Most common cause: Aspergillus Most common species: A. fumigatus (90%) > A. niger > A. flavus. Other offenders are: Mucor, Rhizopus, Alternaria Fungal infection can be of following types: i. Fungus ball ii. Allergic fungal rhinosinusitis iii. Chronic or indolent invasive fungal sinusitis iv. Acute fulminant fungal rhinosinusitis Fungus Ball Fungus ball occurs in adults females M/C agent: Aspergillus Most common sinus involved – Maxillary > sphenoid sinus M/C symptom – unilateral postnasal discharge Most Important Investigation-CT scan Fungus ball is the main fungal rhinosinusitis in an immunocompetent patient. Surgery (FESS) is the most effective treatment for fungus ball. Allergic Fungal Rhinosinusitis AFS is a noninvasive fungal rhonosinusistis Dermatiaceous species are the fungal agents mostly responsible for AFRs. Seen in immunocompetent hosts with allergy to fungus. Clinical and biological criteria for diagnosis is still under debate, and include nasal polyps, thick mucin, hypersensitivity type I for fungus, eosinophilic mucin. Sinus opacities with bone extension are frequently seen on CT scan. Diagnosis of all allergic fungal rhinosinusitis is supported by allergic and fungal criteria (Refer to Ans. 11 for criteria). Treatment = Antifungals Chronic or Indolent Invasive Fungal Rhinosinusitis Chronic invasive fungal rhinosinusitis is a rare pathology occurring mostly in immunocompetent patients. Aspergillus is the most frequent agent isolated in this pathology. Acute Fulminant Fungal Rhinosinusitis Fulminant invasive fungal rhinosinusitis occurs in immunocompromised patients (HIV, diabetes, chemotherapy) Early diagnosis and control of primary immunological disorders is essential for the prognosis. Thus from the above description it can be concluded Option – a – Surgery is required for treatment – (correct) as in all forms of fungal sinusitis – some or the other form of surgery is required. Option – b – M/c organism is Aspergillus niger. Incorrect – M/c is A. fumigatus Option – c – Amphotericin IV is used for invasive fungal sinusitis Correct Option – d – Hazy appearance on X-ray with radiopaque density Correct – Sinusitis gives hazy appearance on X-ray Option – e – Seen only in immunodeficient condition Incorrect – only the acute fulminant form is more common in immunodeficient state whereas others are seen in immnocompetent hosts.