Diseases of PNS
Which among the following is true regarding fungal sinusitis: [AIIMS May 2011]
|A||Surgery is required for treatment|
|B||Most common organism is Aspergillus niger|
|C||Amphoterecin B IV is used for invasive fungal sinusitis|
|D||Hazy appearance on X-ray with radiopaque density|
|E||Seen only in immunodeficient conditions|
Most common cause: Aspergillus
Most common species: A. fumigatus > A. niger> A. f/avus. 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
a. Fungus ball occurs in adults females
b. M/C agent: Aspergillus
c. Most common sinus involved - Maxillary> sphenoid sinus
d. M/C symptom - unilateral postnasal discharge
e. Most Important Investigation-CT scan
f. Fungus ball is the main fungal rhinosinusitis in an immunocompetent patient.
g. Surgery is the most effective treatment for fungus ball.
Allergic Fungal Rhinosinusitis
a. AFS is a noninvasive fungal rhonosinusistis
b. Dermatiaceous species are the fungal agents mostly responsible for AFRs.
c. Seen in immunocompetent hosts with allergy to fungus.
d. Clinical and biological criteria for diagnosis is still under debate, and include nasal polyps, thick mucin, hypersensitivity type for fungus, eosinophilic mucin.
e. Sinus opacities with bone extension are frequently seen on CT scan.
f. Diagnosis of all allergic fungal rhinosinusitis is supported by allergic and fungal criteria .
g. Treatment = Antifungals Chronic or Indolent Invasive Fungal Rhinosinusitis
h. Chronic invasive fungal rhinosinusitis is a rare pathology occurring mostly in immunocompetent patients.
i. Aspergillus is the most frequent agent isolated in this pathology.
Acute Fulminant Fungal Rhinosinusitis
a. Fulminant invasive fungal rhinosinusitis occurs in immunocompromised patients (HIV, diabetes, chemotherapy)
b. 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 (Maqbool11 th/ed p 228) Option - c - Amphotericin IV is used for invasive fungal sinusitis Correct - Ref. Dhingra 5th/ed p 270, 6th/ed p 796
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 imm nocompetent hosts.