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Fungal Infections

  1. Rhinosporidiosis
    Organism : Rhinosporidium seeberi
    1. Distribution: India (Southern parts), Pakistan, Sri lanka
    2. Sites of Affection:
      1. Most commonly: Nose and Nasopharynx
      2. Others: Lip, palate, uvula, maxillary antrum, epiglottis, larynx, trachea, bronchi, scalp, penis, vulva, vagina
      3. Produce osteolytic lesions of hands and feet

Extra Edge. Acute fulminant fungal sinusitis is an invasive sinusitis and is commonly seen in diabetics, HIV infected patients and transplant patients receiving chemotherapy for immunosuppression. Therapy in such cases should be urgent, aggressive surgical debridement and amphotericin-B.
Extra Edge. Fungal sinusitis is mostly caused by Aspergillus.

  1. Features:
    Young males more
    Dust from the dung of infected horse and cattle
    Through contaminated water of ponds
  2. Lesions:   
    1. Polypoid and papillomatous lesions                          
    2. Bleeding polyps - leafy polypoidal masses
    3. Lesions;
      1. Friable
      2. Color: Strawberry colored studded with white dots or sporangia on its under surface.
      3. Site (nose): Vestibule (septal area)
        Microscopic examination : Nasal discharge contains Spores
  3. Diagnosis: Biopsy
  4. Treatment:
    Complete excision of the mass with a cutting diathermy and cauterization of its base.
    Medical management: Local injection of corticosteroids and courses of amphotericin and dapsone.
  1. Aspergillosis:
    1. Aspergillosis: is the commonest fungal infection of the nose & sinuses
      1. Frequency: A. Fumigatus (90%) > A. niger & A. flavus
      2. Spread: air-borne
    2. Features:
      1. Affects the nose & paranasal sinuses
      2. Can affect any age group
    3. Types:
      1. Non-invasive disease (aspergilloma)
        1. Features:
          1. Greenish-brown Sludge (max sinus)
          2. Calcium deposits
        2. Treatment: Surgical debridement and sinus ventilation
    4. Allergic Type
      1. Features:
        1. Young adults with history of asthma or polyps
        2. Thick mucous with eosinophils & Charcot Leyden crystals
      2. Treatment:
        Surgical debridement with systemic corticosteroids
    5. Invasive form
      1. Features:
        1. Behaves like a malignant neoplasm
        2. Spread to the soft tissue of cheek & orbit
      2. Treatment:
        Surgical & adjuvant itraconazole
    6. Fulminant form:
      1. Features;
        1. Rapid, progressive angio-invasive
        2. Affects immune-compromised patients
      2. Treatment:
        1. Radical surgery with i. v. amphotericin or Keto/itraconazole
  2. Mucormycosis ( Rhinocerebral Phycomycosis):
    1. Is an aggressive opportunistic fungal infection
    2. Organism: Order: Mucorales Viz Rhizopus oryzae
    3. Predisposing factors: immuno suppressed patients, uncontrolled diabetics
      1. Features:
        1. Remarkable affinity for blood vessels- arteries
        2. Leads to extensive endothelial damage & thrombosis
      2. Findings:
        The disease begins in the nose, invade a. P.N.S,  b. orbit, c. cribriform plate d. meninges e. brain
    4. Typical Finding
      1. Black necrotic mass seen filling the entire nasal cavity
      2. Erosion of the nasal septum and the hard palate may be appreciable
    5. Investigations:
      Sinus radiographs: Show thickened sinus and spotty destruction of the bony walls
      M.R.I. Detects early vascular and intracranial invasion

Extra Edge. Mucormycosis is acute invasive fungal infection involving nose and paranasal sinuses, where fungal hyphae invade blood vessels causing ischaemic necrosis. Commonly involves lateral nasal walls & turbinates & quickly spreads to orbit, palate, face & cranium. Treatment is surgical debridement & amphotericin-B.

  1. Treatment:
    1. Control of the precipitating factor
    2. Heparinization
    3. Systemic amphotericin
    4. Local drainage and debridement
    5. Orbital exenteration: MANDATORY, if ophthalmoplegia & loss of vision

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