Expert Information for Patients, GPs, and Specialist Nurses
🔎 What Is Aspergillus Sinusitis?
Aspergillus sinusitis refers to fungal involvement of the paranasal sinuses by Aspergillus species, especially A. fumigatus. It spans a spectrum from benign colonisation to destructive invasive disease, depending on the host’s immune status.
There are four main clinical forms, with distinct presentations and treatment approaches.
🧬 Main Forms
| Type | Description | Typical Host |
|---|---|---|
| Allergic Fungal Rhinosinusitis (AFRS) | A hypersensitivity reaction with nasal polyps and allergic mucin | Atopic patients (often young adults) |
| Fungal Ball (Mycetoma) | A dense fungal plug within a sinus cavity, non-invasive | Immunocompetent individuals |
| Chronic Invasive Fungal Sinusitis | Slowly progressive mucosal and bony invasion | Diabetics, immunosuppressed |
| Acute Invasive Fungal Sinusitis | Rapidly destructive, vascular invasion, necrosis | Severely immunocompromised (e.g. neutropenic, transplant recipients) |
👥 Who Is at Risk?
Depends on form:
🟩 AFRS:
-
Asthma, eczema, allergic rhinitis
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Nasal polyps
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Fungal IgE sensitisation (esp. Aspergillus)
🟨 Fungal Ball:
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Older adults
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Dental work (esp. upper molars with root involvement)
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Chronic sinus blockage or prior surgery
🟧 Chronic Invasive:
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Long-term corticosteroid or immunosuppressive use
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Poorly controlled diabetes
🟥 Acute Invasive:
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Haematological malignancies
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Bone marrow/stem cell transplant
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Neutropenia or severe COVID-19
⚠️ Clinical Features
| Symptom | Common To |
|---|---|
| Nasal congestion, discharge | All forms |
| Facial pain or pressure | All forms |
| Nasal polyps | AFRS |
| Foul smell or thick mucus | Fungal ball |
| Eye pain, proptosis, visual changes | Invasive forms |
| Fever, systemic illness | Invasive forms |
| Black eschar or necrosis | Acute invasive sinusitis (medical emergency) |
🧪 Diagnosis
Initial Evaluation:
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Nasal endoscopy: mucosal thickening, polyps, or black necrosis
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CT scan: sinus opacification, bone erosion, hyperdense lesions
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MRI: assesses orbital or intracranial extension in invasive cases
Microbiology & Histopathology:
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Direct microscopy or fungal stain (e.g. GMS)
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Culture for Aspergillus spp.
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Aspergillus-specific IgE/IgG in AFRS
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Tissue biopsy is essential in invasive disease
💊 Treatment
🟩 AFRS:
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Functional endoscopic sinus surgery (FESS) to clear sinuses
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Oral and topical corticosteroids
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Antifungals (controversial; may reduce recurrence)
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Allergen immunotherapy in selected cases
🟨 Fungal Ball:
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Surgical removal only (FESS)
-
No systemic antifungal needed unless complications arise
🟧 Chronic Invasive:
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Surgical debridement
-
Long-term oral antifungals (e.g. voriconazole, posaconazole)
-
Monitor drug levels and imaging
🟥 Acute Invasive:
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Urgent surgical debridement
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High-dose IV antifungals (voriconazole or liposomal amphotericin B)
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Reversal of immunosuppression
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High mortality if delayed — requires ICU and ID team coordination
🧾 Monitoring
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Repeat imaging for resolution (especially invasive forms)
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Symptom scores for AFRS and post-FESS recovery
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Antifungal levels and LFTs if systemic therapy used
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Endoscopic surveillance in high-risk or relapsing patients
📚 More Information
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Specialist input: ENT referral is essential for diagnosis and surgical treatment
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Multidisciplinary management is often needed:
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ENT, microbiology, infectious diseases, immunology
-
-
Resources: aspergillosis.org, Fungal rhinosinusitis: Education; NHS sinusitis
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