Acute invasive fungal rhinosinusitis

Acute invasive fungal rhinosinusitis (eg mucormycosis, aspergillosis) can rapidly progress and has high mortality, so early diagnosis and treatment is important. It occurs in patients with immune compromise (eg haematological cancer, neutropenia, patients with diabetes in whom glycaemic targets are not achieved). For patients with immune compromise and symptoms of acute rhinosinusitis (eg facial pain, nasal congestion, fever), maintain a high degree of suspicion for acute invasive fungal rhinosinusitis. Patients may also have clinical features of acute rhinosinusitis that indicate spread of infection beyond the paranasal sinuses – see Clinical features of acute rhinosinusitis that indicate spread of infection beyond the paranasal sinuses.

If acute invasive fungal rhinosinusitis is suspected, urgently refer to a hospital with facilities for ear, nose and throat surgery, pathology, infectious diseases and intensive care support. Early endoscopy is recommended, with tissue biopsies for microscopy, fungal culture and susceptibility testing, nucleic acid amplification testing (NAAT) (eg polymerase chain reaction [PCR]) and histopathology.

Treatment of acute invasive fungal rhinosinusitis involves empirical antifungal therapy and prompt surgical debridement of infected or necrotic tissue. Seek expert advice from a clinical microbiologist, infectious diseases physician and otolaryngologist.