Acute Invasive Fungal Sinusitis

Abstract

Acute invasive fungal sinusitis (AIFS) is a rapidly progressive and life-threatening infection of the paranasal sinuses that predominantly affects immunocompromised individuals. The disease is characterized by aggressive fungal invasion of mucosal tissues and blood vessels, leading to tissue necrosis and potential extension to the orbit and intracranial structures. Predisposing factors include uncontrolled diabetes mellitus, hematologic malignancies, immunosuppressive therapy, corticosteroid use, and recent viral infections such as COVID-19. The most common causative organisms belong to the orders Mucorales and Aspergillus. Early diagnosis is challenging because initial symptoms may resemble bacterial sinusitis, yet delayed recognition significantly increases morbidity and mortality. Diagnostic evaluation relies on a combination of clinical suspicion, imaging modalities such as CT and MRI, histopathological examination, and microbiologic culture. Effective management requires a multidisciplinary approach involving prompt surgical debridement, systemic antifungal therapy—most commonly liposomal amphotericin B—and correction of underlying predisposing factors. Despite advances in diagnostic techniques and antifungal therapy, AIFS remains associated with high mortality rates, particularly in patients with severe immunosuppression or delayed treatment. Understanding the etiology, pathophysiology, clinical manifestations, diagnostic strategies, and management options is essential for improving early detection and patient outcomes. This review summarizes the current knowledge regarding acute invasive fungal sinusitis, highlighting risk factors, pathogenic mechanisms, diagnostic challenges, and contemporary therapeutic approaches.