Fungal Sinusitis

Chronic Sinusitis caused by fungus

In 1999 researchers at the University of Buffalo showed that fungal organisms were found in the mucus of 96% of patients who had sinus surgery for chronic sinusitis. In addition, inflammatory cells were found to be clumped around the fungi. This led the researchers to test the theory that the chronic sinusitis was in actuality an immune response to the fungus. Their research found that most people have airborne fungi lodged in the mucus lining of their sinuses but only people prone to chronic sinusitis have an immune reaction to the fungi. When the fungi are attacked it can cause the following immune responses in the sinuses; long term nasal congestion, thick mucus, chronic headache, bacterial infection and loss of smell. Chronic sinus headache can have a serious impact on quality of life.

Researchers at the Mayo Clinic and University of Buffalo conducted a study in 2004 using the fungicide Amphotericin-B applied intranasally and found that the “treatment group showed a significant decrease in the inflammatory thickening of the sinus membranes compared to the control group. “ Also, 70% of the patients showed a decrease in the amount of nasal swelling vs. the control group when viewed by endoscope. The study subjects were followed with CT scans of the sinuses at study start and again at six months, as well as endoscope at start of study, three and six months. CT results indicated an 8.8% decrease in mucus thickening in the treatment group vs. an increase of 2.5% in the placebo group.

The researchers hope this study will lead to the development of a fungal product for the treatment of chronic sinusitis. I wasn’t able to find any information on an FDA approved fungal product for this use so testing must still be on-going. (Note: Mayo Clinic sold the rights to the drug to Accentia Biopharmaceuticals and this company was granted FastTrack FDA status for SinuNase in 2006. SinuNase is an intranasal Amphotericin B formulation. However, Accentia is a biotech company that was delisted from the Nasdaq in 2008 and appears to be having financial problems, so future marketing may be uncertain).

I just thought this was an interesting article because most people think sinusitis is only bacterial and this suggested another possible cause. The CT images show the same patient pre and post study after treatment with Amphotericin B. You can see the improvement in the right maxillary sinus in the image on the right. I would imagine that the patient was feeling much better post study because they had a lot of mucus and swelling - ouch!

Reference and images source:

Baker, L. (2004). Chronic sinusitis caused by fungus. UB Reporter, Archives (April 1, 2004). Accessed October 12, 2009 at http://www.buffalo.edu/ubreporter/archives/vol35/vol35n28/articles/Sinusitis.html

Accentia granted FastTrack Status for SinuNase. Accessed October 12, 2009 at http://www.encyclopedia.com/doc/1G1-144391918.html