Sinus fungal balls: characteristics and management in patients with host factors for invasive infection

Background: The characteristics of sinus fungal ball (SFB), classically considered being a non-invasive form of fungal infection, in patients with host factors for invasive fungal infection (IFI) are unknown. Objective: To characterize SFB and their management in patients with host factors for IFI. Methodology: Retrospective single-centre study of the clinical, radiology, histology and mycology records of patients treated for SFB between 1997 and 2007. Patients with and without host factors for IFI were compared. Results: One hundred eighty one patients were classified into two groups: 19 (group 1) with and 162 (group 2) without host factors for IFI. In group 1, SFB were asymptomatic in 26.3% of the cases, ethnnoido-sphenoidal sinuses were more frequently involved than in group 2 and fungal culture was positive in 37.5% of the cases. The main species was Aspergillus sp. in both groups. Four cases of complicated SFB were observed, only in patients of group 1. Cure without recurrence was obtained in both groups by endonasal surgery, combined with triazole therapy in complicated forms with osteolysis. Conclusion: In patients with host factors for IFI, SFB more frequently involves deep sinuses and can be complicated by clinical signs suggestive of invasion and radiological signs of osteolysis, with no histological evidence of fungal invasion.