Fungal and parasitic granulomas of the head and neck

Granulomatous diseases caused by infectious agents have emerged as significant health problems in the United States for three major reasons. Firt is the increased number of patients who are at increased risk of infection because of immunologic diseases or treatment with immunosuppressive drugs. Second is the increased travel of United States citizens to the tropics and the immigration of refugees to the United States, both contributing to the influx of unusual tropical diseases into this country. Finally, aging and the accompanying immunosenescence of the population in the United States have led to an increase in the number of individuals susceptible to fungal granulomatous diseases. Not only has there been an increase in the number of disseminated infections caused by systemic mycoses and an increased awareness of tropical fungal and parasitic infections, but there has also been a marked increase in the number of infections caused by normally commensal or saprophytic fungi in immunosuppressed hosts. The diagnosis and management of many granulomatous infections may be initiated through syndromes that primarily affect the head and neck. This article emphasizes early recognition and appropriate management of these infections, since many require early intervention to ensure a good clinical outcome.