Epidemiology of chronic fungal rhinosinusitis in rural India

Abstract

A descriptive epidemiological study of fungal rhinosinusitis (FRS) was conducted in rural north India in the form of house-to-house survey of villages of two districts each of Punjab and Haryana provinces using a clinical case definition of chronic rhinosinusitis (CRS). The suspected cases were investigated further in the laboratory to confirm FRS. Air and environment were sampled in different seasons to find Aspergillus spore count. The prevalence of chronic FRS cases was at 0.11% of the population and Aspergillus flavus was the predominant (97.6%) agent of all types of chronic FRS. The chronic FRS patients were classified as allergic FRS 41 (56.1%), chronic granulomatous FRS 13 (17.8%), eosinophilic FRS 11 (15.0%), fungal ball 7 (9.5%) and chronic invasive FRS 1 (1.3%). Aspergillus spores were present in large numbers (~20%) in air with significantly higher counts of A. flavus during winter months in the wheat-thrashing areas of Punjab as compared to Haryana (P = 0.0079). The present study identified high prevalence (27.5% of CRS cases) of chronic FRS cases in rural north India and its possible association with wheat harvesting seasons.

Keywords: Aspergillus; allergy; environment; epidemiology; fungus; sinusitis.