Prevalence and clinical profile of fungal rhinosinusitis

Abstract

Background: There are only a few landmark studies from the Indian subcontinent on fungal rhinosinusitis. The lack of awareness among clinicians regarding the varying clinical presentations of fungal rhinosinusitis prompted us to undertake this study.

Objective: To determine the prevalence, etiologic basis, clinical features, radiologic features, and microscopic features of fungal rhinosinusitis, and to evaluate the various treatment modalities available.

Methods: This was a prospective study in which evaluation of 100 patients with chronic rhinosinusitis was done. Specimens collected were subjected to both microbiology and pathologic examination; data collected, including clinical and radiologic features, were analyzed by the Pearson χ(2) test and Fisher's exact test.

Results: The prevalence of fungal rhinosinusitis in our study was 30% (n = 30). Mucor was the most commonly isolated species (n = 15 [50%]) of fungus. Pathologic examination had a higher sensitivity (76.67%) compared with microbiology tests (50%) in the diagnosis of fungal rhinosinusitis. Fungus ball (n = 14 [46.6%]) was the most prevalent entity in the spectrum of fungal rhinosinusitis. Forty percent of cases (n = 12) were of invasive fungal rhinosinusitis. The prevalence of fungal rhinosinusitis was higher among individuals who were immunocompetent (n = 17 [56.6%]). Of patients who were immunocompromised, 84.6% (n = 11) had mucormycosis.

Conclusions: Unilateral involvement of paranasal sinuses was more in favor of fungal etiology. Complications were more common in fungal rhinosinusitis caused by Mucor species. Mucormycosis, a rare clinical entity, in subjects who were immunocompetent, had a high prevalence in our study.

Figure 1.

Flowchart, which depicts patient flow into the study.

Figure 2.

Aspergillus on Lactophenol Cotton Blue staining, showing septate hyphae and swollen vesicle giving rise to phialides from which chains of conidia arise (original magnification ×400).

Figure 3.

Mucor on Lactophenol Cotton Blue staining, showing broad aseptate hyphae, with extension of columella into sporangium and aggregation of sporangiospores (original magnification ×400).

Figure 4.

Tissue section, showing Mucor on Periodic acid-Schiff stain with broad aseptate hyphae (original magnification ×400).

Figure 5.

Computed tomography image showing soft tissue density lesion, with heterogenous hyperdensities in the left maxillary sinus and posterior ethmoids in a patient with fungal rhinosinusitis.

Figure 6.

Fungal organisms isolated on microbiology examination.

Figure 7.

Fungal organisms isolated on histopathology.

Figure 8.

Systemic diseases associated with fungal rhinosinusitis.