ABSTRACT
Background: Fungal rhinosinusitis is a characteristic disease that requires a great deal of interest. Knowing the fungal flora, its prevalence and symptomatic presentation in patients with chronic fungal rhinosinusitis will allow a better understanding of this disease, correct diagnosis, and treatment and developing its prognosis. Clinical presentation can provide to the subcategories of fungal rhinosinusitis however, histopathological and microbiological examinations provide accurate diagnosis and classification
Patients and Methods: This study was conducted on fifty patients of chronic fungal rhinosinusitis who had been referred to otorhinolaryngology surgeon for endoscopic sinus surgery in the last 2 years in Dr. Soliman Fakeeh Hospitals in Jeddah, Kingdom of Saudi Arabia, We selected some immunocompetent chronic rhinosinusitis patients with signs and symptoms of inflammation of nasal and paranasal sinuses. These patients had positive computed tomography and /or histopathological examinations. We evaluated clinical history, otolaryngologic examination with nasal endoscopy, computed tomography scan, mycological and bacterial cultures and histopathological examinations
Results: Fungal rhinosinusitis was the cause of chronic rhinosinusitis in 16.2% of patients with chronic rhinosinusitis submitted to paranasal sinuses endoscopic surgery. Fungal cultures were positive in 60% of specimens with predominance of 63.3% Aspergillus fumigatus, 20% Aspergillus flavus, 3.33% Aspergillus niger and 13.33% Candida albicans. While 40% of patients with rhinosinusitis showed no fungal growth. Bacteriological cultures indicated there is an association of bacterial infection in 16 patients out of 50 as; Staphylococcus aureus [43.75%], Staphylococcus haemolyticus [25%], Pseudomonas aeruginosa [18.75%] and klebsiella pneumonia [12.5%]. In 28% specimens there was no bacterial growth, and in 40% specimens the bacterial examination were not performed. Mixed bacterial and fungal infections were found in 30% as the following: Staphylococcus aureus and Aspergillus fumigatus, Staphylococcus aureus and Aspergillus flavis, Pseudomonas aeruginosa and Aspergillus fumigatus, Klebsiella pneumoniae and Candida albicans, and Staphylococcus haemolyticus and Candida albicans in 33.33%, 22.22%, 22.22%, 11.22% and 11.22% respectively. According to the histopathological findings the detected types were fungal rhinosinusitis, allergic rhinosinusitis, non specific inflammation and mixed reaction in 54%, 22%, 6%, and 18% respectively. All patients presented some type of findings in paranasal sinuses by computed tomography [CT] scan were classified as 60% allergic fungal sinusitis, 34% chronic invasive fungal sinusitis, 4% fungal ball and 2% acute invasive fungal sinusitis. As regards correlation of histopathology, CT and fungal cultures results of the studied 50 patients and according to CT classification of fungal sinusitis, positive histopathological findings were found in 53.33% of cases that were classified as allergic fungal sinusitis, while positive fungal culture were seen in 40%. In chronic invasive fungal sinusitis, histopathological findings were positive in all cases [100%] while positive fungal cultures were seen in 88.23%. In acute invasive fungal sinusitis and fungal ball CT classification, both histopathology and fungal cultures were positive in all cases [100%]
Aim of work: The aim of this study is to analyze and compare the results of clinical endoscopic findings, radiological, mycological, and histological criteria for optimizing the diagnosis of true fungal sinusitis
Conclusion: Early and specific diagnosis of fungal rhinosinusitis is necessary. The traditional methods used in routine practice for the diagnosis of fungal rhinosinusitis may be insensitive and nonspecific. Moreover, the allergic fungal rhinosinusitis represents an immunologic rather than infectious disease. The optimal duration of treatment and the role of patient preferences in clinical decision making also needed to be addressed. The maximum diagnosis will be available by combining traditional culture, histopathology and radiology. In this circumstance, molecular techniques are perhaps best placed to enable rapid and accurate identification