Nose and Paranasal Sinuses: Profile of Fungal Infections

Background: Fungal infections of the nose and paranasal sinuses present with a spectrum of clinical manifestations which is mainly determined by the complex interplay of the pathogenicity of the fungus and the host immune system. In India, most of the fungal infections of the nose and paranasal infections are reported from the southern states although high incidences of paranasal sinusitis are also reported from other states of the country. Data regarding the above from the north-eastern part of the country is hardly available. Hence, it was felt important to make an effort to recognize and detect the presence of fungal infection in this part of the country. Aims & objectives: The present study was conducted to find out the incidence of fungal infections of the nose and PNS among all patients having allergic or infective disorders, to study the various risk factors associated with it, to study the clinical profile of the patients and also to assess the prognosis after treatment. Methods: A prospective study was taken up during the period Feb 2003-Oct 2004 in the Otorhinolaryngology Department of the Regional Institute of Medical Sciences (RIMS), Imphal, Manipur. All the patients attending the OPD and IPD of the department because of chronic allergic and infective disorders were the study subjects. Detailed information on socio-demography and clinical history were collected by using a semi-open interview schedule. Next, a thorough physical examination and examination of the ear, nose and throat were done. Appropriate routine investigations and a thorough fungal study were performed using representative specimens in collaboration with the Department of Microbiology of the same institute. Results: The fungal infection rate was found to be 4.61% (M=4.84% and F=4.21%). This rate went up as high as 17.85% among immuno-compromised patients. The main fungal species identified were Candida (53%) and A. niger (27%). Mucor and Fusarium species were also found. Among the immuno-compromised patients Candida was the commonest species found (93%) whereas among the immune-competent patients A. niger was predominantly found (47%). Nasal obstruction, congested nasal mucosa, epistaxis, nasal discharge and maxillary sinus tenderness were the common clinical findings. Depending on the case-wise merits three-fifths of the cases were given surgical treatment whereas the remaining two-fifths were treated conservatively with medications only. All the cases were either cured or showed improvement. Conclusion: Fungal infection of the nose and PNS in this part of the country was found in 4.61% of patients with chronic allergic and/or infective disorders of the nose and PNS. The common fungi infecting were Candida, A. niger, Mucor and Fusarium. The fungal infection rate was almost six-times increased in immune-compromised patients compared to normal patients. A. niger was predominantly associated with immune-compromised status.