[Classification of etiologic agents in fungal sinusitis by immunohistochemistry, histology and culture]. / Fungale SinusitidenErregerklassifizierung durch Immunhistologie, Histomorphologie und Kultur.

In the invasive forms of fungal sinusitis rapid identification of etiologic agent is of vital importance because of the different reaction of the fungi to various antifungal agents. In the non-invasive forms it is of interest for epidemiologic reasons and because of the potential transition to invasive and generalized mycoses in case of additional immunodeficiency. A diagnosis of fungal genus in histologic slides is desirable since up to 70% of the fungal cultures remain without result.In the present study 77 cases of fungal sinusitis were examined with the comercially available antibodies Anti-Aspergillus and Anti-Rhizomucor. The results of the histological examination and fungal cultures were added. The immunohistochemical examination permitted in 64 cases a classification as Aspergillus/Penicillium. Two cases caused by Zygomyzetes alone or in combination could be confirmed immunohistochemically. Four fungus balls showed no significant immunoreaction with both antibodies. If these where caused by other Hyphomycetes p.e. Pseudallescheria or if it where Aspergillus fungus balls that did not react because of extreme regressive change can not be decided.

[Investigations on allergic fungal genesis of chronic rhinosinusitis]. / Untersuchungen zur pilzallergischen Genese chronischer Rhinosinusitiden.

BACKGROUND: The incidence of allergic fungal sinusitis (AFS) is estimated differently. The importance of hyphal findings in nasal mucus for initiation of chronic hyperplastic sinusitis is not proven. METHODS: 124 patients with clinical signs and CT-scan findings of a chronic-hyperplastic rhinosinusitis were treated by functional endoscopic sinus surgery. During the operation a thick mucus was found in each patient. The mucus was isolated and investigated by histopathological analysis with special Grocott-stain and a culture for fungal growth was initiated. Furthermore the diagnostic for allergic reactions against fungus was done by prick- and RAST-tests. RESULTS: 21 patients had positive histopathological findings of fungus. In 10 cases fungal hyphae were found embedded in typical eosinophilic mucus. A positive allergic reaction against fungus was seen in 7 of these 10 patients. The culture results showed different pictures according to the isolated species, in 3 cases of the 10 AFS cases the culture was negative. The other 11 cases of 21 positive histological findings of fungus were cases of a fungus ball. The other 103 patients were without any sign for fungus in the HE- or Grocott-stain. CONCLUSIONS: A high incidence of AFS is not evident in group of chronic hyperplastic rhinosinusitis. The presence of eosinophilic "allergic" mucus is not the evidence for AFS. The inflammatory cascade leading to the clinical picture is a multifactorial event. The role of detectable fungus hyphae have to be estimated by further investigations.