Abstract
The study was conducted to study the occurrence and clinical presentation of allergic fungal rhinosinusitis (AFRS), characterize the same, and correlate with the microbiological profile. Clinically suspected cases of fungal rhinosinusitis (FRS) depending upon their clinical presentation, nasal endoscopy, and radiological evidences were included. Relevant clinical samples were collected and subjected to direct microscopy and culture and histopathological examination. 35 patients were diagnosed to have AFRS. The average age was 28.4 years with a range of 18–48 years. Allergic mucin was seen in all the AFRS patients but fungal hyphae were detected in only 20%. 80% of cases were positive for IgE. All the patients had nasal obstruction followed by nasal discharge (62.8%). Polyps were seen in 95% (unilateral (48.57%) and bilateral (45.71%)), deviated nasal septum was seen in 28.57%, and greenish yellow secretion was seen in 17.14%. Direct microscopy and septate hyphae were positive in 71.42% of cases. 91.4% of cases were positive by culture. 5.7% yielded mixed growth of A. flavus and A. niger. Prompt clinical suspicion with specific signs and symptoms along with timely sampling of the adequate patient specimens and the optimal and timely processing by microscopy and culture and histopathological examination is a must for early diagnosis and management.
Highlights
Allergic fungal rhinosinusitis (AFRS), a subset of polypoid chronic rhinosinusitis, is characterized by the presence of eosinophilic mucin with fungal hyphae within the sinuses and a type I hypersensitivity to fungi [1]
Allergic fungal sinusitis is seen to range in a wide percentage of patients with chronic rhinosinusitis from 5 to 10% in some studies [2, 3] to a much higher percentage in others [4]
The criteria for diagnosis of AFRS have undergone numerous revisions; most authors agree on the Journal of Allergy following: the presence in patients with chronic rhinosinusitis of characteristic “allergic” mucin containing clusters of eosinophils and their byproducts and the presence of noninvasive fungal elements within that mucin, detectable on staining or culture [2,3,4, 12]
Summary
Allergic fungal rhinosinusitis (AFRS), a subset of polypoid chronic rhinosinusitis, is characterized by the presence of eosinophilic mucin with fungal hyphae within the sinuses and a type I hypersensitivity to fungi [1]. To diagnose AFRS, Bent III and Kuhn in 1994 [3] proposed five diagnostic criteria: type I hypersensitivity, nasal polyposis, characteristic findings on CT scan, presence of fungi on direct microscopy or culture, and allergic mucin containing fungal elements without tissue invasion. The criteria for diagnosis of AFRS have undergone numerous revisions; most authors agree on the Journal of Allergy following: the presence in patients with chronic rhinosinusitis (confirmed by CT scan) of characteristic “allergic” mucin containing clusters of eosinophils and their byproducts and the presence of noninvasive fungal elements within that mucin, detectable on staining or culture [2,3,4, 12]. The main objective of this prospective study was to study the occurrence and clinical presentation of allergic fungal rhinosinusitis, characterize the same, and correlate with the microbiological profile
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