Allergic Fungal rhino-sinusitis frequency in chronic rhino-sinusitis patients and accuracy of fungal culture in its diagnosis.

Khalid Muneer Cheema,Fatima Naumeri,Nukhbat Ullah Awan,Samina Qamar

doi:10.12669/pjms.36.3.1661

Khalid Muneer Cheema, Fatima Naumeri + Show 2 more

Open Access

https://doi.org/10.12669/pjms.36.3.1661

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Abstract

Objective:To determine the frequency of Allergic Fungal Rhino-sinusitis (AFRS) in Chronic Rhino-sinusitis (CRS) patients and the accuracy of fungal culture in diagnosing AFRS.Methods:Immunocompetent patients with CRS and without invasive fungal rhino-sinusitis presenting over a period of 3 years in ENT department of Mayo Hospital, from April 2014 to September 2017 were included in the study. AFRS was diagnosed clinically and on Bent and Kuhn diagnostic criteria. All patients underwent endoscopic sinus surgery. Removed tissue histopathology and fungal culture was done. Diagnostic accuracy of fungal culture in AFRS patients was determined.Results:Out of 216 patients of CRS, 45 (20.8%) had AFRS. Mean age of patients diagnosed with AFRS was 29.49±9.16. Out of 45 patients, 26 were male and 19 were female. Nasal polyps were present in 45 (100%) patients, fungal stain was positive in 39(86.7%). CT scan showed sinus expansion in 28(62.2%) patients, heterogeneous opacity in 45(100%) patients and bone destruction in 13(28.9%). Presence of Allergic Mucin was seen in 45(100%) patients, high IgE levels in 36(80.0%), eosinophilia in 21(46.7%), presence of Charcot Leyden crystals in 27(60.0%). Asymmetrical involvement of sinuses was seen in 30 (66.7%) and co-existent asthma was seen in 18(40.0%). Fungal culture positive patients were 25(55.6%). Diagnostic accuracy of fungal culture was 91.6%.Conclusion:Fungal culture has a key role in confirming diagnosis of AFRS. We also noted that frequency of AFRS is increasing in CRS patients.

Highlights

Fungal rhino-sinusitis is a type of chronic rhinosinusitis (CRS) and has five clinico-pathological variants
Despite adequate research across the world, there is yet no local data to see increase in frequency and incidence of Allergic fungal rhino-sinusitis (AFRS) and to prove diagnostic importance of positive fungal culture in these patients, so we addressed this gap in our study
Immunocompetent patients diagnosed with chronic rhino-sinusitis with or without nasal polyposis were included in the study after informed consent; while patients with invasive fungal rhino-sinusitis were excluded

Summary

Introduction

Fungal rhino-sinusitis is a type of chronic rhinosinusitis (CRS) and has five clinico-pathological variants. Three of these are tissue invasive and include acute necrotizing (fulminant), chronic invasive and granulomatous invasive (indolent) variant. The non-invasive variants include sinus mycetoma (fungal ball) and Allergic fungal rhino-sinusitis (AFRS).[1] CRS has a prevalence of 2%-16%2 and initial reported incidence of AFRS in patients of CRS was 5% to 10% in literature,[3] an increasing incidence in temperate regions have been reported.[4]. AFRS is considered to be a hypersensitivity reaction to fungal antigens.[5] Gold standard for diagnosis of AFRS in CRS patients is debatable as different forms of CRS may have similar clinical presentation and radiological findings. Most commonly used criteria for diagnosis of AFRS is Bent and Kuhn.[6]

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