Clinical subgroups and antifungal susceptibilities in fungal culture-positive patients with chronic rhinosinusitis

Abstract

The goal of this study was to investigate clinical characteristics of chronic rhinosinusitis (CRS) in patients with positive fungal cultures. Fungal cultures were taken from 55 CRS patients and 20 healthy volunteers. Susceptibilities of isolated fungi to fluconazole, amphotericin B, itraconazole, voriconazole, and caspofungin were determined in CRS patients. Fungi grew in the cultures from 44 (80%) CRS patients and 17 (85%) healthy volunteers. Of the patients with positive fungal cultures, 5 (11.3%) had fungal hypersensitivity (FH), and 21 (47.7%) had eosinophilic mucin (EM). Fungal culture-positive patients with EM were more likely to be associated with presence of polyps and higher CT scores than those without EM (P < 0.05). All the patients with FH had EM and polyps, and CT scores of those patients were highest. The sensitivity rates of fungal isolates were 97.8% for amphotericin B, caspofungin, and voriconazole; 74.4% for itraconazole; and 6.4% for fluconazole. The presence of EM with or without FH leaded to more extended CRS, but a part of positive fungal cultures were together with EM in patients with CRS. Sensitivity to antifungal agents, except fluconazole, was high. Because many factors can contribute to the pathogenesis of CRS, medical treatment should be considered on a case-by-case basis.