Prevalence of fungi in patients with chronic rhinosinusitis

Abstract

Objectives: Evaluate the prevalence of fungal rhinosinusitis(FRS) in patients with chronic rhinosinusitis (CR) submitted to endoscopic sinus surgery, identify the main species of fungi and compare the signs and symptoms, laboratory and radiologic evidences in patients with allergic fungal rhinosinusitis (AFRS) and fungal ball (FB). Methods: Sixty-two 6.7%) patients with the diagnosis of FRS, confirmed by direct fungal exam, cultural or histological exams were selected from 865 patients with CR submitted to endoscopic sinus surgery from January 1988 to December 2002. Patients were classified according to surgical findings and histological exam as FB, saprophyt infection, invasive FRS, AFRS, or indolent FRS. Results: FB was diagnosed in 33 patients (53.2%) and AFRS in 24 (38.7%). Comparing preoperative finds, only the use of topical corticosteroids, the history of intolerance to aspirin and asthma, were different among these groups, being more frequent in AFS ( P < 0.001). The presence of nasal polyps in patients with AFRS (78.2%) was also higher ( P < 0.001). More patients with AFRS showed bone erosion, microcalcifications ( P < 0.001), and mucosal thickness ( P = 0.02) on CT scan compared to fungal ball patients. The other signs and symptoms, laboratory and radiologic finds, and fungal species were similar in both groups. Conclusion: The presence of fungi as an etiologic factor of CR in patients with surgical indication is important and must be confirmed by cultural and histological examination. Symptoms like nasal obstruction, nasal secretion, postnasal drip, cough, facial pressure, sore throat, facial pain, olfatory symptoms, fatigue, or the presence of allergic rhinitis cannot differentiate AFRS from FB. Only CT scan and the presence of nasal polyposis can elevate preoperative suspection of AFRS.