Case Of Fungal Rhinosinusitis Research Articles

Study of fungal rhinosinusitis among Covid patients at a tertiary care hospital

IntroductionFungal rhinosinusitis (FRS) is being reported with increasing frequency from around the world and has become an important concern in India following the Covid-19 pandemic (Saha et al., 2016). The objectives of the study were to study the clinical and radiological characteristics of fungal rhinosinusitis, and to identify the causative fungal agents in Covid patients. MethodsA cross-sectional, observational study was conducted at a tertiary care hospital for a period of one and a half years from September 2020 to February 2022. Specimen from 105 clinically suspected cases were collected, processed, and identified by KOH, histopathology, and fungal culture as per standard protocols. ResultsOf the total 105 patients, 58 (55.24 %) were diagnosed to have Covid-19 infection. Amongst them, 42 (72.41 %) were confirmed cases of fungal rhinosinusitis. Of the 47 (44.76 %) who did not have Covid-19 infection, 20 (42.55 %) had fungal rhinosinusitis. The significant clinical manifestations observed were nasal obstruction 41 (97.62 %), headache 33 (78.57 %), and nasal discharge 29 (69.05 %). Diabetes mellitus was the major risk factor observed in 36 (85.71 %) of the cases. Maxillary and ethmoid sinuses together were involved in 21 (50 %) cases. Fungi were isolated in 47 of 62 (75.81 %) cases of fungal rhinosinusitis. Aspergillus flavus 13 (22.41 %) was the most common fungi isolated in culture followed by Rhizopus arrhizus 9 (15.52 %). The sensitivity and specificity of KOH were 91.5 % and 74.13 % respectively and that of histopathology were 91.5 % and 94.8 % respectively. ConclusionIn the wake of Covid 19 pandemic, a conjoint collaboration of clinical, radiological, histopathological, and microbiological diagnosis is essential for the proper management of cases.

A Clinico-pathological Study and Management of Fungal Rhinosinusitis

Background: Fungi are ubiquitous in the environment; hence we are constantly exposed to them. Objectives were to know the clinical presentation, radiological and pathological characteristics and management aspects of fungal rhinosinusitis.Methods: 30 cases of fungal rhinosinusitis reported during study period were evaluated and data was collected through history taking, clinical examination, haematological, histopathological and radiological investigations. Management by surgical & medical modalities were evaluated.Results: Fungal rhinosinusitis is more common in 3rd decade of life with male preponderance and more in low socio-economic status (73.3%). Nasal discharge (100%), nasal obstruction (96.7%), chronic headache (90%) and visual disturbances (23.3%) were important clinical features. Sinu-nasal polyp (66.7%) and allergic mucin (40%) were important associated factors. Orbital extension was seen in 33.3%, intracranial extension (20%) and extension to hard palate (6.7%). Computed Tomography scan had a sensitivity of 56.7% while histopathology and potassium hydroxide mount had a sensitivity of 93.33% in detecting cases. Observed mortality rate was 16.6%.Conclusion: Fungal rhinosinusitis is an important clinical entity which must be considered in all patientspresenting with unresolving rhinosinusitis

Identification of a Unique Morphological Pattern for the Diagnosis of Fungal Rhinosinusitis.

Fungal rhinosinusitis (FRS) is a relatively common, but often misdiagnosed disease of paranasal sinuses. The FRS is classified into invasive and non-invasive forms. The non-invasive form includes fungal ball and allergic FRS, and invasive form includes acute invasive FRS, chronic invasive FRS, and granulomatous FRS. Invasive fungal infections are associated with high morbidity and mortality, hence requiring urgent medical and surgical intervention. The histomorphology can help identify certain fungal organisms that cannot be cultured or are rarely visible in exudates. The morphologic diagnosis of tissue invasive and non-invasive fungal infection is essential for appropriate treatment. We analyzed cases of rhinosinusitis from 2017 to 2019 in Pathology Department at a tertiary care cancer hospital, Lahore, Pakistan. All clinical information was retrieved from patient records. Paraffin-embedded tissue blocks were stained with hematoxylin and eosin (H&E), special Grocott methenamine silver stain (GMS), and periodic acid Schiff stain (PAS) according to standard protocol. They were reviewed by two pathologists blinded by fungus status. A total of 169 cases of rhinosinusitis were reviewed. FRS comprised 146 (86.4%) of them. The mean age of patients with FRS was 32.8±14 years. The male:female ratio was 1.4:1. Maxillary sinus was the main site of involvement in 39 (27%) FRS cases. Aspergillus was identified in 117 (80.1%) cases of FRS. The culture reports were available in 44/146 (30.14%) FRS cases. They were negative in 22/44 (50.0%), and Aspergillus species were isolated in 18/44 (40.9%) cases of FRS. There were 84 (57.5%) cases of non-invasive FRS and 59 (40.4%) cases of invasive FRS. Among invasive FRS, there were 56 (38.4%) chronic granulomatous FRS cases including mixed patterns. Majority cases, 54 (96.4%), of chronic granulomatous FRS showed a unique crowded giant cell pattern comprising of foreign body and Langhans type giant cells. These giant cells were arranged closely forming irregular non-caseating granulomas surrounded by lymphocytes and fibrosis. Interestingly, the giant cells were scattered haphazardly without forming a granuloma as well. Fungal organisms were identified in all 56 cases of chronic granulomatous FRS. Histologically, predominant organism was Aspergillus in 48 (85.7%) on GMS and PAS stain. Our study observed a unique crowded giant cell pattern, which is a hallmark of invasive fungal infection. If pathologists are familiar with this unique pattern, they can make a quick and accurate diagnosis on histology. The physician can start antifungal treatment timely for better prognosis.

Antifungal Resistance Profile of Fungal Isolates from Fungal Rhinosinusitis Patients: A Study from Tertiary Care Hospital.

Objective Fungal rhinosinusitis is on the rise worldwide and it is endemic especially in North India. The main purpose of this study was to determine the antifungal resistance profile of fungal isolates from the cases of fungal rhinosinusitis. Methods Antifungal susceptibility testing of isolated fungi to fluconazole, amphotericin B, itraconazole, and voriconazole was determined by standard CLSI broth microdilution method. Results Sixty-eight fungal isolates of Aspergillus spp . ( n = 49), Rhizopus spp. ( n = 9), Candida spp . ( n = 4), Penicillium spp . ( n = 2), Mucor spp . ( n = 2), Bipolaris spp . ( n = 1), and Alternaria spp . ( n = 1) were obtained from 60 different clinical samples as exudate from nasal mucosa ( n = 28), allergic mucin ( n = 8), nasal lavage ( n = 2), tissue biopsy from nasal polyps ( n = 14), and intraoperative nasal mucosa ( n = 8). Of the 68 isolates, 75% were resistant to fluconazole, 13.23% were resistant to itraconazole, 2.94% to amphotericin B, and none were resistant to voriconazole. Aspergillus flavus (5%) was the only fungi found resistant to amphotericin B, while against itraconazole, A. flavus (7.5%) and A. niger (100%) were found resistant. All the isolates of A. flavus , A. fumigatus , A. niger , and Penicillium spp. were resistant to fluconazole. Conclusion Although amphotericin B stills remains to be the most effective drug, more prospective studies are needed for the requirement of knowledge of the sensitivity pattern for optimal treatment and reduction in morbidity in the long run.

Post Covid-19 Sinonasal Candidiasis: A Crisis Within the Pandemic.

The aim of this study was to find out the association of sinonasal candidiasis and Covid-19 infection. A prospective observational study was conducted at a tertiary care centre from April to September 2021, involving all patients with invasive candidiasis of the paranasal sinuses having a history of Covid-19 infection. A total of 18 patients of covid associated sinonasal candidiasis among the 475 cases of fungal rhinosinusitis were studied. All patients had involvement of nose and sinuses and 2 patients had orbital involvement with no loss of vision, while 3 had intracranial extensions and 1 had pulmonary involvement. Mandible was involved in 1 patient alone, while the maxilla and palate were involved in 5 patients. 15 patients were hypertensive, 12 diabetics and 1 had aplastic anaemia. Cultures showed that 8 patients had C. parapsilosis, 5 had C. albicans, 3 had C. tropicalis and 2 had mixed fungal infections. All patients underwent surgical debridement and antifungal administration. They were followed up for a minimum of 3 months. There was only one mortality (with aplastic anaemia), rest 17 were disease free at the time of writing this article. This is perhaps the first case series of post covid sinonasal candidiasis in the world. Invasive sinonasal candidiasis is a newer sequela of COVID-19 infection. Uncontrolled diabetes and over-zealous use of steroids at the time of Covid-19 are few of the known risk factors. Early surgical intervention and anti-fungal treatment should be sought for management.

Time to speed up the diagnostic evaluation in clinically suspected rhinosinusitis patients: A debate on the conventional versus molecular workup to establish fungal infective etiology for prompt management.

Rhinosinusitis (RS) is a clinical and radiological diagnosis that rarely reaches a proper infective etiological diagnosis. The most dreaded fact about invasive fungal rhinosinusitis is its poor prognosis in immunocompromised patients with a 60-80% mortality rate. The present study highlights and compares the various diagnostic techniques to establish a fungal etiological diagnosis in clinically suspected cases of RS from nasal biopsy specimens, with the emphasis on the molecular diagnostic approach. This prospective study included a total of 34 clinically suspected cases of RS who had recently undergone functional endoscopic sinus surgery (FESS)/biopsy from nasal polyps. Various laboratory methods (microbiological and histopathological) were utilized, including direct microscopic examination of clinical samples and fungal culture isolation. The molecular detection method of polymerase chain reaction (PCR) from clinical samples was also explored simultaneously. Serum immunoglobulin-E (IgE) testing of patients was also performed. Out of 34 clinically suspected RS cases, fungal etiology was established in a total of 18 cases, 17 of whom were culture-proven. A total of 15 and 14 culture-proven cases were also detected on direct microscopic examination by potassium hydroxide (KOH) mount and histopathological staining, respectively. One case was additionally identified by molecular method. Aspergillus flavus complex was the most common pathogen isolated in culture. Allergic fungal RS was the most common type, followed by acute and chronic invasive types among all fungal RS cases. Accurate and prompt etiological diagnosis of fungal RS is still lagging with fewer options for quick results. Although microscopy and culture isolation can't be replaced, PCR is a sensitive and specific method that should be incorporated as a supplementary tool for the early diagnosis and management, considering the delayed growth of fungi.

PREVALENCE OF FUNGAL ISOLATES IN UNILATERAL SINONASAL DISEASE

Fungal sinusitis has been on a rising trend and poses a health burden. Our study aims to nd out the prevalence of fungal isolates in unilateral sinonasal disease and its association with diabetes mellitus. A prospective study was conducted for 2years from August 2017 to August 2019. 150 patients were selected for study based on history, Diagnostic nasal endoscopy and radiological ndings. Patients were subjected to Functional Endoscopic Sinus Surgery (FESS). Sample collected has been sent for fungal smear, fungal culture and Histopathological examination. 50 (33.3%) patients were diagnosed with fungal rhinosinusitis based on fungal smear positivity and histopathology showing fungal elements. 100 (66.7 %) patients were categorized as non-fungal rhinosinusitis. Among the cases of fungal rhinosinusitis, 28 patients (56% of fungal rhinosinusitis) were diagnosed as allergic fungal rhinosinusitis, 15 patients (30% of fungal rhinosinusitis) were diagnosed as acute invasive fungal rhinosinusitis and 7 patients (14 % of fungal rhinosinusitis) were categorized as a fungal ball. A strong association has been found between fungal sinusitis and diabetes mellitus.

A Rare Cause of Fungal Rhinosinusitis: Exophiala jeanselmai

Fungal rhinosinusitis (FRS) is a rarely encountered disease; however, the incidence is increasing. It has a strong association with the impaired immune system of the host as well as a suitable environment for fungal growth. Fungal spores are abundant in the surroundings and can enter the nasal airway and the paranasal sinuses (PNS) through inhalation; however, only a small number of patients develop FRS. The primary organisms responsible for FRS are Aspergillus sp., Rhizopus sp., and some of the dematiaceous fungi. We present a case of FRS in an immunosuppressed patient caused by scarce fungal species, Exophiala jeanselmai. This rare fungus has never been reported to be associated with FRS before. They are dematiaceous fungi of low virulence and infection are usually restricted to skin and soft tissue.International Journal of Human and Health Sciences Vol. 06 No. 02 April’22 Page: 217-221

Histopathological Examination in the Categorization of fungal Rhinosinusitis - a Retrospective Study

Introduction: Fungal Rhinosinusitis is broadly defined as any sinonasal pathology related to the presence of fungi and is increasingly recognized worldwide. This study aimed to assess and ascertain the need for histopathological examination in the management of fungal Rhinosinusitis. Materials and Methods: This study was performed over two years, from April 2019 to April 2021, in the Department of Pathology, Vinayaka Missions KirupanandaVariyar Medical College and Hospital, Salem. A total of 383 cases of rhinosinusitis/nasal polyps were studied. Histopathological examination and categorization were done and compared with clinical diagnosis. Results: Only 4/18 cases of acute fungal Rhinosinusitis were correctly diagnosed(22.22%). Nineteen cases of the fungal ball were diagnosed, but none was correctly categorized. Clinical suspicion of fungal sinusitis was present in 10 cases of Rhinosinusitis, which turned out to be chronic Rhinosinusitis in histopathology. In AFRS, fungal elements were overlooked in Hematoxylin and Eosin stained slides and identified only by Grocottmethenamine silver in one-fourth of the cases. Conclusions: Though clinical diagnosis was made in 86% of fungal rhinosinusitis cases, correct categorization was done only in one-third of cases. CT scan could diagnose 60% of cases, but none was categorized. As treatment depends on the type of fungal Rhinosinusitis, histopathological examination is the gold standard for diagnosing and treating fungal Rhinosinusitis.

Microbiological and Radiological Perspective of Fungal Rhinosinusitis during the COVID-19 Pandemic: A Prospective Observational Study in A Tertiary Care Centre in Northern India

Radiological investigations are essential for the diagnosis and classification of fungal rhinosinusitis; however, radiological findings might occasionally be misleading. Computed tomography (CT) scan and magnetic resonance imaging (MRI) complement each other, facilitating clinicians to arrive at a diagnosis. Hence, even with the best radiological modalities, correlation between clinical and microbiological findings is crucial for the accurate diagnosis of fungal rhinosinusitis. In addition, the role of traditional methods such as KOH microscopy and culture should be accurately evaluated. To this end, we aimed to diagnose rhinosinusitis with a fungal etiology based on radiological findings and subsequently correlate these findings with those of microbiological techniques, namely culture and KOH microscopy. A total of 57 clinically suspected fungal rhinosinusitis cases were included in the study. Radiological investigations were performed using either CT or MRI. Tissues samples were processed and analyzed using KOH microscopy and culture. The results of the study suggest that using a single method for the diagnosis of fungal rhinosinusitis is inadequate. Rather, the diagnosis should be based on radiological as well as microbiological findings, especially for cases that are clinically ambiguous.

MICROBIOLOGICAL ASPECT OF FUNGAL RHINOSINUSITIS: STUDY CONDUCTED IN TERTIARY CARE HOSPITAL OF NORTH INDIA.

Introduction: Fungal rhinosinusitis is the emerging disease of current era, so isolation of fungus is important aspect to plan the treatment modalities accordingly.
 Methods: 50 samples of suspected patients of fungal rhinosinusitis were studied. Various samples like nasal secretion, nasal lavage and tissue were examined on direct microscopy using KOH and processed by standard protocols for fungal culture.
 Result: Out of 50 suspected cases fungal rhinosinusitis was seen in 23 (46%) cases. The 40% of cases were positive by direct microscopy using 20%KOH and 46% were positive by fungal culture. The most common fungal isolates was Aspergillus flavus (65.5%) followed by Aspergillus niger (13%).
 Conclusion: Aspergillus spp. was the most common isolated species among all the cases of fungal rhinosinusitis.
 Keywords: Aspergillus spp., Fungal, Rhinosinusitis.

First case of fungal rhinosinusitis due to Aspergillus nomius in a child with aplastic anaemia

Recently, infections caused by Aspergillus species have increased dramatically. Invasive aspergillosis (IA) is one of the most important causes of morbidity and mortality in immunocompromised patients, such as those with haematological malignancies who undergo chemotherapy, bone marrow and solid organ transplant recipients, and patients with other immunodeficiency. The most common species causing invasive infections include Aspergillus fumigatus, followed by Aspergillus flavus. Aspergillus nomius is an anamorphic species belonging to Aspergillus section Flavi, which currently include 22 species that can be grouped into seven clades (Aspergillus flavus, Aspergillus tamarii, Aspergillus nomius, Petromyces alliaceus, Aspergillus togoensis, Aspergillus leporis and Aspergillus avenaceus) based on morphological characters, sequence data, and extrolite profiles. These species may also produce toxic and carcinogenic aflatoxins. However, Aspergillus nomius is an emerging pathogen as a cause of IA; we found only two reported cases of invasive infection caused by this fungus in literature up till now. We reported a case of fungal rhinosinusitis caused by Aspergillus nomius in a child with aplastic anaemia and to our knowledge, it is the first case as an agent of rhinosinusitis. The isolate was identified by sequencing based methods.

Allergic fungal rhinosinusitis caused by <i>Aspergillus flavus</i>

Allergic fungal rhinosinusitis is a chronic inflammatory disorder of the sinonasal mucosa, with or without nasal polyps, which is frequently associated with microbial colonization including fungi. A case of fungal rhinosinusitis in Aseer area, Saudi Arabia, is described. The patient was admitted with common symptoms including nasal obstruction accompanied by itching, sneezing, rhinorrhea, epistaxis and recurrent headache. The patient was examined clinically and by CT scan. Nasal sinus swabs and a biopsy specimen were submitted for microbiological analysis. Polyps were surgically removed during functional endoscopic sinus surgery. Histopathology showed the presence of acute and chronic inflammatory cell infiltrates (rich in eosinophils) in the covering epithelium layers. Aspergillus flavus was isolated and identified from the lesions. The patient was discharged after showing good recovery, and home follow-up revealed no recurrences.Keywords: Paranasal sinuses, Polypoidal disease, Rhinorrhea, Fungi, Endoscopic sinus surgery

A clinicopathological and microbiological study of fungal rhinosinusitis

The role of fungal etiology in chronic rhinosinusitis has been increasingly recognized Yet the etiology pathogenesis and natural history of the disease is unclear In this article the author reports cases of fungal rhinosinusitis which were managed at a tertiary hospital and the clinical microbiological and pathological characteristics were analyzed

Signal void and pseudo-pneumatized sinus in fungal rhinosinusitis – Case report

Abstract BACKGROUND. Signal void, or the absence of signal on MRI sequences, in the sinonasal region may be encountered in fungal rhinosinusitis cases with the aspect of a pseudo-pneumatized sinus, leading to diagnostic errors. CASE REPORT. We present the case of a 75-year-old woman referred to our clinic for complete and persistent right-sided nasal obstruction. The patient was evaluated using sinus CT and contrast-enhanced head MRI. Opacification of the right maxillary, ethmoid and frontal sinuses as well as of the right nasal fossa were seen on CT, with maxillary sinus expansion and osseous erosion. The MRI showed T2 signal void in the maxillary sinus with extension to the nasal fossa, creating the appearance of a pseudo-pneumatized sinus, and hyperintense signal in the ipsilateral anterior ethmoid and frontal sinuses. The patient underwent endoscopic sinus surgery. The dual imaging evaluation of the patient aided the preoperative differential diagnosis and choosing the surgical approach.

Fungal Rhinosinusitis: Microbiological and Histopathological Perspective.

On the basis of histopathology Fungal Rhinosinusitis (FRS) is categorized into non-invasive (allergic fungal rhinosinusitis, fungal ball) and invasive (acute invasive, chronic invasive and granulomatous invasive fungal sinusitis). This differentiation helps to decide the treatment. Role of latest molecular methods such as PCR and conventional methods such as KOH microscopy and culture also needs to be evaluated. Therefore, in this study we planned to categorise fungal rhinosinusitis on the basis of histopathology and compare it with other methods such as PCR, culture and KOH microscopy. To analyse fungal rhinosinusitis cases by both histopathologically and microbiologically. A total of 76 clinically suspected fungal rhinosinusitis cases were included in the study. The tissue of suspected cases were processed and examined by KOH microscopy, histopathologically, culture and PCR. Histopathological examination was done by PAS, GMS and H&E stain. FRS was diagnosed in 37 (48.68%) cases out of 76 clinically suspected cases of FRS. In which 17 (22.3%) cases were positive by direct microscopy, 21 (27.6%) by culture, 27 (35.5%) by PCR and 14 (18.42%) by histopathology. Approximately 14 cases of FRS were classified according to histopathology; 10 (71.3%) as non-invasive FRS. Out of these 10, 9 (64.2%) were classified as AFRS and 1 (7.14%) as fungal ball. Only 4 cases (28.5%) were diagnosed with invasive FRS. Out of these 4 cases, 2 (14.2%) were of chronic invasive fungal rhinosinusitis, 1 (7.14%) was of granulomatous invasive fungal rhinosinusitis and 1 (7.14%) was of acute fulminant invasive fungal rhinosinusitis. Allergic Fungal Rhinosinusitis (AFRS) is the most common type of FRS. Aspergillus flavus was found to be the most common fungi causing FRS. Diagnosis should not be based on the single method. It should be done by both histopathological and microbiological methods, especially for those cases which are difficult to diagnose.

Expression of maspin in invasive fungal rhinosinusitis.

This study aimed to test the expression of maspin in invasive fungal rhinosinusitis and explore its value in diagnosing invasive fungal rhinosinusitis. Forty-two fungal rhinosinusitis cases (12 invasive and 30 non-invasive) were selected as the experimental group, and 30 chronic rhinosinusitis cases comprised the control group. Maspin expression was assessed in nasal mucous membrane specimens by immunohistochemical staining. Compared with the control group, maspin expression was down-regulated in the fungal rhinosinusitis group (p < 0.05). Furthermore, the staining score for maspin was lowest in the invasive fungal rhinosinusitis group, as compared with both the non-invasive fungal rhinosinusitis group and the control group (p < 0.05). A maspin staining score of 5.70 was the critical value for diagnosis of invasive fungal rhinosinusitis, with sensitivity and specificity of 91.7 per cent and 88.3 per cent, respectively. The results of this study suggest that the maspin staining score may be a biomarker for effective and rapid diagnosis of invasive fungal rhinosinusitis.

Saksenaea erythrospora, an emerging mucoralean fungus causing severe necrotizing skin and soft tissue infections – a study from a tertiary care hospital in north India

Background: Saksenaea erythrospora is an emerging and recently described pathogenic fungus mainly causing invasive cutaneous infections. Globally, very few human cases, caused by S. erythrospora, have been reported. In India, among the genus Saksenaea, S. vasiformis was the only reported pathogenic species, until recently when a case of fungal rhinosinusitis was reported to be caused by S. erythrospora. We observed five human cases of necrotizing skin and soft tissue infections caused by S. erythrospora following traumatic implantation over 1-year study period.Methods: The study was conducted for a year observing the causative role of Saksenaea species in primary cutaneous necrotizing infections. The clinical entities were diagnosed by both microbiological and histopathological examination of the skin biopsies. The final identification of fungal strains was done by comparing internal transcribed spacer (ITS) and D1–D2 domains of the LSU (larger subunit) of the nuclear ribosomal RNA (rRNA) sequences with those of type strains of the different species of Saksenaea.Results: Out of total 23 cases of necrotizing skin and soft tissue infections, 5 were caused by S. erythrospora. Intramuscular injection into the gluteal region was the predisposing factor in four patients, while upper limb involvement, following medicated adhesive tape application, was seen in one patient. All patients were treated with liposomal amphotericin B (LAMB) along with extensive debridement of necrotic tissues. Four patients responded well however one died.Conclusion: Saksenaea erythrospora is an emerging mucoralean fungus isolated in India among patients undergoing inadvertent I/M injections entailing necrotizing fasciitis at the local site.

Analysis of the correlated factors and clinical features of 332 cases of fungal rhinosinusitis

Objective:To investigate the correlated factors and clinical features of fungal rhinosinusitis(FRS).Method:Retrospective analysis the clinical medical records of 332 cases of FRS(observation group) and 725 cases of chronic rhinosinusitis(control group) during 2007 to 2015 in our hospital including symptoms,signs,history,results of laboratory examinations and imaging findings.Then analysis and compare the differences between two groups of data.Result:The average age(50.25±13.42)years,the proportion of women(57.2%) and the time course of clinical symptoms<1 year(69.9%) ratio of observation group were significantly higher than that in control group, and all the differences were statistically significant(P<0.05).Clinical symptoms of observation group, such as haem nasal discharge,epistaxis,nose smelly, headaches,facial discomfort,were significantly higher than that in the control group, and percentages of nasal obstruction, pus snot and hyposphresia were significantly lower than that in the control group,all the differences had statistical significant(P<0.05).There was no statistically significant difference between two groups of nasal itching ratio(P>0.05).The rates of history of hypertension, diabetes, hyperthyroidism/hypothyroidism low hemoglobin in observation group, were notably higher than that in control group,and the rates of history of nasopharyngeal carcinoma radiotherapy and multiple history of nasal endoscopic surgery were notably lower than the control group,all the differences were statistical significant(P<0.05).There were no statistically significant difference(P>0.05) between the two groups smoking and drinking habits ratio.Single sinus disease,unilateral diseaseratio in observation group were obviously higher than that of control group,but the nasal septum deviation ratio significantly lower than the control group, the differences were statistically significant(P<0.05).Conclusion:There are many strong specificities of correlated factors and clinical features in FRS compared with CRS.It may help to make early intervention and clinical diagnosis depending on these specificities..

Allergic Fungal Rhinosinusitis: A Study in a Tertiary Care Hospital in India.

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.