Fungal Rhinosinusitis
Clinicopathological Study of 10 Years
Keywords:
Fungal rhinosinusitis, nose, paranasal sinuses, culture
Abstract
Background: To study clinicopathological correlation of fungal infections of nose and paranasal sinuses, to classify them and correlate with fungal culture. Methods: A Retrospective study of biopsy specimens from nose and paranasal sinuses, diagnosed as fungal rhinosinusitis (FRS) on histology, over a ten year period from January 2002 to October 2012, was carried out. The detailed clinical history was collected from clinical record and culture reports were collected whenever available. The tissues were studied with Haematoxylin and Eosin stain (H&E) Gomori Methenamine silver (GMS) & Periodic acid Schiff (PAS) stain. The sinusitis was classified based on histological features. Results: Total 30 cases of fungal rhinosinusitis were studied. Age ranged between 12 to 82 years. Maximum incidence was seen in 5th and 6th decade with equal sex distribution. Paranasal sinuses were more commonly involved by fungal infections than nasal cavity. Nasal obstruction and rhinorrhea were the common presenting symptoms. Out of 30 cases, 12 were immunocompetent. 7 cases were of non-invasive FRS which included 1 (3.33%) case of saprophytic fungal infestation, 3 (10%) cases of fungal ball, and 3 (10%) cases of allergic fungal rhinosinusitis. Invasive FRS constitutes 23 cases, which included 2 (6.67%) cases of chronic granulomatous invasive FRS, 7 (23.33%) cases of chronic invasive FRS, and 14 (46.67%) cases of acute fulminant FRS. Invasive FRS was characterized by extensive necrosis with or without granulomatous inflammation. Only 9 out of the 13 fungal cultures available correlated with the histomorphology. Conclusion: FRS should be suspected in nasal biopsies showing extensive necrosis in immunocompromised individuals. Microbiological culture is must for species identification.References
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8. Chakrabarti A, Das A, Panda N. Overview of fungal rhinosinusitis. Ind J of Otorhinolaryngol and Head and Neck Surg 2004; 56(4): 251-258.
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11. Washburn RG, Kennedy DW, Begley MG, Henderson DK, Bennett JE. Chronic fungal sinusitis in apparently normal hosts. Medicine (Baltimore). 1988 Jul;67(4):231-47
12. Bharathi R, Arya AN. Mucormycosis in an immunocompetent patient. J Oral Maxillofac Pathol 2012; 16: 308-309.
13. Mignogna MD, Fortuna G, Leuci S, Adamo D, Ruppo E, Siano M, et al. Mucormycosis in immunocompetent patients: a case-series of patients with maxillary sinus involvement and a critical review of the literature. Int J Infect Dis 2011; 15 (8): e533-e540.
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2. Chakrabarti A, Denning DW, Ferguson BJ, Ponikau J, Buzina W, Kita H, et at. Fungal rhinosinusitis: a categorization and definitional schema addressing current controversies. Laryngoscope 2009; 119: 1809-1818.
3. deShazo RD, Chapin K, Swain RE, Fungal sinusitis, New Eng J Med 1997.337 254-259
4. Challa S, Uppin SG, Hanumanthu S et al., “Fungal rhinosinusitis: a clinicopathological study from South India,”European Archives of Oto-Rhino-Laryngology, 2010; 267, 1239–45.
5. Das A, Bal A, Chakrabarti A, Panda N, Joshi K, “Spectrum of fungal rhinosinusitis; Histopathologist’s perspective,” Histopathology, 2009; 54, 854–859.
6. Michael R, Michael J, Ashbee R, Mathews M, “Mycological profile of fungal sinusitis: an audit of specimens over a 7-year period in a tertiary care hospital in Tamil Nadu,” Indian Journal of Pathology and Microbiology, 2008; 51, 493–496.
7. Kathleen T. Montone, Virginia A. Livolsi, Michael D. Feldman, et al., “Fungal Rhinosinusitis: A Retrospective Microbiologic and Pathologic Review of 400 Patients at a Single University Medical Center,” International Journal of Otolaryngology, vol. 2012, Article ID 684835, 9 pages, 2012. doi:10.1155/2012/684835
8. Chakrabarti A, Das A, Panda N. Overview of fungal rhinosinusitis. Ind J of Otorhinolaryngol and Head and Neck Surg 2004; 56(4): 251-258.
9. Schubert MS, Allergic fungal sinusitis, Otolaryngol Clin N Am 2004, 37 301-326
10. Mylona S, Tzavara V, Ntai S, Pomoni M, Thanos L. Chronic invasive sinus aspergillosis in an immunocompetent patient: a case report. Dentomaxillofac Radiol. 2007 Feb; 36(2):102-4.
11. Washburn RG, Kennedy DW, Begley MG, Henderson DK, Bennett JE. Chronic fungal sinusitis in apparently normal hosts. Medicine (Baltimore). 1988 Jul;67(4):231-47
12. Bharathi R, Arya AN. Mucormycosis in an immunocompetent patient. J Oral Maxillofac Pathol 2012; 16: 308-309.
13. Mignogna MD, Fortuna G, Leuci S, Adamo D, Ruppo E, Siano M, et al. Mucormycosis in immunocompetent patients: a case-series of patients with maxillary sinus involvement and a critical review of the literature. Int J Infect Dis 2011; 15 (8): e533-e540.
14. Watts JC, Chandler FW. Aspergillosis. In: Connor DH, Chandler FW, Schwartz DA, Manz HJ, Lack EE, editors. Pathology of infectious diseases. Vol 2. Connecticut; Appleton and Lange: 1997. 933-941.
Published
2018-05-29
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