Isolation, Identification and Speciation of Fungi Associated With Chronic Rhinosinusitis from Specimens Collected During Functional Endoscopic Sinus Surgery

Abstract

Introduction: Chronic rhinosinusitis is defined as an inflammatory condition of the mucosa of nasal cavity and the four paranasal sinuses, lasting more than 12 weeks duration.1 Fungi are being increasingly implicated in etiopathogenesis of rhinosinusitis. Fungal sinusitis is frequently seen in immunocompromised patients having diabetes, malignancy and on steroids, also in 45% of immunocompetent individuals. Fungi are most often under-diagnosed cause of chronic rhinosinusitis. Fungal sinusitis is known to have recurrence and refractory to antibiotic treatment. Its main treatment modality remains repeated Functional Endoscopic Sinus Surgery and antifungal drugs. Identification of fungal species helps in diagnosis and prescribing suitable antifungal to patient & adequate management. Hence the present study is undertaken to isolate and identify fungal species from FESS (Functional Endoscopic Sinus Surgery) samples of patients with chronic rhinosinusitis (CRS). Aims & Objectives:1. To isolate, identify & speciate the fungi associated with chronic rhinosinusitis from specimens collected during FESS. 2. To classify the fungal sinusitis by histopathology. Material And Methods: All clinically diagnosed cases of chronic rhinosinusitis in all age groups and of both sexes, attending Otorhinolaryngology OPD and undergoing Functional Endoscopic Sinus Surgery were taken for this study. 70 samples were collected during FESS procedure. Specimen were subjected to Direct microscopy(KOH preparation) using 10% and 20% Potassium hydroxide. They were inoculated onto Sabouroud Dextrose Agar with and without antibiotics (Chloramphenicol and Cycloheximide).Isolates were identified by standard mycological techniques. Tissue sections were stained with Haematoxylin and Eosin. The presence of fungal elements were confirmed with special fungal stains (Gomori Methanamine Silver and Periodic Acid Schiff). Results: Out of 70 samples, 25 were both KOH and culture positive, 39 samples were both KOH & culture negative,5 samples were KOH positive but culture negative. One of sample was KOH negative & culture positive. Commonest age group found to be affected is 21-30 years (40%).Least age group affected is 61-70 year(1.42%). Total male:female ratio is 1.3:1. A.flavus was most common isolate(13) .A.niger was next common isolate (5),.C.carionii(3),H.dematioides(1),S.prolificans(1),P.expansum(1) were the other isolates. Histopathologically,majority of samples , 25(96%) were of Allergic fungal sinusitis type,while 1(4%) was of Fungal ball/Mycetoma type. Prevalence of fungal sinusitis based on Culture positive status in present study is 35.17%. Discussion: • 70 cases of chronic rhinosinusitis were reported with age range of 6-63 years,most patients were in age range of 21-30 years(40%). • Male:female ratio was 1.3:1.Most (55/70) patients were from rural background. • Prevalence of fungal sinusitis based on Culture positive status in present study is 35.17%. • A.flavus was the most common isolate. • This correlated well with studies done by Klossek et al,Michael et al,Prateek et al,Giri et al, Ragini et al. Reports of unusual causes of FRS have been on the rise from India as well as other countries. We have also isolated rare fungi like Cladosporium carionii, Hormonema dematioides, Scedosporium prolificans & Penicillium expansum. • Giri et al,Baradkar et al,Swain et al,Premamalini et al,Janagond et al & Shivprakash et al also reported rare causes of FRS in their studies. Conclusion: Fungal sinusitis is very common in our country with several contributing factors like hot humid climate, poor hygiene, increased outdoor activities, inhalation of spores and immunosuppression. Accurate and early diagnosis of fungal sinusitis helps in preventing progression to Invasive fungal sinusitis, which is associated with high morbidity and mortality, and unnecessary administration of antibiotics to the patient. Thus better patient care & management.