The role of fungi in the etiology of chronic rhinosinusitis: A prospective study

OBJECTIVES: Allergic fungal sinusitis (AFS) may represent an endpoint in a spectrum of sinonasal disease. Patients fulfilling criteria for a diagnosis of AFS have a poor prognosis often requiring multiple surgeries. The detection of 'allergic mucin' with mucus containing clusters of eosinophils and the detection of fungi by histological examination or culture is key criteria necessary for diagnosis. This study was performed to assess the strength of the association of the presence of fungi with the presence of eosinophils in a group of patients with chronic rhinosinusitis and controls. METHODS: Thirty patients with a clinical diagnosis of chronic rhinosinusitis and 10 individuals as control group were selected for the study. Total serum IgE level testing, nasal mucus cytology and fungal culture were performed in all subjects. RESULTS: Fungal spores were present in the nasal mucus in 14 patients with rhinosinusitis, and in 7 controls. The detection of eosinophils on cytology correlated significantly both with a clinical diagnosis of chronic rhinosinusitis (95% confidence intervals (CI) 0.34-0.81) and with the presence of fungal elements on cytology (p=0.02). The average serum IgE level was higher in patients with fungal spores (p=0.039). CONCLUSION: In certain susceptible individuals inhaled fungi may provoke an eosinophilic response. This response varies from simple eosinophilic inflammation to classic allergic fungal sinusitis.