Title: Chronic Rhinosinusitis-Fungal Etiology & Clinical, Histopathological, Radiological Profile in a Tertiary Care Centre

Authors: Dr Archana, Dr Sindhu V Nath, Dr Salima R Windsor

 DOI:  https://dx.doi.org/10.18535/jmscr/v6i9.149

Abstract

Background & Objectives: Rhinosinusitis comprises a spectrum of inflammatory and infectious disease that involves the sinuses and nasal mucosa which affects approximately 20% of the population. Fungi are being increasingly implicated in the etiopathology of rhinosinusitis& its clinical presentation is almost indistinguishable from that of chronic rhinosinusitis. The aim of this study is to determine the proportion of fungal sinusitis among diagnosed cases of chronic rhinosinusitis and to describe the clinical, radiological, microbiological and pathological profile.

Methods: 186 Chronic rhinosinusitis patients were included in the study after fulfilling the inclusion and exclusion criteria. This study was conducted at Department of ENT, Medical College, Thiruvananthapuram over a period of 13 months. After obtaining informed written consent, detailed history and clinical examination was performed and investigation findings were noted. After surgery, the histopathological, fungal stain and culture results of the tissue samples send were analysed statistically using SPSS software.

Results & Discussion: Out of 186 cases of chronic rhinosinusitis, 50 cases (26.9%) were found to be fungal culture positive. Among them 29(58%) were caused by Aspergillus species. Headache, nasal obstruction and nasal discharge were the most common presenting symptoms of these cases. Radiological features like double density, sclerosis, bone erosion, and unilateral affection of the disease were found to be significantly associated with fungal sinusitis cases.

Conclusion: The early diagnosis and recognition of fungal sinusitis is very important, not only because it is curable in the early stages, but also to prevent progression of the disease into more destructive invasive forms. Aspergillus species is the most common culprit causing fungal sinusitis. CT scan plays a very important role & is one of the best diagnostic tools in diagnosing fungal rhinosinusitis.

Keywords: Fungal rhinosinusitis, Aspergillus, culture, KOH mount, radiological, chronic rhinosinusitis, endoscopic sinus surgery.

References

  1. Hussain S, Salahuddin N, Ahmad I, Salahuddin I, Jooma R. Rhinocerebral invasive mycosis: occurrence in immunocompetent individuals. Eur J Radiol. 1995 Jul. 20(2):151-5.
  2. Scharf JL, Soliman AM. Chronic rhizopus invasive fungal rhinosinusitis in an immunocompetent host. Laryngoscope. 2004 Sep. 114(9):1533-5.
  3. Siddiqui AA, Shah AA, Bashir SH. Craniocerebral aspergillosis of sinonasal origin in immunocompetent patients: clinical spectrum and outcome in 25 cases. Neurosurgery. 2004 Sep. 55(3):602-11; discussion 611-3.
  4. Lanza D C, Kennedy D W. Adult Rhinosinusitis Defined Otolaryngology- Head and Neck Surgery 1997 (3Pt 2)S 1-7.
  5. Lund VJ, Mckay IS. Staging Rhinosinusitis. Rhinology 1993;31:183-4.
  6. Das A, Bal A, Chakrabarti A, Panda NK, Joshi K. Spectrum of fungal rhinosinusitis; Histopathologist's perspective. Histopathology 2009;54:854-9.
  7. Panda NK, Chakrabarti A, Das A, Bapuraj RJ, Saravanan K. To study the prevalence of allergic fungal rhinosinusitis among the patients with chronic sinusitis. In: 5 th National Conference, Society for Indian Human and Animal Mycologists Abstract Book; 2004. p. 51
  8. Krishnan K U, Agatha D, Selvi R. Fungal rhinosinusitis: A clinicomycological perspective. Indian J Med Microbiol 2015;33:120-4.
  9. Prateek S, Banerjee G, Gupta P, Singh M, Goel M M, Verma V. Fungal rhinosinusitis: A prospective study in a University hospital of Uttar Pradesh. Indian J Med Microbiol 2013;31:266-9.
  10. Shivani, Bimla Devi, Karan Sharma, Pushpa Devi, Rupali, Gagan Deep. Mycological profile of fungal rhinosinusitis in a tertiary care hospital. International Journal of Contemporary Medical Research 2016;3(4):1026-1028.
  11. Lakshmanan A, Anandha Lakshmi S, Selvarajan G. Clininco mycological pattern of fungal rhinosinusitis – A study from a tertiary care centre. Int J Pharm Bio Sci 2014;5:267-73.
  12. Kavitha, K., N.Rathnapriya, K.G. Venkatesh and Jayalakshmi, G. 2016. A Study on the categorization and Mycological profile of chronic fungal Rhinosinusitis in a Tertiary care hospital. Int. J.Curr.Microbiol.App.Sci.5(2): 775-783.
  13. Chakrabarti A, Sharma SC, and Chandler J. Epidemiology of pathogenesis of paranasal sinus mycoses. Otolaryngol Head Neck Surg 107:745–750, 1992.
  14. Santhi T, Rajan KV. Presence of Fungal Organisms in Chronic Rhinosinusitis with Nasal Polyposis: A Clinico Pathological Study from Kerala. Int J Sci Stud 2015;3(3):99-104.
  15. Siddiqui AH, Sheikh AA, Khan TZ, Marfani MS, Ali A. Sinonasal polyposis and fungus: A growing relationship. Int J Endorsing Health Sci Res 2014;2:58-61.
  16. Pokharel M, Karki S, Shrestha BL, Shrestha I, Amatya RCM. Correlations Between Symptoms, Nasal Endoscopy, Computed Tomography and Surgical Findings in Patients with Chronic Rhinosinusitis. Kathmandu Univ Med J 2013;43(3):201-205.
  17. S. Satish, Jolene Alokkan. Clinical Study of Fungal Rhinosinusitis,IOSR Journal of Dental and Medical Sciences (IOSR-JDMS) e-ISSN: 2279-0853, p-ISSN: 2279-0861.Volume 5, Issue 4 (Mar.- Apr. 2013), PP 37-40.
  18. Bhardwaj BB, Gill JS, Singh T. The Role of CT Scan and Histopathology in Diagnosis of Allergic Fungal Sinusitis. ClinRhinol An Int J 2014;7(3):117-120.

Corresponding Author

Dr Sindhu V Nath

12 Vasanth Vihar, Kumarapuram, Trivandrum, Kerala 695011, India