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

Abstract

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.

Recurrence Pattern and Complication Rate of Allergic Fungal Sinusitis: A 10-Year Tertiary Center Experience

“…The mean age in our study was 31.57 years with a range of 13–55 years. This is quite similar to a study conducted in India in which the mean age was 28.4 years with a range of 18–48 years [ 8 ]. In contrast, in the USA in 2008, the mean age was found to be on the higher side, being 45 years with a range of 18–88 years [ 9 ].…”

“…Past nasal surgeries were found in 32.14% of patients. In contrast, the study which was done in India showed that previous nasal surgeries were seen in 20% of cases followed by bronchial asthma (14.2%) and allergic disorders (11.42%) [ 8 ].…”

Non-Invasive Rhinosinusitis: Clinical and Microbiological Perspective

“…Some cases with positive direct KOH smear examination yielded a negative culture, which may be due to inadequate specimen or improper sample collection or antifungal therapy of the patient. Our study findings were also found comparable to a recent study conducted in 2016 in New Delhi, India [19].…”

Microbiological Aspect of Fungal Rhinosinusitis: Study Conducted in Tertiary Care Hospital of North India.

“…The predominance was seen in males with a male to female ratio 1.27:1, as compared to study conducted by Michael et al where the predominance was seen in female patients with male to female ratio 0.8:1 with a mean age of 45.7 years ranging from 11 to 79 years. [7]Our finding were similar with the studies done by Prateek S et al, Ajay Kumar Singh et al and Kaur R et al [1,5,6] The predominant agent in western countries were found to be pigment producing dematiaceous fungi-Bipolaris species, Curvularia lunata and Alternaria species. [8] In the present study Aspergillus flavus (65.5%) was most common followed by Aspergillus niger (13%), results were similar with the study done by Kaur R et al [6] Study done by Prateek S et al and Saravanan et al the most common fungal isolate was found to Aspergillus flavus( 57.1%, 81%) followed by Aspergillus fumigatus (14.2%, 9%).…”

“…In the present study the incidence of fungal rhinosinusitis was 46% , the similar incidence (48.7%) had been reported by Ajay Kumar Singh et al [5] The other similar studies from the North and South Indian regions of the country has reported the incidence of fungal rhinosinusitis ranging from 21% to 46.7%. [1,3,6].…”