Fungal colonization of the paranasal sinuses*

Abstract

Fungal infection of the paranasal sinuses occur in four primary types: acute invasive (1), chronic invasive (2), chronic fungus ball (3) and allergic fungal sinusitis (4). The first and second form can be fatal and is often found in immunosuppressed patients. The present paper concerns a group of immunocompetent patients with non-invasive chronic sinusitis caused by moulds. Over the period from 1994 to 1998, 132 tissue samples from the paranasal sinuses obtained by endoscopic operation from 117 patients was examined for mycotic infections. The mycological examination was carried out if granulomatous and crumbly material was seen in the sinus by endoscopy (91 times maxillary sinus, 23 times ethmoid sinus, 11 times frontal sinus, 7 times sphenoid sinus). Out of 117 patients 29 were positive (24,9%). From 132 surgical specimens fungi were proved in 34 times (25,7%). The following fungal species were isolated: Aspergillus fumigatus 17 times, other Aspergillus spp 6 times, Alternaria alternate 2, Penicillium rugulosum 1, and moulds without differentiation 5 times. In the histological examination an invasive mycelial growth in the mucous membrane or in the bones was never observable. Our findings represented a commensal colonization of the paranasal sinuses, but not a mycosis. The colonization is evidently assisted by a chronic hyperthrophic sinusitis with increased mucus production which impedes the mucociliary clearance. For immunosuppressed patients, however, this situation causes a danger of invasion with fatal consequences.

Detection and Identification of Fungi from Fungus Balls of the Maxillary Sinus by Molecular Techniques

“…Thus, these fungi may well exist in the sinus without causing sinusitis or a fungus ball. This is consistent with the findings of Vennewald et al (27), who described a commensal colonization of the paranasal sinuses, mainly by Aspergillus spp. but also by other molds.…”

Fungus culture and PCR in nasal lavage samples of patients with chronic rhinosinusitis

“…ml À1 indicated low quantities of viable fungal elements within the lavage samples. This detection rate lies within the range of several other investigations (Lebowitz et al, 2002;Willinger et al, 2003;Vennewald et al, 1999). However, cultural fungus detection rates in patients with CRS in this study were far less than those described in two recent investigations employing similar sampling and culture techniques on patients from the USA and Austria (Ponikau et al, 1999;Braun et al, 2003).…”

Simultaneous Detection and Identification of Aspergillus and Mucorales Species in Tissues Collected from Patients with Fungal Rhinosinusitis

“…Fungi are considered to be major etiological agents, of which members of the order Mucorales and genus Aspergillus (order Eurotiales) are the most pathogenic (5,10,13). The course, therapeutic treatment, and prognosis of fungal rhinosinusitis caused by Aspergillus and Mucorales species are radically different; therefore, early diagnosis and accurate identification of pathogenic fungal species are crucial for effective treatment and clinical decision-making (21). Currently, diagnosis of fungal sinusitis still depends on histopathological examination and culture from nasal biopsy, but conventional culture-based phenotypic identification techniques often include significant delays and can fail to yield growth in clinical samples (17).…”