Non-Invasive Rhinosinusitis: Clinical and Microbiological Perspective

Abstract

Objectives: Objectives: Fungal rhinosinusitis is one of the important healthcare problems and its incidence and prevalence are increasing over the past three decades. It affects approximately 20% of the population at some time in their lives. We aimed to identify and characterize the microorganisms causing non-invasive rhinosinusitis and to correlate the findings with the clinical profile of patients. Methods: Clinically suspected cases of rhinosinusitis were enrolled in the study and detailed clinical history was taken. Samples like nasal mucosa, nasal crusts, scrapings / excised nasal polyps, and biopsy were collected. The specimens were processed for fungal culture. Isolates were identified as per standard protocols. Results: A total of 74 patients clinically suspected of rhinosinusitis were enrolled in our study out of which 60.8% were males. The most common presenting complaint was nasal obstruction (91.8%) followed by nasal discharge (77%). Clinically characterizing, the most common type of non-invasive rhinosinusitis seen in our study was allergic rhinosinusitis (44.6%). KOH positivity was 45.6% and fungal culture positivity was 30.4%. The most common fungal isolate was Aspergillus flavus. Conclusion: Continuous and periodic evaluation of the microbiological patterns of isolates is necessary to decrease the potential risk of complications by early institution of appropriate treatment. J Microbiol Infect Dis 2021; 11(1):21-26.

Keywords

• Fungal rhinosinusitis
• Allergic rhinosinusitis
• Aspergillus

References

1. 1. Kennedy DW, Thaler ER. Acute vs. chronic sinusitis: etiology, management, and outcomes. Infect Dis Clin Pract 1997; 2:49-58.
2. 2. Das A, Bal A, Chakrabarti A, Panda N, Joshi K. Spectrum of fungal rhinosinusitis histopathologist’s perspective. Histopathology 2009;54(7):854-859.
3. 3. Taxy J. Paranasal Fungal Sinusitis: Contributions of Histopathology to Diagnosis. The Am J Surg Pathol 2006;30(6):713-720.
4. 4. deShazo RD, O’Brien M, Chapin K, Soto-Aguilar M, Swain R, Lyons M, et al. Criteria for the diagnosis of sinus mycetoma. J Allergy Clin Immunol 1997;99: 475-485.
5. 5. Morgan J, Warnock DW. Fungi. In: Browning GG, Burton MJ, Clarke R, Hibbert J, et al. Scott-Brown’s Otorhinolaryngology, Head and Neck Surgery. 7th ed. London: Edward Arnold; 2008; 217- 79.
6. 6. Baker RD. Mucormycosis: A new disease? JAMA 1957;163(10):805-8.
7. 7. Prayaga N, Srinivas M, Jadi L, Sudhakar K, Anil N. Clinical application of a microbiological study on chronic suppurative otitis media. Indian J Otolaryngol Head Neck Surg 2013; 2:290-4.
8. 8. Prakash M, Lakshmi K, Anuradha S, Swathi GN. Bacteriological profile and their antibiotic susceptibility pattern of cases of CSOM. Asian J Pharm Clin Res 2013; 6:210-2.

9. 9. Chander J. Fungal sinusitis. Textbook of Medical Mycology 3rd ed. New Delhi: Mehta Publishers; 2009 :480- 520.
10. 10. Browning GG, Burton MJ, Clarke R, et al. Rhinosinusitis. Scott-Brown’s Otorhinolaryngology, Head and Neck Surgery. 7th ed. London: Edward Arnold; 2008. p. 1423-1467.
11. 11. Ponikau JU, Sherris DA, Kern EB, et al. The diagnosis and incidence of allergic fungal sinusitis. Mayo Clinic Proceedings. 1999; 74:877-84.
12. 12. Manning SC, Holman M. Further evidence for allergic pathophysiology in allergic fungal sinusitis. Laryngoscope 1998; 108:1485-96.
13. 13. Micheal RC, Micheal JS, Ashbee RH, Mathews MS. Mycological profile of fungal sinusitis: an audit of specimens over a 7 year period in a tertiary care hospital in Tamil Nadu. Indian J Pathol Microbiol 2008; 51(4):493-6.
14. 14. Farhani F, Mashouf RY, Hashemian F, Esmaeli R. Antimicrobial Resistance Patters of Aerobic Organisms in Patients with Chronic Rhinosinusitis in Hamadan, Iran. Avicenna J Clin Microb Infec 2014;1(2):e18961.
15. 15. Irfan S, Farooq I, Fayaz W. Microbiological profile of patients with chronic sinusitis in Kashmir valley. JMS 2014;4(1):410-16.
16. 16. Joshi RR, Bhandary S, Khanal B, Singh RK. Fungal Maxillary sinusitis: A prospective study in a tertiary care hospital of eastern Nepal. Kathmandu Univ Med J 2007;5(2):195-198.
17. 17. Madani SA, Hashemi SA, Fazli M, Esfandiar K. Bacteriology in patients with chronic rhinosinusitis in North Iran. Jundishapur J Microbiol 2013; 6(8):e7193.
18. 18. Chakrabarti A, Sharma SC, Chander J. Epidemiology and pathogenesis of paranasal sinus mycoses. Otolaryngol Head Neck Surg 1992;107 :745-750.
19. 19. Kaur R, Lavanya S, Khurana N, Gulati A, Dhakad MS. Allergic Fungal Rhinosinusitis: A Study in a Tertiary Care Hospital in India. J Allergy (Cairo) 2016; 2016:7698173.