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Fungal colonization of the paranasal sinuses
I Vennewald1, M Henker, E Klemm
1Hautklinik, Krankenhauses Dresden-Friedrichstadt, Germany.
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 alternata 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 hypertrophic sinusitis with increased mucus production which impedes the mucociliary clearance. For immunosuppressed patients, however, this situation causes a danger of invasion with fatal consequences.
Insights
Fungal colonization, not infection, was found in immunocompetent patients with chronic sinusitis. This non-invasive mold presence in paranasal sinuses may indicate a risk for invasive disease in immunocompromised individuals.
Area of Science:
- Mycology
- Otolaryngology
- Immunology
Background:
- Fungal sinusitis presents in four types: acute invasive, chronic invasive, fungus ball, and allergic fungal sinusitis.
- Invasive forms are potentially fatal, particularly in immunosuppressed patients.
- This study focuses on non-invasive fungal colonization in immunocompetent individuals with chronic sinusitis.
Purpose of the Study:
- To investigate the prevalence and nature of mycotic infections in immunocompetent patients undergoing surgery for chronic paranasal sinus issues.
- To differentiate between fungal colonization and invasive fungal sinusitis in this patient group.
Main Methods:
- Analysis of 132 paranasal sinus tissue samples from 117 immunocompetent patients between 1994 and 1998.
- Mycological and histological examinations were performed on samples obtained during endoscopic surgery.
- Samples were analyzed when granulomatous or crumbly material was observed during endoscopy.
Main Results:
- Fungi were detected in 24.9% of patients and 25.7% of surgical specimens.
- Aspergillus fumigatus was the most common isolate (17 times), followed by other Aspergillus species (6 times).
- Histological examination revealed no invasive mycelial growth, indicating fungal colonization rather than infection.
Conclusions:
- The findings suggest a commensal colonization of molds in the paranasal sinuses of immunocompetent patients with chronic hypertrophic sinusitis.
- This colonization may impede mucociliary clearance and poses a potential risk for invasive fungal disease in immunosuppressed individuals.
- Non-invasive fungal presence in this context is not classified as a mycosis but warrants consideration for underlying sinus conditions.