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Published on: May 10, 2024
Role of fungus in eosinophilic sinusitis
1Department of Otolaryngology, Head and Neck Surgery, University of Mainz, School of Medicine, Mainz, Germany. gosepath@hno.klinik.uni-mainz.de
Purpose Of Review:
Chronic rhinosinusitis is characterized by a broad diagnostic and etiologic spectrum. It has been postulated that fungal organisms might represent the immunologic target initiating and maintaining the disease process in patients with chronic rhinosinusitis as a common denominator. This review analyzes the available data to describe the current understanding of the role of fungus in the pathophysiology of chronic rhinosinusitis.
Recent Findings:
Recent findings have demonstrated that using highly sensitive methods, the detection rate of fungi in nasal mucin can be increased to approximately 100% in patients and in healthy controls. If this ubiquitous fungal contamination were to be related to a causative mechanism in chronic rhinosinusitis, there would have to be an immunologic sensitization in patients in contrast with healthy individuals, which is yet not fully understood. However, studies were able to demonstrate cytokine production in blood-derived lymphocytes in the presence of fungi in patients, but not in healthy controls. Several questions arise. If this is a relevant finding, in what percentage of chronic rhinosinusitis patients could it be causative? Is chronic rhinosinusitis, then, a systemic disease? How is the extramucosal target in the mucin presented to the immune system? Is intranasal, topical antifungal treatment a successful option?
Summary:
The role of fungal organisms in the etiology of eosinophilic rhinosinusitis is reviewed with respect to novel findings, and arising questions are discussed in the light of recent investigations.
Insights
Fungal organisms may play a role in chronic rhinosinusitis (CRS). While fungi are common in nasal passages, CRS patients show immune responses to fungi not seen in healthy individuals, suggesting a potential link.
Area of Science:
- Immunology
- Otolaryngology
- Mycology
Background:
- Chronic rhinosinusitis (CRS) presents diverse diagnostic and etiologic challenges.
- Fungal organisms are hypothesized as a common factor initiating and sustaining CRS.
- Understanding the fungal role in CRS pathophysiology is crucial.
Purpose of the Study:
- To review current data on the role of fungi in CRS pathophysiology.
- To analyze novel findings regarding fungal involvement in CRS.
- To discuss emerging questions in fungal-related CRS.
Main Methods:
- Review of available scientific literature.
- Analysis of recent findings on fungal detection in nasal mucin.
- Examination of immunologic responses to fungi in CRS patients versus controls.
Main Results:
- Highly sensitive methods detect fungi in nearly 100% of CRS patients and healthy controls.
- CRS patients, unlike controls, exhibit cytokine production in lymphocytes upon fungal exposure.
- The precise percentage of CRS cases caused by fungi and the presentation of fungal antigens remain unclear.
Conclusions:
- Fungal organisms are implicated in the etiology of eosinophilic rhinosinusitis.
- Further research is needed to understand the immune response to fungi in CRS.
- Questions regarding systemic involvement and treatment efficacy require investigation.
Related Concept Videos
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