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Allergic Fungal Rhinosinusitis: A Study in a Tertiary Care Hospital in India
Ravinder Kaur1, S Lavanya2, Nita Khurana3
1Department of Microbiology, Maulana Azad Medical College and Associated Hospitals, New Delhi 110002, India; Department of Microbiology, Lady Hardinge Medical College and Associated Hospitals, New Delhi 110001, 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.
Insights
Allergic fungal rhinosinusitis (AFRS) diagnosis requires prompt clinical suspicion and specific testing. Early identification through microscopy and culture is crucial for effective management of this condition.
Area of Science:
- Otolaryngology
- Mycology
- Immunology
Background:
- Allergic fungal rhinosinusitis (AFRS) is a distinct clinical entity within fungal rhinosinusitis.
- Understanding its occurrence, presentation, and microbiological associations is vital for diagnosis and treatment.
Purpose of the Study:
- To investigate the incidence and clinical features of AFRS.
- To characterize AFRS cases and correlate findings with microbiological profiles.
- To emphasize the importance of early diagnostic methods.
Main Methods:
- Inclusion of clinically suspected fungal rhinosinusitis (FRS) cases based on presentation, endoscopy, and radiology.
- Collection and analysis of clinical samples via direct microscopy, culture, and histopathology.
- Diagnosis of 35 patients with AFRS.
Main Results:
- All 35 AFRS patients exhibited allergic mucin; fungal hyphae were detected in 20%.
- Nasal obstruction (100%) and discharge (62.8%) were common. Nasal polyps occurred in 95%.
- Microscopy confirmed septate hyphae in 71.42%, and culture was positive in 91.4%.
Conclusions:
- Prompt clinical suspicion, specific signs/symptoms, and timely specimen processing are essential for AFRS diagnosis.
- Microscopy, culture, and histopathology are critical for identifying fungal elements.
- Early and accurate diagnosis facilitates appropriate management of AFRS.
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