Aspergillus Sinusitis: Risk Factors and Phenotyping
Lena Hafrén1, Riitta Saarinen1, Rane Kurimo1
1Department of Otorhinolaryngology-Head and Neck Surgery, HUS Helsinki University Hospital, University of Helsinki, 00029 Helsinki, Finland.
Abstract:
Background: Aspergillus can cause fungal rhinosinusitis (FRS). We aimed to identify risk factors for sinonasal Aspergillus disease. Methods: Patients with a positive sinonasal mycological culture for Aspergillus species diagnosed in our hospital located in a continental climate were included in the 9-year retrospective study. Results: Of the 86 patients, 3 had invasive FRS (IFRS), 51 had fungal ball (FB) disease, and 32 had chronic rhinosinusitis with fungus (CFRS). In the IFRS group, all patients had a malignancy and were immunocompromised. Allergies, allergic rhinitis, asthma, nasal polyps, and the use of inhaled and nasal steroids were more common in the CFRS group, and IgE levels were greater than those in the FB and IRFS groups (p < 0.05). Conclusion: FB disease is a relatively symptom-free single-sinus disease among elderly individuals, and IFRS is dominant among immunocompromised patients. We discovered a third patient group, predominantly with nasal polyps, atopy, asthma, and elevated blood IgE and eosinophils, that did not fulfill the allergic FRS (AFRS) criteria. It is possible that a less fulminant category of underdiagnosed AFRS exists in cold climates. Treatment with local debridement is usually sufficient for FRS, apart from IFRS, and relapses are not common in cold climates.
Insights
This study identified risk factors for fungal rhinosinusitis (FRS) caused by Aspergillus. Invasive FRS predominantly affects immunocompromised patients, while a distinct group with allergic features may represent an underdiagnosed AFRS in cold climates.
Area of Science:
- Mycology
- Otolaryngology
- Immunology
Background:
- Fungal rhinosinusitis (FRS) is a significant condition caused by Aspergillus species.
- Identifying risk factors is crucial for effective management and diagnosis.
Purpose of the Study:
- To identify risk factors associated with sinonasal Aspergillus disease.
- To characterize different subtypes of FRS based on clinical presentation and patient demographics.
Main Methods:
- Retrospective study of 86 patients with positive sinonasal Aspergillus cultures over 9 years.
- Classification of patients into invasive FRS (IFRS), fungal ball (FB), and chronic rhinosinusitis with fungus (CFRS) groups.
- Analysis of clinical data including comorbidities, allergies, medication use, and IgE levels.
Main Results:
- Invasive FRS occurred exclusively in immunocompromised patients with malignancy.
- Chronic rhinosinusitis with fungus was associated with allergies, allergic rhinitis, asthma, nasal polyps, and steroid use, alongside elevated IgE levels.
- A distinct patient group with nasal polyps, atopy, asthma, and elevated IgE/eosinophils was identified, not meeting typical allergic FRS criteria.
Conclusions:
- Fungal ball disease is typically a benign condition in elderly individuals.
- Invasive FRS is linked to immunocompromised status.
- A potentially underdiagnosed form of allergic FRS may exist in colder climates, characterized by specific allergic markers and nasal polyps.
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