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.
Journal of Clinical Medicine
|May 11, 2024
Summary
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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