A Clinicopathological study of Fungal Diseases in Patients with Chronic Rhinosinusitis and Sinonasal Polyposis

Mathew Jackson Edward, I (2020) A Clinicopathological study of Fungal Diseases in Patients with Chronic Rhinosinusitis and Sinonasal Polyposis. Masters thesis, Tirunelveli Medical College, Tirunelveli.


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INTRODUCTION: Fungi have been implicated in the etiopathogenesis of chronic rhinosinusitis with nasal polyposis. In an era with AIDS, broad spectrum antibiotic therapy, cytotoxic drugs, steroid therapy and the organ transplantations, fungal infections are becoming increasingly common and very diverse. The most common site of fungal infections in man is the lung with or without haematogenous spread to other organs. But localised fungal infections can also occur in the upper respiratory tract and is more common than was previously suspected. FUNGAL SPECIES: The common fungal infection which affect the nose and sinuses are Candidiasis, Aspergillosis, Phycomycosis, Actinomycosis, Coccidioidomycosis, Histoplasmosis, Cryptococcosis, Blastomycosis, Sporotrichosis and Nocardiosis. FUNGAL SINUSITIS: Fungus is ubiquitous, present in all our surroundings and the air we inhale.Most healthy people do not react to the presence of fungus due to functioning immune system. However, in rare instances,fungus may cause inflammation in the nose and sinuses. Fungal sinusitis may come in different forms, differing in pathology, symptoms, course, severity and the treatment required. CLASSIFICATION OF FUNGAL RHINOSINUSITIS: Fungal Rhinosinusitis is broadly classified into 2 groups 1) INVASIVE, 2) NON INVASIVE INVASIVE diseases include: a) Acute Invasive (Fulminant) Fungal Rhinosinusitis – Mucorales and Aspergillus. b) Granulomatous invasive Fungal rhinosinusitis – A.flavus c) Chronic invasive fungal rhinosinusitis – A.fumigatus NonInvasive diseases include: a) Fungal ball – A.fumigatus, A.flavus, Scedesporium b) Allergic fungal rhino-sinusitis – Bipolaris sp., Curvularia lunata, A.fumigatus. AIMS OF THE STUDY: To study the prevalence of Fungal Diseases in all cases of Sinonasal polyposis and chronic rhino-sinusitis admitted for Functional Endoscopic Sinus Surgery in our Hospital. OBJECTIVES: 1. To find out the prevalence of Fungal Sinusitis in cases of sinonasal polyposis/Chronic rhino-sinusitis. 2. To determine the presence of fungal organisms in Chronic rhinosinusitis associated with nasal polyposis by both KOH mount and fungal culture. 3. To identify the type of fungal sinusitis in sinonasal polyposis/Chronic rhino-sinusitis. 4. To identify the fungal isolates most common in chronic sinusitis and sinonasal polyposis. 5. To study the clinical and pathological manifestations of fungal infections of the nose and paranasal sinuses. 6. To find the association of Fungal sinusitis with Systemic diseases. MATERIALS AND METHODS: Specimen: sinus secretions and Polyps. Sample Size: 156. Patients of all age groups and of either sex who presented with radiologically proven sinusitis with symptoms > 12 weeks duration and undergoing functional endoscopic sinus surgery was included in the study. Patients were interviewed by structured questionnaire after obtaining informed consent. All the patients were also clinically assessed Inclusion Criteria: • All cases of CRS who underwent functional endoscopic sinussurgery in the department of ENT, TVMCH. • All age groups. • Both male & female. Exclusion Criteria:  Patients who were on topical or systemic steroid for the past One month before the study period.  All cases with characteristic appearance of fungi in DNE and during surgery.  Cases with Clinically appearing Malignant Nasal mass and Rhinosporidiosis. Period of study: 2 years. Duration : November 2017 to June 2019. METHODS OF COLLECTION OF DATA.  Detailed History taking and clinical examination.  Relevant radiological investigations(CTscan).  Obtaining a definitive diagnosis with the help of KOH mount and Fungal Culture reports. Sample collection and processing. During my study period , samples of nasal sinus tissue, sinus secretions and allergic mucin from patients undergoing FESS were subjected to mycological culture. The specimen was collected in sterile saline per operatively and taken to the microbiology lab as early as possible and was processed on the sameday. The sample was be subjected to direct microscopy with 10% potassium hydroxide and culture. RESULTS: In the present study 156 patients of chronic rhinosinusitis, majority of the patients were in the age group of 31 – 40 years. followed by 21-30 years.The mean age of the patients affected with fungal rhinosinusitis was 34.5 yrs. Males were predominant (55%) compared to females (45%). Male to female ratio was (1.3:1). The most common symptoms were nasal obstruction 85%, headache 56%, nasal discharge 24%, and sneezing 21%. In this study, 53 patients had nasal polyp 60 had deviated nasal septum, 15 patients had diabetes, 9 had hypertension and 4 had both. In this present study,out of 156 cases of chronic rhinosinusitis, prevalence of fungal rhinosinusitis was found to be 13%. In this study fungal positivity was found in 20 patients by direct examination (KOH mount) or culture In this study majority of the fungi isolated were Aspergillus species (90%) in particular A.flavus. Out of the 18 Aspergillus isolates 13 were Aspergillus flavus and 5 were Aspergillus fumigatus. CONCLUSION: The sinonasal mycotic infection accounts for 13% of chronic rhinosinusitis. The most commonly affected age group are the third and fourth decade. The sex ratio is more or less equal. Fungal sinusitis should be suspected in those patients with CRS presenting with signs and symptoms such as nasal obstruction, nasal polyps, nasal discharge. With the help of histopathological examination of all sinus specimens, CT scan, Diagnostic Nasal Endoscopy thediagnosis of CRS have become easier nowadays. Endoscopic sinus surgery followed by antifungal therapy role is the major treatment of fungal sinusitis. Due to the increased incidence in fungal infections of paranasal sinuses, the Otorhinolaryngolgists should keep fungal infections in their mind during their daily practice. In fungal sinusitis, unilateral involvement of paranasal sinuses is more common. Maxillary sinus is the most commonly affected sinus among all the paranasal sinuses in fungal rhinosinusitis.

Item Type: Thesis (Masters)
Additional Information: 221714303
Uncontrolled Keywords: Chronic rhinosinusitis, Fungal sinusitis, Mycotic infections, sinonasal polyposis
Subjects: MEDICAL > Otolaryngology
Depositing User: Subramani R
Date Deposited: 15 Feb 2021 05:02
Last Modified: 15 Feb 2021 05:02
URI: http://repository-tnmgrmu.ac.in/id/eprint/14232

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