'Eosinophilic fungal rhinosinusitis': a common disorder in Europe?

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1: Laryngoscope. 2003 Feb;113(2):264-9. Related Articles, Links

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'Eosinophilic fungal rhinosinusitis': a common disorder in Europe?

Braun H, Buzina W, Freudenschuss K, Beham A, Stammberger H.

University Ear, Nose and Throat Hospital, Auenbruggerplatz 26/28,

8036 Graz, Austria. hannes.braun@...

OBJECTIVES/HYPOTHESIS: The traditional criteria for the diagnosis of

allergic fungal sinusitis include chronic rhinosinusitis, " allergic

mucin " (mucus containing clusters of eosinophils), and detection of

fungi by means of histological examination or culture. In 1999, a

group of Mayo Clinic researchers, with a novel method of mucus

collection and fungal culturing technique, were able to find fungi

in 96% of patients with chronic rhinosinusitis. Immunoglobulin E-

mediated hypersensitivity to fungal allergens was not evident in the

majority of their patients. Because the presence of eosinophils in

the allergic mucin, not a type I hypersensitivity, is probably the

common denominator in the pathophysiology of allergic fungal

sinusitis, the Mayo Clinic group proposed a change in terminology

from allergic fungal sinusitis to eosinophilic fungal

rhinosinusitis. Using new techniques of culturing fungi from nasal

secretion, as well as preservation and histological examination of

mucus, we investigated the incidence of " eosinophilic fungal

rhinosinusitis " in our patient population. STUDY DESIGN METHODS: In

an open prospective study nasal mucus from patients with chronic

rhinosinusitis as well as from healthy volunteers was cultured for

fungi. In patients, who underwent functional endoscopic sinus

surgery, nasal mucus was investigated histologically to detect fungi

and eosinophils within the mucus. RESULTS: Fungal cultures were

positive in 84 of 92 patients with chronic rhinosinusitis (91.3%).

In all, 290 positive cultures grew 33 different genera, with 3.2

species per patient, on average. Fungal cultures from a control

group of healthy volunteers yielded positive results in 21 of 23

(91.3%). Histologically, fungal elements were found in 28 of 37

patients (75.5%) and eosinophilic mucin in 35 of 37 patients

(94.6%). Neither fungi nor eosinophils were present in 2 of 37

patients (5.4%). CONCLUSIONS: Our data show that the postulated

criteria of allergic fungal sinusitis are present in the majority of

patients with chronic rhinosinusitis. Either those criteria will be

found to be invalid and need to be changed or, indeed, " eosinophilic

fungal rhinosinusitis " exists in the majority of patients with

chronic rhinosinusitis. Based on our results, fungi and eosinophilic

mucin appear to be a standard component of nasal mucus in patients

with chronic rhinosinusitis.

PMID: 12567080 [PubMed - indexed for MEDLINE]