Evaluation of pulmonary fungal diseases in patients with fungal rhino-sinusitis

SettingLittle is known on the concomitant occurrence of pulmonary fungal diseases in patients with fungal rhino-sinusitis.ObjectiveTo evaluate presence of pulmonary fungal diseases in patients with fungal rhino-sinusitis.Patients and methodsA prospective study was done for 44 patients who fulfilled inclusion criteria (sinus CT, and histopathological examination). All patients were assessed for pulmonary symptoms, chest X-ray, CT scan, routine lab study, and broncho-alveolar lavage. Microscopic examination of fungal hyphae, fungal culture, skin prick tests, total and specific IgE was done to all cases.ResultsThe mean age of patients was 32.5 ± 13.2. Fungal sinusitis was categorized into allergic FS 24 (54.5%) 6 of them (25%) were asthmatic, fungus ball 16 (36.4%) four (25%) were asthmatic, acute fulminant FS 3 cases (6.8%) one (33%) was asthmatic and chronic invasive sinusitis 1 (2.3%) not asthmatic. Eleven cases (25%) had pulmonary symptoms mainly cough and wheeze, malaise 7 cases (16%), dyspnea and fever 6 cases (14%), weight loss 3 cases (7%) and expectoration of golden brown cast in 2 cases (5%). Six patients (14%) had radiological involvement. Three cases (6%) in allergic FS group had the diagnostic criteria for sino-bronchial allergic mycosis (SAM). One patient was in acute stage I, second was in stage III corticosteroid dependant state, and third was in stage 1V of exacerbation with high total, specific IgE for Aspergillus fumigatus.ConclusionUniversal screening for pulmonary fungal infection especially in patients with fungal rhino sinusitis is highly recommended to treat it early, decrease morbidity and mortality of the diseases.