Allergic Fungal Sinusitis Is Often Associated with a Mix of Different Fungal Pathogens: A Microbiologic Assessment of 147 Patients over a 28 Year Period
KT Montone, VA Livolsi, MD Feldman, I Nachamkin. University of Pennsylvania, Philadelphia, PA
Background: Allergic fungal sinusitis (AFS) is a form of non-invasive sinonasal fungal disease which most likely results from an allergic reaction to fungal antigens produced by fungi which have colonized the sinonasal tract. A variety of different filamentous fungi, most notably dematiaceous fungi have been associated with AFS. In this study, we present a fungal culture analysis of a series of AFS patients seen at our institution over a 28 year period.
Design: The surgical pathology archives were searched for all cases either with a diagnosis of allergic mucin or allergic fungal sinusitis from 1991-2008. The surgical pathology reports for each case as well as any previous sinus surgeries and fungal culture data were reviewed for each patient if available.
Results: A total of 233 patients (450 specimens) were included in the study. All 233 patients had at least one specimen which contained allergic mucin with or without fungal organisms. Of the 233 patients, 157 were classified as having AFS by the presence of allergic mucin with histologic evidence of fungal forms on silver stain or by the presence of allergic mucin without histologic evidence of fungus and positive fungal cultures at the time of surgery. Of the 157 documented AFS patients, 130 had fungal cultures performed. Cultures were negative in 23 patients (18%). The remaining 107 patients (82%) showed either one fungal isolate (58 patients, (54%)) or multiple fungal isolates (39 patients (46%). Of the 58 patients with one fungal isolate, Aspergillus sp. was the most common (40%), followed by a variety of different Dematiaceous fungi (26%), yeast including C. albicans (17%), molds including Penicillium sp. and non-sporulating molds (7%), Scedosporium sp (5%), and Fusarium (3%). Of the 39 patients with more than one fungal isolate, 46% grew Aspergillus and at least one other fungal isolate. One patient grew up to 10 different fungal pathogens.
Conclusions: Greater than 80% of AFS patients have at least one fungal pathogen isolated in culture. In almost half of AFS patients, multiple pathogens are isolated over the course of the disease process. In our population, Aspergillus sp. is the most common fungal isolate followed by the dematiaceous fungi.
Category: Head & Neck
Monday, March 9, 2009 1:00 PM
Poster Session II # 177, Monday Afternoon