ALLERGIC FUNGAL SINUSITIS AMONG CANDIDATES FOR FUNCTIONAL ENDOSCOPIC SINUS SURGERY (FESS) IN SARI (IRAN)

Allergic fungal sinusitis (AFS) has been clinicopathologically defined as a noninvasive form of fungal infection. This study was designed to distinguish AFS among patients with chronic sinusitis who failed to respond to repeated courses of antibiotics and were therefore candidates for functional endoscopic sinus surgery (FESS) in Sari. Allergic mucin and sinus lavage was collected during FESS from 100 patients meeting the diagnostic criteria for AFS and were submitted for mycology and pathology investigations. The specimens were centrifuged and the sediment was mounted in 10% KOH and Gram's stain for direct examination. The specimens were inoculated in Sabouraud's Dextrose Agar. Multiple fragments of mucosa were removed at surgery and stained with H&E and PAS for the pathology evaluation. In this study we report 9 proven cases of AFS (with demonstration of fungal hyphae by direct exam and culture) and 8 suspected cases (confirmed by direct exam or culture). The patient's age ranged from 12 to 62 years, with a mean age of 24.5 years with female predominance. All of the patients were immunocompetent. 47% of the patients had a history of atopy. Histopathologically, hyphae were not seen. The genera of the fungi were identifiable in all but one patient. 53% of isolated fungi were from the hyaline hyphomycete group particularly Aspergillus and Penicillium and 47% of them were members of the dematiaceous family particularly Cladosporium and Nigrospora. In eleven out of the seventeen, fungal hyphae were noted and in all of the seventeen there were positive fungal cultures. Fungal sinusitis should be considered in all patients with chronic sinusitis that fails to repond to repeated courses of treatment. Recent advances in endoscopy and computed tomography and physician awareness will lead to improved diagnosis and treatment and will prevent multiple surgical procedures