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

SETTING: Little is known on the occurrence of pulmonary fungal diseases in patients with fungal rhino-sinusitis. OBJECTIVE: To investigate the presence of pulmonary fungal diseases in patients with FS. Patients and Methods: A prospective study was done for 44 patients who fulfilled inclusion criteria (sinus CT, microbiological and histopathologically). All patients were assessed for pulmonary symptoms, chest X- ray, CT scan, routine lab study, and Broncho-alveolar lavage. Detection of fungal hyphae, fungal culture, skin prick tests, total and specific IgE were done to all cases. RESULTS: The mean age of patients were 32.5±13.2 with 21 (48%) male and 23 (52%) female. Categorization of FS into allergic FS 24 (54.5%), fungus ball 16 (36.4%), acute fulminant FS 3 cases (6.8%) and chronic invasive sinusitis 1 (2.3%). Asthma was present in 11 cases 6 (25%) in AFS, 4 (25%) in fungal ball, and 1 (33%) in AFFS. Eleven cases (25%) had chest symptoms as cough and wheeze in all cases, malaise 7 cases (16%), dyspnea in 6 cases (14%), weight loss in 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 category only had the diagnostic criteria for SAM one case of them had ABPA plus AFS and pulmonary fungus ball. 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 fumigates. CONCLUSION: Evaluation for pulmonary fungal infection especially in patients with fungal rhino sinusitis is highly recommended. There is an urgent need to treat it early to decrease morbidity and mortality of the diseases.