Isolation of fungi by standard laboratory methods in patients with chronic rhinosinusitis.
OBJECTIVE
Allergic fungal sinusitis and the role of fungi in the pathogenesis of chronic rhinosinusitis are topics of interest and controversy in rhinology. The classification of chronic rhinosinusitis as either a bacterial infection or an allergic (eosinophilic) reaction to fungi has significant implications for treatment of this disease process. We designed a study to determine whether standard isolation techniques, as employed in a university hospital mycology laboratory, could isolate and identify fungi in the intraoperative specimens from patients undergoing functional endoscopic sinus surgery for chronic rhinosinusitis.


METHODS
Forty-five random patients with a diagnosis of chronic rhinosinusitis by clinical and computed tomography criteria underwent endoscopic sinus surgery during 2001, performed by two senior surgeons (J.B.J., R.A.L.). Specimens of mucin, sinus secretions, and/or tissue were obtained intraoperatively and sent to the New York University Medical Center (New York, NY) mycology laboratory for isolation and identification of fungi.


METHODS
Specimens were treated with Sputolysin and chloramphenicol; plated on Sabouraud, ChromAgar/Candida, Mycosel, and Niger seed agar plates; and incubated at 30 degrees C (or 37 degrees C) for up to 1 month.


RESULTS
We were able to demonstrate the presence of fungi in 56% of intraoperative specimens obtained from patients undergoing surgery for chronic rhinosinusitis.


CONCLUSIONS
Using a standard hospital mycology laboratory protocol, which is relatively inexpensive and readily available, fungus can be isolated from a majority of patients undergoing functional endoscopic sinus surgery for chronic rhinosinusitis. Educational statement: Discuss the possible role of fungus in chronic rhinosinusitis and evaluate the efficacy of documenting the presence of fungus in a routine fashion to encourage clinically relevant directed treatments.)
Lebowitz
Richard A
RA
Department of Otolaryngology, New York University Medical Center, New York University School of Medicine, NY, USA. Richard.Lebowitz@med.nyu.edu
Waltzman
Michael N
MN
Jacobs
Joseph B
JB
Pearlman
Aaron
A
Tierno
Philip M
PM
D000328:Adult; D002908:Chronic Disease; D019411:Clinical Laboratory Techniques; D004724:Endoscopy; D005260:Female; D005658:Fungi / Q000302:isolation & purification*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009181:Mycoses / Q000175:diagnosis*; D012220:Rhinitis / Q000382:microbiology*; D012852:Sinusitis / Q000382:microbiology*; D013048:Specimen Handling