title: Fungal DNA is present in tissue specimens of patients with chronic rhinosinusitis.
abstract: BACKGROUND
  It has been postulated that fungal organisms might represent the immunologic target initiating and maintaining the disease process in patients with chronic rhinosinusitis (CRS). The presence of fungi in nasal mucus has been established by different groups, but so far it has not been shown how the immune system could even recognize such extramucosal--extracorporal--fungal targets. The aim of this study was to determine whether fungal DNA is present in tissue specimens taken from patients with polypoid CRS.
  
  
  METHODS
  Twenty-seven surgical specimens were collected from patients suffering from CRS. Fifteen surgical specimens from healthy ethmoidal mucosa served as controls. A second set of controls consisted of five surgical specimens of acoustic neuroma, which were included to rule out contamination within the protocol. All paranasal tissue samples were treated and rinsed carefully with a solution of Dithiothreitol to digest any nasal mucus and ensure that only tissue was examined. A highly sensitive two-step polymerase chain reaction (PCR) was applied to detect fungal DNA, using one universal primer for unspecific detection of fungal DNA and a second primer pair specific for Alternaria.
  
  
  RESULTS
  Fungal DNA was detected in all 27 CRS specimens equally with both PCR primers. Controls from healthy paranasal mucosa were positive using the panfungal primers in 10 of 15 cases but were all negative for Alternaria DNA. PCR was negative for fungal DNA in all five neuroma specimens.
  
  
  CONCLUSIONS
  Fungal DNA can be detected within sinonasal tissue specimens of patients suffering from CRS. These findings need to be discussed with respect to the proposed hypothesis of the immune system recognizing extramucosal organisms and initiating an immune response in sensitized patients.
authors.affiliation: Department of Otolaryngology, Head and Neck Surgery, University of Mainz, School of Medicine, Mainz, Germany.
authors.forename: Jan
authors.initials: J
authors.lastname: Gosepath
authors.forename: Juergen
authors.initials: J
authors.lastname: Brieger
authors.forename: Konstantin
authors.initials: K
authors.lastname: Vlachtsis
authors.forename: Wolf J
authors.initials: WJ
authors.lastname: Mann
mesh_terms: D000293:Adolescent; D000328:Adult; D016022:Case-Control Studies; D002648:Child; D002908:Chronic Disease; D004271:DNA, Fungal / Q000032:analysis*; D005260:Female; D005658:Fungi / Q000235:genetics* / Q000472:pathogenicity*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009297:Nasal Mucosa / Q000382:microbiology; D009298:Nasal Polyps / Q000382:microbiology; D009463:Neuroma / Q000382:microbiology; D009669:Nose Neoplasms / Q000382:microbiology; D016133:Polymerase Chain Reaction; D012220:Rhinitis / Q000382:microbiology*; D012852:Sinusitis / Q000382:microbiology*
chemical_list: D004271:DNA, Fungal