European Archives of Oto-Rhino-Laryngology

, Volume 271, Issue 1, pp 93–101 | Cite as

Impact of fungal load on diagnosis and outcome of allergic fungal rhinosinusitis

  • Ahmed RagabEmail author
  • Rehab Monir Samaka
  • Mohamed Salem


Fungal load colonization may modify the classic eosinophilic inflammation in allergic fungal rhinosinusitis (AFRS). We aimed to evaluate the impact of fungal load on diagnosis and outcome of AFRS. In the present cohort study fungal load differences were determined prospectively according to Gomori methenamine silver (GMS) fungal stained (histopathological and cytological examination) with the tenacious mucus, cheesy clay-like materials and sinus mucosa/polyps in 12 AFRS patients. Two groups with different fungal loads, AFRS with (six patients) and without (six patients) high fungal loads (HFL) were evaluated for nasal endoscopic score, paranasal sinuses CT score, histopathological and immunohistochemical changes. Endoscopic outcome scoring differences were evaluated for 1 year after endoscopic sinus surgery and 1 month oral corticosteroids treatment. No differences were observed between both groups (AFRS with/without HFL) concerning the total CT score and opacification features (P > 0.05). Eosinophils and CD3 + CD8 + T cell were dominant in both groups. More edema and less fibrosis were observed in HFL group. Gliotoxin producers Aspergilli were present in all HFL in comparison to 5/6 (83.3 %) in cases without HFL. Fewer patients 1/6 (16.6 %) and less number of recurrences/year 0.1 ± 0.4 occurred in the AFRS with HFL compared to the AFRS without HFL [5/6 (83.3 %) and 1.16 ± 0.7) (P = 0.021 and 0.023, respectively]. In addition to mucus and mucosal tissues, cheesy clay-like materials must be assessed in AFRS cases. Although patients of AFRS with HFL had negligible clinical differences from ordinary AFRS without HFL, they had better outcome after treatment.


Fungal load Allergic fungal rhinosinusitis Diagnosis Mycosis diagnosis Nasal polyps diagnosis Sinusitis diagnosis Outcome Nasal polyps outcome Sinusitis outcome 


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Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  • Ahmed Ragab
    • 1
    Email author
  • Rehab Monir Samaka
    • 2
  • Mohamed Salem
    • 3
  1. 1.Otorhinolaryngology Department, ORL H&N SurgeryMenoufia University HospitalShebin El-KomEgypt
  2. 2.Pathology DepartmentMenoufia University HospitalShebin El-komEgypt
  3. 3.Mycology Research Unit, Genetic Engineering and Biotechnology Research InstituteMenoufia UniversitySadatEgypt

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