Skip to main content

Advertisement

SpringerLink
Log in

Mycological Profile and Antifungal Susceptibility of Fungal Isolates from Clinically Suspected Cases of Fungal Rhinosinusitis in a Tertiary Care Hospital in North India

  • Published:
Mycopathologia Aims and scope Submit manuscript

Abstract

A prospective observational study was conducted for 18 months to analyze the mycological profile of clinically suspected cases of fungal rhinosinusitis requiring endoscopic sinus surgery and test antifungal susceptibility of the isolates according to Clinical and Laboratory Standards Institute guidelines. Per-operative biopsies (n = 126) from 106 patients were processed by standard mycological procedures. Out of 126 samples, 59 (46.83 %) had fungal elements on KOH mount examination. Fungal growth was obtained in 76 (60.32 %) samples, of which single fungal organism was isolated in 68 samples and more than one fungal species in eight samples. The most common isolates belonged to the genus Aspergillus (n = 53, A. flavus being most common) followed by mucormycetes (9), Candida species (7), Penicillium species (5), Alternaria species (5), Fusarium species (1), Curvularia species (1) and black yeast (1). Two hyaline septate fungal isolates could not be identified. Aspergillus species were susceptible to amphotericin B (n = 46), itraconazole (n = 48), voriconazole (n = 52), posaconazole (n = 53), caspofungin (n = 51), anidulafungin (n = 53) and micafungin (n = 53). All mucormycetes isolates (n = 9) were susceptible to amphotericin B, posaconazole and itraconazole. Filamentous non-Aspergillus, non-mucormycetes isolates (n = 15) were susceptible to amphotericin B (n = 12), itraconazole (n = 13), voriconazole (n = 15), posaconazole (n = 15) and echinocandins (n = 15). Amongst the 07 Candida species, 05 isolates of Candida tropicalis were susceptible to amphotericin B, posaconazole, echinocandins and 5-flucytosine; one isolate of Candida albicans had the same susceptibility but was resistant to 5-flucytosine also, and one strain of Candida species was susceptible to all the nine antifungal drugs.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Fokkens WK, Lund VJ, Mullol J, Bachert C, Cohen N, Cobo R, et al. European position paper on nasal polyps. Rhinology. 2007;45:1–139.

    Google Scholar 

  2. Meltzer EO, Hamilos DL. Rhinosinusitis diagnosis and management for the clinician: a synopsis of recent consensus guidelines. Mayo Clin Proc. 2011;86:427–43.

    Article  PubMed Central  PubMed  Google Scholar 

  3. Chakrabarti A, Denning DW, Ferguson BJ, Ponikau J, Buzina W, Kita H, et al. Fungal Rhinosinusitis: a categorization and definitional schema addressing current controversies. Laryngoscope. 2009;119:1809–18.

    Article  PubMed Central  PubMed  Google Scholar 

  4. Meltzer EO, Hamilos DL, Hadley JA, Lanza DC, Marple BF, Nicklas RA, et al. Rhinosinusitis: establishing definitions for clinical research and patient care. J Allergy Clin Immunol. 2004;114:155–212.

    Article  PubMed  Google Scholar 

  5. Devaiah AK. Adult chronic rhinosinusitis: diagnosis and dilemmas. Otolaryngol Clin N Am. 2004;37:243–52.

    Article  Google Scholar 

  6. Slavin RG, Spector SL, Bernstein IL. The diagnosis and management of sinusitis: a practice parameter update. J Allergy Clin Immunol. 2005;116:S13–47.

    Article  PubMed  Google Scholar 

  7. Kennedy DW, Bolger WE, Zinreich SJ. Diseases of the sinuses. London: BC Decker; 2001.

    Google Scholar 

  8. Panda NK, Sharma SC, Chakrabarti A, Mann SBS. Paranasal sinus mycoses in north India. Mycoses. 1998;41:281–6.

    Article  CAS  PubMed  Google Scholar 

  9. deShazo RD, Chapin K, Swain RE. Current concepts: fungal sinusitis. N Engl J Med. 1997;337:254–9.

    Article  CAS  PubMed  Google Scholar 

  10. deShazo RD, Swain RE. Diagnostic criteria for allergic fungal sinusitis. J Allery Clin Immunol. 1995;96:24–35.

    Article  CAS  Google Scholar 

  11. Chander J. Textbook of medical mycology. 3rd ed. New Delhi: Mehta Publishers; 2009.

    Google Scholar 

  12. Al-Mujaini A, Wali U, Alkhabori M. Functional endoscopic sinus surgery: indications and complications in the ophthalmic field. Oman Med J. 2009;24:70–80.

    PubMed Central  PubMed  Google Scholar 

  13. Mackay IS, Bull TR. Scott–Brown’s otolaryngology. 6th ed. Oxford: Reed Educational and Professional Publishing; 1997.

    Google Scholar 

  14. Walsh TJ, Anaissie EJ, Denning DW, Herbrecht R, Kontoyiannis DP, Marr KA, et al. Treatment of Aspergillosis: clinical practice guidelines of the infectious diseases Society of America. Clin Infect Dis. 2008;46:327–60.

    Article  CAS  PubMed  Google Scholar 

  15. Ghannoum MA, Rice LB. Antifungal agents: mode of action, mechanisms of resistance and correlation of these mechanisms with bacterial resistance. Clin Microbiol Rev. 1999;12:501–17.

    CAS  PubMed Central  PubMed  Google Scholar 

  16. Rodriguez-Tudela JL, Arendrup MC, Arikan S, Barchiesi F, Bille J, Chryssanthou E, et al. EUCAST Definitive Document E.Def 9.1: Method for the determination of broth dilution minimum inhibitory concentrations of antifungal agents for conidia forming moulds. EUCAST E.Def 9.1 2008;1–13.

  17. Clinical and Laboratory Standards Institute. Reference method for broth dilution antifungal susceptibility testing of filamentous fungi; approved standard-second edition. CLSI document M38-A3. Wayne, PA: CLSI; 2008.

  18. Ryan D. Management of acute rhinosinusitis in primary care: changing paradigms and the emerging role of intranasal corticosteroids. Prim Care Respir J. 2008;17:148–55.

    Article  PubMed  Google Scholar 

  19. Fagnan LJ. Acute sinusitis: a cost-effective approach to diagnosis and treatment. Am Fam Phys. 1998;58:1795–802.

    CAS  Google Scholar 

  20. Donald PJ, Gluckman JL, Rice DH. The sinuses. New York: Raven Press; 1995.

    Google Scholar 

  21. deHoog GS, Guarro J, Gené J, Figueras MJ. Atlas of clinical fungi. Centraalbureau voor Schimmelcultures. 2nd ed. Reus, Spain: Utrecht, Netherlands/UniversitatRovira I Virgili; 2000.

    Google Scholar 

  22. Clinical and Laboratory Standards Institute. Reference method for broth dilution antifungal susceptibility testing of yeast; approved standard-third edition. CLSI document M27-A3. Wayne, PA: CLSI; 2008.

  23. Granville L, Chirala M, Cernoch P, Ostrowski M, Truong LD. Fungal sinusitis: histologic spectrum and correlation with culture. Hum Pathol. 2004;35:474–81.

    Article  PubMed  Google Scholar 

  24. Dall’Igna C, Palombini BC, Anselmi F, Araújo E, Dall’Igna DP. Fungal rhinosinusitis in patients with chronic sinusal disease. Rev Bras Otorrinolaringol. 2005;71:712–20.

    Google Scholar 

  25. Challa S, Uppin SG, Hanumanthu S, Panigrahi MK, Purohit AK, Sattaluri S, et al. Fungal rhinosinusitis: a clinicopathological study from south India. Eur Arch Otorhinolaryngol. 2010;267:1239–45.

    Article  PubMed  Google Scholar 

  26. Luong A, Marple B. The role of fungi in chronic rhinosinusitis. Otolaryngol Clin N Am. 2005;38:1203–13.

    Article  Google Scholar 

  27. Aribandi M, McCoy VA, Bazan C. Imaging features of invasive and noninvasive fungal sinusitis: a review. Radiographics. 2007;27:1283–96.

    Article  PubMed  Google Scholar 

  28. deShazo RD, O’Brien M, Chapin K, Soto-Aguilar M, Gardner L, Swain R. A new classification and diagnostic criteria for invasive fungal sinusitis. Otolaryngol Head Neck Surg. 1997;123:1181–8.

    Article  CAS  Google Scholar 

  29. Chen CY, Sheng WH, Cheng A, Chen YC, Tsay W, Tang JL, et al. Invasive fungal sinusitis in patients with hematological malignancy: 15 years experience in a single university hospital in Taiwan. BMC Infect Dis. 2011;11:250.

    Article  PubMed Central  PubMed  Google Scholar 

  30. Cody DT, Neel HB, Ferreiro JA, et al. Allergic fungal sinusitis: the Mayo Clinic experience. Laryngoscope. 1994;104:1074–9.

    Article  PubMed  Google Scholar 

  31. Chakrabarti A, Sharma SC. Paranasal sinus mycoses. Indian J Chest Dis Allied Sci. 2000;42:293–304.

    CAS  PubMed  Google Scholar 

  32. Torres C, Ro JY, El-Naggar AK, Sim SJ, Weber RS, Ayala AG. Allergic fungal sinusitis: a clinicopathological study of 16 cases. Hum Pathol. 1996;27:793–9.

    Article  CAS  PubMed  Google Scholar 

  33. Macmillan RH, Copper PH, Body BA, Hills AS. Allergic fungal sinusitis due to Curvularia lunata. Hum Pathol. 1987;18:960–4.

    Article  PubMed  Google Scholar 

  34. Houser SM, Corey JP. Allergic fungal rhinosinusitis—pathophysiology, epidemiology and diagnosis. Otolaryngol Clin N Am. 2000;33:399–408.

    Article  CAS  Google Scholar 

  35. Chatterjee SS, Chakrabarti A. Epidemiology and medical mycology of fungal rhinosinusitis. Otorhinolaryngol Clin Int J. 2009;1:1–13.

    Article  Google Scholar 

  36. Schubert MS, Goetz DW. Evaluation and treatment of allergic fungal sinusitis. Demographics and diagnosis. J Allergy Clin Immunol. 1998;102:387–94.

    Article  CAS  PubMed  Google Scholar 

  37. Reddy CEE, Gupta AK, Singh P, Mann SBS. Imaging of granulomatous and chronic invasive fungal sinusitis: comparison with allergic fungal sinusitis. Otolaryngol Head Neck Surg. 2010;143:294–300.

    Article  PubMed  Google Scholar 

  38. Das A, Bal A, Chakrabarti A, Panda N, Joshi K. Spectrum of fungal rhinosinusitis; histopathologist’s perspective. Histopathology. 2009;54:854–9.

    Article  PubMed  Google Scholar 

  39. Michael RC, Michael JS, Ashbee RH, Mathews MS. Mycological profile of fungal sinusitis: an audit of specimens over a 7-year period in a tertiary care hospital in Tamil Nadu. Indian J Pathol Microbiol. 2008;51:493–6.

    Article  PubMed  Google Scholar 

  40. Shah H, Bhalodiya N. Scenario of fungal infection of nasal cavity and paranasal sinuses in Gujarat: a retrospective study. Guj Med J. 2014;69:27–31.

    Google Scholar 

  41. Aribandi M, Bazan C. CT and MRI features in Bipolaris fungal sinusitis. Australas Radiol. 2007;51:127–32.

    Article  CAS  PubMed  Google Scholar 

  42. Klossek JM, Serrano E, Peloquin L, Percodani J, Fontanel JP, Pessey JJ. Functional endoscopic sinus surgery and 109 mycetomas of paranasal sinuses. Laryngoscope. 1997;107:112–7.

    Article  CAS  PubMed  Google Scholar 

  43. Dannaoui E, Meletiadis J, Tortorano AM, Symoens F, Nolard N, Viviani MA, et al. Susceptibility testing of sequential isolates of Aspergillus fumigatus recovered from treated patients. J Med Microbiol. 2004;53:129–34.

    Article  CAS  PubMed  Google Scholar 

  44. Narbona MT, Guinea J, Alarcón JM, Peláez T, Bouza E. In vitro activities of amphotericin B, caspofungin, itraconazole, posaconazole and voriconazole against 45 clinical isolates of Zygomycetes: comparison of CLSI M38-A, Sensititre YeastOne and the Etest. Antimicrob Agents Chemother. 2007;51:1126–9.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Microbiology, Government Medical College and Hospital, Sector 32, Chandigarh, India

    Ruby Jain, Nidhi Singla & Jagdish Chander

  2. Department of Otorhinolaryngology, Government Medical College and Hospital, Sector 32, Chandigarh, India

    Surinder K. Singhal

  3. Department of Pathology, Government Medical College and Hospital, Sector 32, Chandigarh, India

    Rajpal S. Punia

Authors
  1. Ruby Jain
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Surinder K. Singhal
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Nidhi Singla
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Rajpal S. Punia
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Jagdish Chander
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Jagdish Chander.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Jain, R., Singhal, S.K., Singla, N. et al. Mycological Profile and Antifungal Susceptibility of Fungal Isolates from Clinically Suspected Cases of Fungal Rhinosinusitis in a Tertiary Care Hospital in North India. Mycopathologia 180, 51–59 (2015). https://doi.org/10.1007/s11046-015-9873-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11046-015-9873-6

Keywords

Search

Navigation