بررسی سینوزیت آلرژیک قارچی در مبتلایان به سینوزیت مزمن مراجعه کننده به بیمارستان بوعلی سینا ساری 1377

Background and purpose: Allergic fungal sinusitis is known as a non invasive fungal infection clinically as well as pathologically. The aim of this study was to determine the rate of AFS in chronic sinusitis patients who did not respond to repeated antibiotic therapy and were candidate for functional endoscopy ( sinus surgery = fess) in sari in 1377. Materials and methods: This research was descriptive. Main allergic and sinus lavage were collected from the patients who- were diagnosed as AFS on the basis of clinical assessment during fess sinus surgery. The samples were sent for the mycological and pathological investigations. For mycological study the samples were centrifuged and the sediment was drawn and a wet mount smear was prepared with 10%koh and stained. Also the same samples were transferred to different media containing sabrouts dextrose agar and incubate at 22oc for one month. For pathologic study the segment of mucus obtained during surgery, this slide was prepared and stained with H&E and PAS. AFS referes to the patients with the following criteria. Radiologically confirmed sinusitis allergic mucin in sinuses, observation of hyphae direct mucin test and isolation of fungi in culture media, and nondiabetic, non malignant immune difficiency disease or recent immunosuppressive therapy and lack of invasive fungal infection at the time of diagnosis. All the patients were followed for 6 months. Results: In this report 9 patients were confirmed and 8 patients were suspected of having AFS. The patients were in the age group of 24.5, usually of females history of diabefis mellitus. Malignancy, immunodeficiency and recent therapy with immunosuppressive was not observed. 47% of them had history of antopy. In histopathologic observation hyphae was not observed. Fungus was detected in all of the patients except one. 53% of isolated fungi study were of hyaline hyphomycete particulary Aspergillus and penicillium were in 47% of the cases cladosporium and trigrospora of the family dematiaceous were isolated. 11 out of 17 cases (64.7%) hyphae of fungi in driect observation was identified. But all of them were culture positive. During follow up there were two cases of reccurency without fungal observation. Conclusion: Fungal sinusitis must be considered in all the chronic sinusitis patients who did not respond to the repeated course of antibiotic recent development in sinus endoscopy and CT scan, awareness of physicians lead to the diagnosis of the disease