Frequency of fungal agents identified in sinus samples from patients with clinically suspected rhinosinusitis Alejandra Zuluaga a , Johanna Ospina-Medina b , Isabel Castaño-Gallego b , Karen Arango a , Ángel González c, ⁎ a Medical and Experimental Mycology Unit, Corporación para Investigaciones Biológicas (CIB), Carrera 72A No. 78 B 141, Medellín, Colombia b School of Microbiology, Universidad de Antioquia, Calle 70 No. 52-21, Medellín, Colombia c Basica and Applied Microbiology Research Group (MICROBA), School of Microbiology, Universidad de Antioquia, Calle 70 No. 52-21, Medellín, Colombia abstract article info Article history: Received 14 July 2014 Received in revised form 14 November 2014 Accepted 25 November 2014 Available online 3 December 2014 Keywords: Rhinosinusitis Fungal infection Fungal rhinosinusitis Aspergillus spp Schizophyllum commune Fungal rhinosinusitis (FRS) is one of the most important rhinosinusoidal disorders, which involves a variety of etiological agents. We carried out a study to determine the frequency of fungal agents in sinus samples from pa- tients with clinically suspected rhinosinusitis (RS). A total of 205 clinical samples were assessed from 174 pa- tients with clinically suspected RS, of which 48 were positive for microscopic examination and culture, 47 were positive for direct examination but negative by culture, 4 were negative for direct examination but positive by culture, and 106 were negative for both methodologies. The main fungal agents isolated were Aspergillus spp. (32.7%), followed by Schizophyllum commune (28.8%). Sensitivity and specificity of the direct examination were 92.3% and 69.3%, respectively, and concordance between the direct examination and culture was 48.4%. This study indicated that both Aspergillus and S. commune appear to be the most important agents involved in the de- velopment of FRS. © 2015 Elsevier Inc. All rights reserved. 1. Introduction Sinusitis or rhinosinusitis (RS) is a common disorder, which is char- acterized by inflammation of the mucus membrane lining the paranasal sinuses and is very heterogeneous in its clinical and pathological pre- sentations (Braun, 2003; Chan and Kuhn, 2009). This disease is highly prevalent and is estimated to affect approximately 20% of the popula- tion at some time in their lives (Chakrabarti et al., 2009; Fonseca and Fernández, 2005; Granville et al., 2004; Jofre et al., 2009). Sinusitis may be caused by allergic, irritant, or infectious agents and can be clas- sified into several categories according to the affected sinus (ethmoidal, maxillary, frontal, or sphenoidal) and etiological agent involved (virus, bacteria, and fungi), among others (Braun, 2003; Chan and Kuhn, 2009). RS is characterized by the presence of 2 or more symptoms including nasal congestion, discharge, and obstruction accompanied by facial pressure or pain and loss of the sense of smell. This may be accompanied by endoscopic manifestations such as presence of polyps or mucopurulent discharge from the middle meatus with edema and mu- cosal obstruction (Jofre et al., 2009). Moreover, this infection can be acute (ARS) or chronic (CRS) (Chakrabarti et al., 2009; Granville et al., 2004). ARS is well characterized (Chakrabarti et al., 2009; Granville et al., 2004) and is associated with a viral infection of the upper tract (Granville et al., 2004), where it usually affects the maxillary and eth- moidal sinuses (Braun, 2003; Brook, 2005). Chronic presentations com- prise over 90% of cases (Chakrabarti et al., 2009), in some of which surgery may be required as treatment or to obtain tissue biopsies for an accurate diagnosis (Granville et al., 2004). However, different diag- nostic criteria and treatment may be used to combat this infection (Ebbens et al., 2009; Jofre et al., 2009; Mowry et al., 2008; Ponikau et al., 1999; Won et al., 2012). In the majority of cases, microbiological diagnosis of CRS is considered to be unnecessary, and the condition is treated empirically (Braun, 2003). In complicated cases, diagnosis is confirmed by culturing tissue samples or secretions obtained through endoscopic aspirates of the affected sinus (Braun, 2003). Although CRS may be caused by several conditions, the majority of cases are due to fungal infections (Granville et al., 2004). Fungal RS (FRS) can be classified according to its histopathological characteristics and clinical presentation; thus, the invasive forms may be necrotizing acute, chronic, or granulomatous, while the noninvasive categories include fungal ball and allergic fungal sinusitis (Crisci, 2010; Fonseca and Fernández, 2005; Vallejo et al., 2005). There are a variety of causative agents of FRS (Chakrabarti et al., 2009; Davis and Kita, 2004; López-Vázquez et al., 2012; Montone et al., 2012; Mowry et al., 2008; Vallejo et al., 2005), and its prevalence varies with geographic location (Chakrabarti et al., 2009; Krishnan et al., 2009; Montone et al., 2012; Ponikau et al., 1999; Taxy, 2006; Won et al., 2012). Among these agents are hyaline molds such as Aspergillus spp. and Fusarium spp.; dematiaceous molds including Bipolaris spp., Curvularia spp., and Alternaria spp. (Alvarez et al., 2011; Castro et al., 2010; Chakrabarti et al., 2009; Ponikau et al., 1999); and yeasts such Candida spp. (Vallejo et al., 2005; Vergara and Hernández, 2007). Coloni- zation by Mucorales includes Rhizopus spp., Lichtheimia (Absidia spp.), and Mucor spp. (Davis and Kita, 2004); in this case, the infection is considered Diagnostic Microbiology and Infectious Disease 81 (2015) 208–212 ⁎ Corresponding author. Tel.: +57-4-2195483. E-mail address: angelgonzalezmarin1972@gmail.com (Á. González). http://dx.doi.org/10.1016/j.diagmicrobio.2014.11.017 0732-8893/© 2015 Elsevier Inc. All rights reserved. Contents lists available at ScienceDirect Diagnostic Microbiology and Infectious Disease journal homepage: www.elsevier.com/locate/diagmicrobio