A study on the prevalence of allergic fungal rhinosinusitis in patients with refractory chronic rhinosinusitis in Sari city

ntroduction: Allergic fungal Rhinosinusitis (AFRS) is the most common form of fungal sinusitis in patients with refractory chronic rhinosinusitis (CRS). According to high occurrence of AFRS in warm regions with high humidity, in this study we evaluated the prevalence of AFRS in patients with refractory chronic rhinosinusitis from Sari city, Iran. During one year, 134 surgical sinus specimens were retrieved from 50 cases with refractory CRS. Specimens were analyzed by histopathological and mycological methods including Hematoxylin & Eosin, Periodic Acid- Schiff, and CalcoFlour White staining and also mounted by KOH. These samples were also processed for fungal culture. Total serum IgE was evaluated for all patients. Of 50 patients, 12 cases (24%) showed AFRS based on clinical, histopathological, mycological and radiological findings. Although collected samples from these patients were all microscopically positive for fungi, only 58.34% of these patient's specimens yielded fungi in culture. Aspergillus flavus was the most prevalent isolated fungi (33.34 %). 16/66% of these patients had elevated total IgE levels. Nasal polyps, history of atopy and Eosinophilic mucin were seen in all patients with AFRS. The results of our study showed AFRS is a common disorder in patients with CRS. Sinonasal polyposis and history of atopy were found in all patients with AFRS, therefore considering these important criteria in diagnosis of AFRS is emphasized.