Microbiological study of role of fungi in primary atrophic rhinitis

Abstract

Background: Fungal rhinosinusitis has gained much attention in recent years. To our knowledge, no previous studies have addressed the role of fungus in primary atrophic rhinitis.Study design: Prospective case study. Patients and methods: All cases of primary atrophic rhinitis presenting to the out-patient department at El-Sahel Teaching Hospital over a five-month period were included in the study. Crusts and purulent secretions removed from patients' nasal cavities underwent microbiological analysis at the Medical Microbiology and Immunology department of the Cairo University Faculty of Medicine. Special emphasis was placed on fungal isolation.Results: Fourteen consecutive cases of primary atrophic rhinitis were studied in the five-month period starting 26 November 2007. Patients comprised eight females and six males, with an age range of 12 to 65 years (mean 37 years). Microscopy of the crusts and purulent secretions showed pus cells in most of the samples. Klebsiella species were isolated from nine patients (65 per cent), and other bacterial species were isolated in most of the remainder. Fungal elements, most commonly aspergillus species, were isolated in 13 patients (93 per cent).Conclusion: It is proposed that the initial trigger for primary atrophic rhinitis is a virulent bacterial infection of the nasal lining, which leads to damage of the ciliated epithelium. This initiates the cascade of events leading to inflammation of the mucosa and submucosa, with secondary pyogenic osteomyelitis of the turbinate bone. The persistence of purulent secretion, within the setting of impaired mucociliary clearance, leads to saprophytic fungal colonisation which contributes greatly to the clinical picture.

Funktionen und Funktionsstörungen der respiratorischen Schleimhaut der Nase und der Nasennebenhöhlen

“…Diese prim ä re Form besitzt auch eine hohe veterin ä rmedizinische Bedeutung bei Schweinen, sodass verschiedene veterin ä rmedizinische Vakzinen gegen das ausl ö sende Pasteurella multocida-Toxin entwickelt wurden [277] . Endonasal zeigt sich unabh ä ngig von der ausl ö senden Form eine Borkenbildung (vor allem an der mittleren Muschel), Metaplasie der Epithelien mit Verlust der Zilien und Superinfektion der Schleimhaut (zu 65 -100 % Nachweis von Klebsiella oceanae [274,278] ) mit Vasodilatation [274] und Knochenver ä nderungen bis hin zur Osteitis des Os turbinale [278] . Als Folge zeigt sich eine vergr ö sserte MCA1 [279] .…”

Mycological study on cholesteatoma keratin obtained during primary mastoid surgery

“…6 In a previous study, we postulated that the fetor associated with primary atrophic rhinitis was caused by saprophytic fungal colonisation of the nasal cavities of affected patients. 7 We therefore hypothesised that the fetor associated with infected cholesteatomas might be caused by saprophytic fungal colonisation within the keratinous debris.…”

Physiology and pathophysiology of respiratory mucosa of the nose and the paranasal sinuses

“…Endonasal crust formation (usually on the middle turbinate), epithelial metaplasia with loss of cilia and superinfection of nasal mucosa (with detection of Klebsiella ocaena in 65–100% [274], [278]) are visible. In addition, vasodilatation [274] and changes in bone formation including osteitis of the turbinate bony may occur [278].…”

“…In addition, vasodilatation [274] and changes in bone formation including osteitis of the turbinate bony may occur [278]. As a consequence, MCA1 is enlarged [279].…”