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Evaluation of Pulmonary Fungal Dseases in Patients With Fungal Rhino-sinusitis FREE TO VIEW

Mohamed Badawy, MD
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South Valley University, Luxor, Egypt

Chest. 2015;148(4_MeetingAbstracts):1018A. doi:10.1378/chest.2275015
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SESSION TITLE: Signs and Symptoms of Chest Diseases Posters

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 28, 2015 at 01:30 PM - 02:30 PM

PURPOSE: To evaluate presence of pulmonary fungal diseases in patients with fungal rhinosinusitis.

METHODS: A prospective study was done for 44 patients who fulfilled inclusion criteria (sinus CT, and histopathological examination). All patients were assessed for pulmonary symptoms, chest X-ray, CT scan, routine lab study, and broncho-alveolar lavage. Microscopic examination of fungal hyphae, fungal culture, skin prick tests, total and specific IgE was done to all cases.

RESULTS: The mean age of patients was 32.5 ± 13.2. Fungal sinusitis was categorized into allergic FS 24 (54.5%) 6 of them (25%) were asthmatic, fungus ball 16 (36.4%) four (25%) were asthmatic, acute fulminant FS 3 cases (6.8%) one (33%) was asthmatic and chronic invasive sinusitis 1 (2.3%) not asthmatic. Eleven cases (25%) had pulmonary symptoms mainly cough and wheeze, malaise 7 cases (16%), dyspnea and fever 6 cases (14%), weight loss 3 cases (7%) and expectoration of golden brown cast in 2 cases (5%). Six patients (14%) had radiological involvement. Three cases (6%) in allergic FS group had the diagnostic criteria for sino-bronchial allergic mycosis (SAM). One patient was in acute stage I, second was in stage III corticosteroid dependant state, and third was in stage 1V of exacerbation with high total, specific IgE for Aspergillus fumigatus.

CONCLUSIONS: Universal screening for pulmonary fungal infection especially in patients with fungal rhino sinusitis is highly recommended to treat it early, decrease morbidity and mortality of the diseases.

CLINICAL IMPLICATIONS: Patients with asthma and/or rhinosinusitis along with sensitization to aspergillus antigens are at an increased risk of developing ABPA and/or AAS. ABPA must be excluded in all patients with AAS and vice versa. Patients who presented with passage of nasal and sputum plugs should alert the physician to the possibility of coexistent ABPA and AAS. Presence of hemoptysis in ABPA patient considers an alarming manifestation for developing aspergilloma. AFS patient presented with highly elevated total IgE should raise the suspicion of having ABPA. Presence of double dense lesions in the nasal CT and central bronchiectasis in the chest radiography of the same patient should strengthen the suspicion of having concomitant ABPA and AFS in this patient.

DISCLOSURE: The following authors have nothing to disclose: Mohamed Badawy

The research is finlized and published and would like to present it in this big scientific congress




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