Laboratory support in chronic fungal rhinosinusitis non-IgE-mediated

Chronic rhinosinusitis (CRS) is a pathology first described many years ago and is now divided into invasive and non-inva- sive, which are then subdivided into the typical picture of the “fungus ball” and Allergic fungal rhinosinusitis (AFRS). There are many fungal species implicated in CRS even if the most frequently isolated mycetes belong to the Aspergillus family and to some demaziacei fungi. Considering the role that the regulation of the Th response has in the pathogenesis of chronic rhinosinusitis with nasal poliposi, the aim of this study was to show the role of some laboratory examinations for aspergillosis at the rhinosinusal level in 12 patients affected by poliposi who underwent surgery. For each patient the following were dosed: IgG, IgM and IgA anti-Aspergillus in indirect immunofluorescence with and with- out serum absorption, the serum dosages of the precipitin in agarose gel, mycological examination of the mucin and of the bioptic fragments and finally, the microscopic examination of the mucin for the presence of granulocytes, neutrophils and eosinophils. From the comparison of the antibody titers of IgG and IgM anti-Aspergillus in IFA with and without serum absorption with spores of Penicillium sp. and A. flavus, it was seen that, even if not in all patients, a decrease of the antibody titers on the absorbed serum. Only in one patient, clinically diagnosed as having chronic fungal rhinosinusitis non-IgE-mediata, was an IgG titer equal to 640 found, notwithstanding surum absorption, the positivity to IgM and IgA and the isolation in culture of Aspergillus flavus mucin. In conclusion, considering the low number of patients examined, further studies are needed to evaluate the role and usefulness that these serum tests could have for patients affected by chronic fungal rhinosinusitis.

La rinosinusite cronica è una patologia che può riconoscere un'eziologia micotica. Molte specie fungine possono essere implicate, specilamente l'Aspergillo. La frequente associazione della rinosinuiste cronica con poliposi nasale ha condotto alla valutazione in tale patologia di alcuni esami di laboratorio che potessero essere indicativi dell'eventuale presenza di un substrato micotico nella genesi della poliposi nasale.