Fungal Sinusitis: Sudanese Experience

Special Article – Fungal Sinusitis

Austin J Otolaryngol. 2016; 3(4): 1085.

Fungal Sinusitis: Sudanese Experience

Mahgoub ES, Ismail MAI and Gabr A*

Department of Microbiology, Faculty of Medicine, University of Khartoum, Sudan

*Corresponding author: Mahgoub ES, Department of Microbiology, Faculty of Medicine, University of Khartoum, Sudan

Received: October 24, 2016; Accepted: December 06, 2016; Published: December 08, 2016


Chronic Invasive Fungal Sinusitis (CIFS) is frequently seen in otolaryngology clinics in Sudan. Patients presented late with maxillary sinus swelling and unilateral proptosis Surgical removal used to be the sole management approach and was often associated with recurrence. The causative organism used to be Aspergillus flavus. A total of 579 operative specimens were received in the mycology laboratory, faculty of medicine, university of Khartoum between 2010 and 2015. These were studied by culture and Counter Immuno Electrophoresis (CIE).

Clinical information of eight patients was available. Only 280 operative specimens (46.3%) gave positive growth of fungi and positive CIE test. A. flavus constituted the majority of fungi isolated but there were a few ones due to A.terreus and Bipolaris specifera. In addition to surgery the former was treated with Itraconazole and the latter with Voriconazole. An appreciable number of specimens were from nasal polyps.

In conclusion:

Keywords: Fungal sinusitis; Paranasal Aspergillus granuloma; Aspergillus flavus; A. fumigatus; A. terreus; Bipolaris specifera


Fungal sinusitis is inflammation 0f the membrane of the nasal sinuses by different fungi mostly Aspergillus species. Fungal sinusitis, formerly described as Paranasal Aspergillus Granuloma (PNAG) because the sinus affected most was the Maxillary sinus, the histopathological reaction was typical granuloma and the fungus isolated was an Aspergillus the term Paranasal Aspergillus Granuloma (PNAG) was used for many years in Sudan [1,2].

Fungal sinusitis is a relatively common disease frequently reported from Sudan and India [3-5]. Since the advent of AIDS interest developed in cases in both immunocompromised and immunocompetent individuals in relation to treatment of the causative fungi. Cases were reported from Japan, Saudi Arabia, Taiwan and USA [6-9].

Reports on fungal sinusitis (Paranasal Aspergillus Granuloma) in Sudan date back to 1967 when the first patient reported with unilateral proptosis was wrongly diagnosed as cancer of the eye and consequently the eye was removed [10]. When the specimen was sent to Edinburgh University Aspergillus flavus was isolated.

At the beginning cases seen involved Paranasal sinuses particularly the maxillary sinus and causing unilateral proptosis. However in recent years more patients reported with nasal polyps.

This paper describes the clinical findings, diagnosis, causative organisms and treatment of cases or specimens that presented to the Mycology unit of the department of microbiology, faculty of medicine, and university of Khartoum in the last five years.

Patients & Materials

Details of eight patients whose laboratory request forms included clinical information are shown in (Table 1). Specimens received were either tissue or serum. The former were divided in two, one half was used for culture by grinding it first in saline using a 10-Broeck tube. Suspension was placed on glucose nutrient agar with chloramphenicol at 26°C for 10 days. The other half was sent for histopathology. Histological slides were stained with H/E and Gomori Methenamine silver. Serum was tested against Aspergillus antigens in the Counter Immuno Electrophoresis (CIE) for diagnosis and follow up [11].