Skip to main content

A seven-year retrospective analysis of the clinicopathological and mycological manifestations of fungal rhinosinusitis in a single-centre tropical climate hospital

  • L C Goh (a1), E D Shakri (a2), H Y Ong (a2), S Mustakim (a3), M M Shaariyah (a2), W S J Ng (a2) and A B Zulkiflee (a1)...
Abstract Objective:

To evaluate the clinicopathological and mycological manifestations of fungal rhinosinusitis occurring in the Tengku Ampuan Rahimah Hospital, in Klang, Malaysia, which has a tropical climate.


Records of patients treated from 2009 to 2016 were analysed retrospectively. Data from the records were indexed based on age, gender, clinical presentations, symptom duration, clinical signs and mycological growth.


Of 80 samples, 27 (33.75 per cent) had fungal growth. Sixteen patients were classified as having non-invasive fungal rhinosinusitis and 11 as having invasive fungal rhinosinusitis. The commonest clinical presentation was nasal polyposis in non-invasive fungal rhinosinusitis patients (p < 0.05) and ocular symptoms in invasive fungal rhinosinusitis patients (p < 0.05). The commonest organism was aspergillus sp. (p < 0.05) in non-invasive fungal rhinosinusitis and mucorales in invasive fungal rhinosinusitis.


There is an almost equal distribution of both invasive and non-invasive fungal rhinosinusitis, as seen in some Asian countries. Invasive fungal rhinosinusitis, while slightly uncommon when compared to non-invasive fungal rhinosinusitis, is potentially life threatening, and may require early and extensive surgical debridement. The clinical presentation of nasal polyposis was often associated with non-invasive fungal rhinosinusitis, whereas ocular symptoms were more likely to be associated with invasive fungal rhinosinusitis.

Corresponding author
Address for correspondence: Dr Goh Liang Chye, Department of Otorhinolaryngology, University of Malaya, Jalan Universiti, 50603 Kuala Lumpur, Wilayah Persekutuan, Malaysia Fax: +60 3 7955 6963 E-mail:
Hide All
1 Bent, JP 3rd, Kuhn, FA. Diagnosis of allergic fungal sinusitis. Otolaryngol Head Neck Surg 1994;111:580–8
2 Goh, BS, Gendeh, BS, Rose, IM, Pit, S, Samad, SA. Prevalence of allergic fungal sinusitis in refractory chronic rhinosinusitis in adult Malaysians. Otolaryngol Head Neck Surg 2005;133:2731
3 Kontoyiannis, DP, Marr, KA, Park, BJ, Alexander, BD, Anaissie, EJ, Walsh, TJ et al. Prospective surveillance for invasive fungal infections in hematopoietic stem cell transplant recipients, 2001–2006: overview of the Transplant-Associated Infection Surveillance Network (TRANSNET) Database. Clin Infect Dis 2010;50:1091–100
4 Singh, N. Trends in the epidemiology of opportunistic fungal infections: predisposing factors and the impact of antimicrobial use practices. Clin Infect Dis 2001;33:1692–6
5 Schell, WA. Unusual fungal pathogens in fungal rhinosinusitis. Otolaryngol Clin North Am 2000;33:367–73
6 Brandt, ME, Warnock, DW. Epidemiology, clinical manifestations, and therapy of infections caused by dematiaceous fungi. J Chemother 2003;15(suppl 2):3647
7 DelGaudio, JM, Clemson, LA. An early detection protocol for invasive fungal sinusitis in neutropenic patients successfully reduces extent of disease at presentation and long term morbidity. Laryngoscope 2009;119:180–3
8 Valera, FC, do Lago, T, Tamashiro, E, Yassuda, CC, Silveira, F, Anselmo-Lima, WT. Prognosis of acute invasive fungal rhinosinusitis related to underlying disease. Int J Infect Dis 2011;15:e8414
9 Granville, L, Chirala, M, Cernoch, P, Ostrowski, M, Truong, LD. Fungal sinusitis: histologic spectrum and correlation with culture. Hum Pathol 2004;35:474–81
10 Das, A, Bal, A, Chakrabarti, A, Panda, N, Joshi, K. Spectrum of fungal rhinosinusitis; histopathologist's perspective. Histopathology 2009;54:854–9
11 Soontrapa, P, Larbcharoensub, N, Luxameechanporn, T, Cheewaruangroj, W, Prakunhungsit, S, Sathapatayavong, B et al. Fungal rhinosinusitis: a retrospective analysis of clinicopathologic features and treatment outcomes at Ramathibodi Hospital. Southeast Asian J Trop Med Public Health 2010;41:442–9
12 Montone, KT, Livolsi, VA, Feldman, MD, Palmer, J, Chiu, AG, Lanza, DC et al. Fungal rhinosinusitis: a retrospective microbiologic and pathologic review of 400 patients at a single university medical centre. Int J Otolaryngol 2012;2012:684835
13 Challa, S, Uppin, SG, Hanumanthu, S, Panigrahi, MK, Purohit, AK, Sattaluri, S et al. Fungal rhinosinusitis: a clinicopathological study from South India. Eur Arch Otorhinolaryngol 2010;267:1239–45
14 Dufour, X, Kauffmann-Lacroix, C, Ferrie, JC, Goujon, JM, Rodier, MH, Klossek, JM. Paranasal sinus fungus ball: epidemiology, clinical features and diagnosis. A retrospective analysis of 173 cases from a single medical center in France, 1989–2002. Med Mycol 2006;44:61–7
15 Panda, NK, Sharma, SC, Chakrabarti, A, Mann, SB. Paranasal sinus mycoses in north India. Mycoses 1998;41:281–6
16 Ebbens, FA, Fokkens, WJ. The mold conundrum in chronic rhinosinusitis: where do we stand today? Curr Allergy Asthma Rep 2008;8:93101
17 Ebbens, FA, Georgalas, C, Fokkens, WJ. Fungus as the cause of chronic rhinosinusitis: the case remains unproven. Curr Opin Otolaryngol Head Neck Surg 2009;17:43–9
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

The Journal of Laryngology & Otology
  • ISSN: 0022-2151
  • EISSN: 1748-5460
  • URL: /core/journals/journal-of-laryngology-and-otology
Please enter your name
Please enter a valid email address
Who would you like to send this to? *



Full text views

Total number of HTML views: 6
Total number of PDF views: 52 *
Loading metrics...

Abstract views

Total abstract views: 371 *
Loading metrics...

* Views captured on Cambridge Core between 25th August 2017 - 21st March 2018. This data will be updated every 24 hours.