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Some Chronic Rhinosinusitis Patients Have Significantly Elevated Populations of Seven Fungi in their Sinuses
Citation:
Murr, A. H., A. N. Goldberg, S. D. Pletcher, K. Dillehay, L. J. WYMER, AND S. J. VESPER. Some Chronic Rhinosinusitis Patients Have Significantly Elevated Populations of Seven Fungi in their Sinuses. The Laryngoscope. Lippincott Williams & Wilkins, Philadelphia, PA, 122(7):1438-1445, (2012).
Impact/Purpose:
Approximately 9% of children have asthma. The medical costs of asthma are approximately $15 billion per year in the US alone and asthma results in about 2,000 deaths per year (Fisk et al. 2007). Lost school and work days run into the millions each year. The IOM’s expert committee (2004) concluded that exposure to moldy, damp indoor environments was associated with asthma. A subsequent review (Sahakian et al. 2008) of more recent publications also linked dampness to mold and asthma/asthma symptoms. The World Health organization has come to the same conclusion and suggest that exposure to molds should be “minimized” (WHO 2009). A meta-analysis of studies associating mold contamination with adverse health effects demonstrated that building dampness and mold were associated with approximately a 30 to 50% increase in a variety of respiratory and asthma-related health outcomes (Fisk et al. 2007). Therefore, it is critical that mold assessments are accurate and meaningful. US EPA researchers developed a DNA-based method of mold analysis called MSQPCR which is sensitive, specific and accurate. The US EPA in conjunction with HUD developed a simple, standard method of sampling homes for mold populations and created a scale called the ERMI to compare the mould burden in homes across the US (Vesper et al. 2007). In four epidemiological studies, higher ERMI values in homes were associated with increased risk of asthma in children. Remediating the water-damage and mould in asthmatics homes resulted in a statistically significant improvement in the child’s health and a reduction in the need for hospitalizations and emergency room visits (Kercsmar et al. 2006). Although these results are from a limited number of studies and have not been corroborated independently by other research groups, they are suggestive of the conclusions that mold problems are not always obvious. Furthermore, discovering hidden mold is possible using the ERMI analysis and subsequently correcting a mold problem may reduce asthma’s costs to the US by reducing hospitalizations and emergency room visits.
Description:
Abstract: Objectives/Hypothesis: To measure the populations of 36 fungi in the homes and sinuses of chronic rhinosinusitis (CRS) and non-CRS patients. Study Design: Single-blind cross-sectional study. Methods: Populations of 36 fungi were measured in sinus samples and in the home vacuum cleaner dust of CRS (n = 73) and non-CRS patients (n = 16) using quantitative polymerase chain reaction. Etest strips containing amphotericin B, anidulafungin, caspofungin, fluconazole, and voriconazole were used to test the susceptibility of seven potentially relevant fungi. Results: Seven fungi (Alternaria alternata, Cladosporium cladosporioides types 1 and 2, Cladosporium herbarum, Penicillium brevicompactum, Penicillium crustosum, and Penicillium chrysogenum type 2) were discovered at very high concentrations in some CRS patients. In vitro antifungal susceptibility testing of these seven fungi demonstrated species specific sensitivities. Four CRS patients with marked elevations of fungal populations in their sinus samples underwent endoscopic sinus surgery. After surgical treatment, the fungal populations were reduced by several orders of magnitude. Conclusions: Seven fungi were found in very high concentrations in the sinuses of some CRS patients. Not one of the five common antifungal agents could control all seven of these fungi based on in vitro tests.