The Fungi Flora of Healthy Nasal Mucosa in Kerman, Iran

Iranian Journal of Otorhinolaryngology No.2, Vol.23, Serial No.63, Spring-2011 Original Article The Fungi Flora of Healthy Nasal Mucosa in Kerman, Iran Ali-Asghar Arabi Mianroodi1, Dariush Nasiri2, *Narges Khanjani3, Seyyed Amin Ayatollahi Mousavi4 Abstract Introduction: Environmental fungi, molds and yeasts, can infest the nasal cavity through inhaled air. There is some evidence that they could be the main cause of Chronic Rhinosinusitis (CRS) but little is known about the normal fungal flora in the human nose. The objective of this study was to assess the normal fungal flora of the nasal mucus in adults in Kerman. Materials and Methods: We conducted a cross sectional study. Nasal swabs were used to sample the nasal cavity of 100 adults, 46 men and 54 women between 17 and 60 years old, currently living in Kerman, Iran. Results: Among 100 healthy people, one or more types of fungi were detected in 31 (31%) persons; Candida in 12 persons, Aspergillus in 8 persons, Streptomyces in 8 persons, and Penicillium, Nocardia and Mucor in a few persons. In only 4 persons, more than one type of fungi was detected. There was no significant relation between age, sex, education or smoking with the presence of fungi. Conclusion: Fungi have been considered one of the causative agents of CRS and differences in climatic conditions can influence the fungi flora. Keywords: Fungi, Flora, Nasal Received date: 12 Oct 2010 Accepted date: 1 Feb 2011 1 Department of otorhinolaryngology, Kerman University of Medical Sciences, Kerman, Iran Department of otorhinolaryngology, Kerman University of Medical Sciences, Kerman, Iran 3 Department of biostatistics and epidemiology Department, Faculty of Public Health, Kerman University of Medical Sciences, Kerman, Iran 4 Department of medical mycology and parasitology, Kerman University of Medical Sciences, Kerman, Iran *Corresponding author: Haft-Bagh-e-Alavi Blvd, Faculty of Public Health, Kerman University of Medical Sciences, Kerman, Iran Email: , Tel: +98341320 5136, Fax: +98341 320 5134 2 21 The Fungi Flora of Healthy Nasal Mucosa in Kerman Introduction The inflammation of paranasal sinuses, often known as rhinosinusitis, is one of the most common and very costly diseases. In the United States, over 14% of the population, i.e. every seventh person is inflicted with an acute or chronic type of the disease (1). Even though most of its cases are acute, rhinosinusitis is one of the most common chronic diseases in the world (2). The annual direct cost of the disease in the United States is $4.3 billion, and in 2001, one out of each five antibiotic prescription was for the treatment of rhinosinusitis (2). The cost of leave from work due to this disease is also high. In 1992, in the U.S., there were 73 million leave from work days due to rhinosinusitis (1). Rhinosinusitis can be classified based on clinical presentation, the type of the affected sinus cavity, the responsible organisms (viral, bacterial and fungal) etc. (3). Various predisposing and causative factors have been identified in chronic rhinosinusitis, including local factors, systemic factors, immune-deficiencyrelated factors, environmental factors, and infectious factors such as bacteria and fungi (3). The causative agent of chronic rhinosinusitis can be an allergy (e.g. to fungi) or an inflammatory reaction to the presence of bacteria and/or fungi. Fungi have recently summoned a lot of attention as the causative agents of this condition. Different types of fungi have adjusted to various climatic conditions, and their spores can hence be found everywhere in the world. Differences in climatic and weather conditions (the AMSL height, sunlight, humidity, type of the soil, and the presence or absence of fresh, salty, current, still, ground, and or surface water, etc.) can influence the fungal flora of a region directly, or indirectly by influencing the flora and fauna of the region. For instance, Histoplasma is common in such areas as Missouri and Mississippi, in the U.S., where there is an abundance of bat and bird droppings. Nonetheless, rhinosporidosis is usually found in Asian and African regions with contaminated water (4). Yet Paracoccidioidomycosis is found in the hot and humid regions of Latin America (5), and the Aspergillus found in chronic pulmonary conditions and in paranasal sinuses is especially common in Sudan and Saudi Arabia (5). Fungi have certain microscopic forms, and their spores, through the inhaled air or contaminated water and food, make their way into the human body, particularly via the oral and nasal cavities. Were it not for the immune system in the mucosal secretions and the blood-rich mucus of the nasal cavity, the warm and damp cavity would have provided an ideal medium for the growth and reproduction of fungi. However, before conclusively identifying fungi as the major causative agent of all or some (for instance allergic) types of rhinosinusitis, we should have a good knowledge of the fungal flora of the nasal cavity of a healthy individual. No doubt, to diagnose any pathologic condition, we should first know and define the “normal” state as the first step. Therefore, to systematically examine the role of fungi in chronic rhinosinusitis, we should first identify the normal fungal flora of a healthy individual, an undertaking which has been performed inadequately, and which, because of the various differences in this flora caused by climatic differences, should be repeated in different parts of the world. The aim of this study was to identify the fungal flora of the nasal mucus of healthy individuals in Kerman, Iran. To the best of our knowledge, this is the first study of this type conducted in the country. Materials and Methods This was a cross-sectional study. A group of 100 patients (54 females, 46 males) visiting the clinic of Shafa Hospital, Kerman, were entered into the study after 22, Iranian Journal of Otorhinolaryngology No.2, Vol.23, Serial No.63, Spring-2011 Arabi-Mianroodi A, et al the primary selection based on case histories and self-report questionnaires. The selected individuals ranged between 17 and 60 in age, and had been residing in Kerman for at least one month prior to the commencement of the study. For each individual, a questionnaire was completed by one of the administrators, in which, in addition to personal information of the subject (e.g. name, age and address), information was recorded on the symptoms, habits, medications and medical conditions of the subject. Those who had reported chief complaints of upper respiratory tracts or of active acute rhinosinusitis were eliminated from the study. Those eliminated also included subjects who had nasal obstruction, pathological nasal discharge, previous allergic episodes, any nasal medication in the last month leading to the study, hospitalization and surgery in the last month leading to the study, histories of rheumatological conditions, local or systemic use of antibiotics in the (...truncated)