Detection of fungi in sinus fluid of patients with allergic fungal rhinosinusitis

We aim to develop a rapid, accurate and sensitive diagnostic assay with whi ch to detect the surface antigens of fungi thought to be involved in allerg ic fungal rhinosinusitis (AFRS), by assessing the usefulness of immunofluor escence microscopy (IMF) and enzyme linked immune-absorbent assays (ELISA). The age, sex, clinical symptoms and signs, imaging (CT and/or MRI), microb iological subculture data, sinus contents, blood eosinophilia, aspergillosi s precipitins. radioallergoabsorbent technology (RAST) for fungal allergens and histopathology were performed on individuals undergoing endoscopic sin us surgery for suspected AFRS. Thirteen patients were examined, and five mo noclonal antibodies raised to the surface washings of various fungi were fo und to recognize and differentiate between fungal species implicated in sin us disease, i.e. Aspergillus niger, Alternaria alternata, Cochliobolus luna ta, Penicillium expansum and Cladosporium species. The IMF microscopy prove d to be a useful assay to distinguish visually between the cultured fungi, but was less useful for visualization of fungi in the patient samples. Howe ver, ELISA assays with 5 monoclonal antibodies gave clear and unambiguous d ata as to the presence of certain fungi within the patient samples. There i s good correlation bt tween the ELISA data and the pathology findings. This preliminary study suggests that both IMF and ELISA techniques may offer an important advance in this area.