Immunologic Role of Fungi in the Pathophysiology of Chronic Rhinosinusitis

Shin, Seung Heon

Abstract

Chronic rhinosinusitis (CRS) is a very common condition but it's pathogenesis is not completely understood. Although, fungi have been suggested to play an important role in the pathogenesis of CRS, there is a significant controversy among rhinologist. The host defense mechanisms against fungi are numerous ranges from innate immunity to adaptive immunity. Fungal biofilms and superantigens are clearly present on the sinus mucosa of CRS patients; they are interacting with the host immune system in perpetuating chronic inflammation. Fungi also play as an inducer of marked inflammatory reaction by enhancing the production of chemical mediators from respiratory mucosa and inflammatory cells. However, the inability to reduce symptoms and sings of CRS inflammation by antifungal treatment means that the hypothesis that fungi play a role in a majority of the cases of CRS has to be rejected. However, there are not many arguments to suggest a causative role of fungi in CRS and due to the intrinsic or induced change in immunity of CRS patients, fungi might have a disease-modifying role.