Emerging Contribution of Histopathology to Our Understanding of Chronic Rhinosinusitis Endotypes: Tissue Eosinophil Count and Aggregates

Background Rhinologists are currently trying to find evidence useful for classifying chronic rhinosinusitis with nasal polyps (CRSwNP) in terms of pathophysiology-based endotypes. This would help us to tailor targeted therapies and follow-up protocols to each patient, improving treatment efficacy and reducing relapse risk. The histopathological study of inflammatory cells in tissue and their tendency to form aggregates has shown promise in determining the pathogenesis and predicting the clinical outcome. Objective The main purpose of this study was to assess tissue eosinophil count, eosinophil aggregation, and their relationship to different CRSwNP phenotypes. Methods A consecutive series of 96 patients who underwent endoscopic sinus surgery for CRSwNP was retrospectively assessed. Our structured histopathological approach considered eosinophil count and eosinophil aggregates. Results Patients’ clinical features included allergic fungal rhinosinusitis (AFRS) in 17 cases, nonsteroidal anti-inflammatory drug-exacerbated respiratory disease (NERD) in 19 cases, intrinsic asthma in 18 cases, extrinsic asthma in 21 cases, and allergy in 21 cases. Statistical analysis revealed more eosinophil aggregates in patients with NERD than in those with AFRS ( P = .020), intrinsic asthma ( P = .019), or extrinsic asthma ( P = .029). NERD patients had a significantly higher tissue eosinophil count than the other groups considered, apart from the AFRS ones. AFRS patients had a higher tissue eosinophil count than patients with intrinsic asthma. Conclusion Our results showed in particular that the NERD patient group’s rhinosinusitis was sustained by a significantly more severe eosinophilic reaction than in the other groups. Structured histopathology can provide useful information for classifying CRSwNP on pathophysiological grounds.

Moulds Menaces in Flood-Ravaged Homes: A Case Study of Dar Es Salaam City Tanzania

<p class="jbls"><span lang="EN-GB">Recently, Dar es Salaam city has been experiencing unexpected heavy rains which causes flood in several parts of the city. After the flood, houses are left cloggy, muddy and dumpy which promote the growth of moulds likely to affect returning residents. This work investigated the moulds status in 175 houses affected by the flood. Sampling was done using both Non-Volumetric Air Sampling (NVAS) and Swab Sampling (SS) methods. Macro-micromorphological characters were used for identification of the moulds. The results showed that out of the 175 examined houses 170 (97.1%) were found to have moulds while five houses (2.9%) including one control house were free of moulds. Five types of moulds were found dominated by a black spore former <em>Aspegillus niger</em> found in 87 houses (41.2%) followed by <em>Penicillium</em> species in 65 houses (37.1%) and <em>Cladosporium</em> species found in 60 houses (34.3%). The least group of moulds were the yellow mould <em>Aspergillus flavus</em> and white dermatophyte <em>Trichophyton</em> species each found in 15 houses (8.6%). The revealed moulds are well known to be associated with human health problems including production of carcinogenic metabolites, triggering allergic reactions to sensitive individuals, causing keratitis, skin lesions, nail fungus, sinusitis, intrinsic asthma, and pulmonary infections. The study thus suggest an premeditated public awareness on adverse effects that might be caused by moulds, call for the government interventions on thoroughly moulds status establishment and immediate deploy methods of moulds controls before residents returns to their flooded homes wherever such catastrophe occur for the healthy generation. </span></p>