In about 10% of patients who are operated on for chronic
sinusitis, an aspergilloma is found in the affected paranasal sinus. In order to detect possible underlying immune defects, 25 patients with aspergillomas were subjected to an immunological screening program. The data obtained were compared with those of patients with non-mycotic chronic
sinusitis and healthy controls. Total lymphocyte counts and
immunoglobulin levels were normal in both groups with
sinusitis. However, leukocyte subset analyses using membrane fluorescence revealed a significant decrease of CD11+ cells (macrophages, monocytes and natural killer-cells) in both types of
sinusitis. Furthermore, a markedly enhanced frequency of CD25+ cells (interleukin 2-receptor-bearing cells), was observed in patients with the aspergillomas. Additionally, peripheral blood lymphocytes in both groups of patients showed a significant reduction in the proliferative response to both T- and B-cell
mitogens, with the values for the
mitogens ConA and PHA being significantly lower in the aspergilloma patients as compared to those with non-mycotic
sinusitis. This lack of lymphocyte stimulation in the aspergilloma group was also manifest in skin tests to recall
antigens. These first data suggest that there is an immune deficiency in patients with chronic
sinusitis caused by Aspergillus fumigatus. Further studies are needed to clarify if this defect is the cause or the result of the mycotic
infection.