Ann Lab Med 2018; 38(2): 125-131  
Serum Cytokine Profile in Patients with Chronic Rhinosinusitis with Nasal Polyposis Infected by Aspergillus flavus
Gargi Rai, M.Sc.1, Mohammad Ahmad Ansari, Ph.D.1, Sajad Ahmad Dar, Ph.D.1,2, Shyama Datt, M.Sc.1, Neelima Gupta, M.S.3, Sonal Sharma, M.D.4, Shafiul Haque, Ph.D.2,5, Vishnampettai Ganapathysubramanian Ramachandran, Ph.D.1, Arpeeta Mazumdar, M.D.1, Shivprakash Rudramurthy, M.D.6, Arunaloke Chakrabarti, M.D.6, and Shukla Das, M.D.1
Department of Microbiology1, University College of Medical Sciences (University of Delhi) & Guru Teg Bahadur Hospital, Delhi, India; Research and Scientific Studies Unit2, College of Nursing & Allied Health Sciences, University of Jazan, Jazan, Saudi Arabia; Department of Otorhinolaryngology3, and Pathology4, University College of Medical Sciences (University of Delhi) & Guru Teg Bahadur Hospital, Delhi, India; Department of Biosciences5, Faculty of Natural Sciences, Jamia Millia Islamia (A Central University), New Delhi, India; Department of Medical Microbiology6, Post Graduate Institute of Medical Education & Research, Chandigarh, India
Correspondence to: Shukla Das
Department of Microbiology, University College of Medical Sciences (University of Delhi) & Guru Teg Bahadur Hospital, Delhi 110095, India
Tel: +91-11-22582972-74
Fax: +91-11-22590495
E-mail: shukladas_123@yahoo.com
Received: March 26, 2017; Revised: June 28, 2017; Accepted: October 24, 2017; Published online: March 1, 2018.
© The Korean Society for Laboratory Medicine. All rights reserved.

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract
Background: Fungi, especially Aspergillus flavus, can cause chronic rhinosinusitis with nasal polyposis and modulate host innate immune components. The objective of this study was to examine the serum levels of T helper (Th) cell subset Th1, Th2, and Th17 cytokines and total IgE in patients having chronic rhinosinusitis with nasal polyposis and Aspergillus flavus infection.
Methods: A case-control study including 40 patients with chronic rhinosinusitis with nasal polyposis and 20 healthy controls was conducted. Aspergillus flavus infection was confirmed by standard potassium hydroxide (KOH) testing, culture, and PCR. Serum samples of all patients and controls were analyzed for various cytokines (interleukins [IL]-1β, IL-2, IL-4, IL-6, IL-17, IL-21, IL-27, TGF-β) and total IgE by ELISA. Data from patients with Aspergillus flavus infection and healthy volunteers were compared using the independent t-test and non-parametric Mann–Whitney U test.
Results: Aspergillus flavus infection was found in 31 (77.5%) patients with chronic rhinosinusitis with nasal polyposis. IL-1β, IL-17, IL-21, and TGF-β serum levels were significantly higher in these patients than in controls; however, IL-2, IL-4, IL-6, and IL-27 levels were lower. Compared with nine (22.5%) patients without Aspergillus flavus infection, IL-17 level was higher while IL-2 level was lower in patients with Aspergillus flavus infection. Total IgE was significantly higher in patients with Aspergillus flavus infection than in controls.
Conclusions: High levels of IL-17 and its regulatory cytokines in patients with chronic rhinosinusitis with nasal polyposis infected by Aspergillus flavus raise a concern about effective disease management and therapeutic recovery. Surgical removal of the nasal polyp being the chief management option, the choice of post-operative drugs may differ in eosinophilic vs. non-eosinophilic nasal polyposis. The prognosis is likely poor, warranting extended care.
Keywords: Nasal polyposis, Chronic rhinosinusitis, Aspergillus flavus, Cytokines



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