Which fungi are commonly involved in allergic or chronic sinus disease in the immunocompetent?

• A. Dematiaceous fungi
• B. Candida albicans
• C. Aspergillus fumigatus
• D. Dematiaceous fungi or Alternaria species

Answer: (D)

In immunocompetent individuals, allergic or chronic sinus disease is most often linked to pigmented, dematiaceous fungi, with Alternaria species frequently implicated. These fungi tend to colonize the nasal passages and trigger an eosinophil-rich inflammatory response and mucinous buildup seen in allergic fungal rhinosinusitis. The pigmentation (melanin) and allergenic potential of dematiaceous fungi, especially Alternaria, make them the typical culprits in this setting.

Candida albicans is more associated with mucosal candidiasis rather than allergic or chronic sinus disease in otherwise healthy people. Aspergillus fumigatus can cause sinus problems, including allergic complications, but the most consistent and characteristic culprits in immunocompetent hosts are dematiaceous fungi or Alternaria species.