Prevalence of Allergic Fungal Sinusitis in Refractory Chronic Rhinosinusitis in Adult Malaysians

2005 ◽  
Vol 133 (1) ◽  
pp. 27-31 ◽  
Author(s):  
Bee-See Goh ◽  
Balwant Singh Gendeh ◽  
Isa Mohamed Rose ◽  
Sabiha Pit ◽  
Shamim Abdul Samad
Keyword(s):  
Chronic Rhinosinusitis ◽  
Immunoglobulin E ◽  
Cross Sectional Study ◽  
Fungal Sinusitis ◽  
Allergic Fungal Sinusitis ◽  
Cross Sectional ◽  
Positive Skin ◽  
Identification Of Fungi ◽  
Aspergillus Sp ◽  
Fungal Allergen

OBJECTIVE: To determine the prevalence of allergic fungal sinusitis (AFS) in refractory chronic rhinosinusitis (CRS) in adult Malaysians. STUDY DESIGN AND SETTING: This cross-sectional study involved 30 immunocompetent CRS patients who underwent surgery. Specimens were sent for mycology and histopathologic analysis for identification of fungi. Clinical and immunological workup was performed for atopy in all patients and controls. RESULTS: Fungal cultures were positive in 5 (16.7%) and 11 (36.7%) of 30 patients from nasal secretions and surgical specimens, respectively. Allergic mucin was found in 8 surgical specimens (26.7%). Hence, prevalence of AFS was 26.7%. The most common causative agent was Aspergillus sp. (54.5%). In 3 (37.5%) of 8 patients, AFS was found to be associated with asthma. Twenty-five percent (2/8 patients) had aspirin intolerance, and 62.5% (5/8 patients) had elevated total immunoglobulin E levels. All patients had positive skin test reactivity to fungal allergen. CONCLUSIONS: This preliminary study suggests that AFS does exist in Malaysia. Proper handling of surgical specimens and accurate diagnosis by the pathologist and mycologist are essential.

Atopy and Quality of Life in Pediatric Chronic Rhinosinusitis

2019 ◽  
Vol 33 (5) ◽  
pp. 586-590 ◽  
Author(s):  
Anamika Anamika ◽  
Arunabha Chakravarti ◽  
Raj Kumar
Keyword(s):  
Quality Of Life ◽  
Skin Prick Test ◽  
Chronic Rhinosinusitis ◽  
Cross Sectional Study ◽  
Endoscopic Examination ◽  
Positive Skin Prick Test ◽  
Cross Sectional ◽  
Positive Skin ◽  
Prick Test

Background Atopy has been suggested in the development of chronic rhinosinusitis (CRS), as allergic rhinitis (AR) is common coexisting disease in pediatric and adult patients with CRS. The contribution of AR to CRS is less clear till date. Objectives The objectives of this study were to determine atopic profile of children with CRS and impact of atopic status on disease severity and quality of life. Methods One hundred ten patients, aged between 7 and 18 years of age, diagnosed with CRS based on history, detailed clinical examination including nasal endoscopic examination were included in this cross-sectional study. Scoring of CRS was done according to Lund Mackay Endoscopic Appearance Score. Patients underwent skin prick test against 65 common aeroallergens (1:10 w/v, 50% glycerinated) for evidence of atopy. SN-5 Sinus and Nasal Quality of Life Survey was used to assess the quality of life in the study subjects. Results Positive skin prick test to at least one of the common aeroallergens was present in 58 (52.7%) patients. Most common aeroallergen sensitivity was seen with insects in 48 (43.6%) patients. Patients of CRS with atopy had higher mean Lund Mackay endoscopic score and SN-5 score than nonatopic patients which was statistically significant. Conclusion In conclusion, we recommend that testing for aeroallergen sensitivity and assessment of quality of life should be included in the protocol for diagnosis and management of pediatric patients with CRS. Early diagnosis and treatment of allergy may halt the progression of CRS and also the development of asthma and other allergic multimorbid disorders.

scholarly journals Allergic rhinitis, part of the allergic respiratory syndrome

2020 ◽  
Vol 73 (9-10) ◽  
pp. 301-308
Author(s):  
Aleksandra Aleksic ◽  
Mirjana Gnjatic ◽  
Mirjana Stupar-Hofman ◽  
Vesna Tomic-Spiric
Keyword(s):  
Allergic Rhinitis ◽  
Chronic Rhinosinusitis ◽  
Immunoglobulin E ◽  
Otitis Media With Effusion ◽  
Systemic Disease ◽  
Positive Family History ◽  
Cross Sectional Study ◽  
Cross Sectional ◽  
Statistical Analysis System ◽  
Analysis System

Introduction. Diseases associated with immunoglobulin E hypersensitivity, such as allergic rhinitis, may have different clinical expressions. Patients with allergic rhinitis often have associated diseases, comorbidities, which supports the concept of allergy as a systemic disease. The aim of this study was to evaluate the incidence and types of comorbidities in allergic rhinitis. We also evaluated the possible effects of certain clinical and demographic parameters on the onset of comorbidities. Material and Methods. This retrospective, observational, and cross-sectional study included patients with a clinical diagnosis of allergic rhinitis treated at the Department of Ear, Nose and Throat in the period from October 2011 to April 2013. The collected data were analyzed using the Statistical Analysis System (Institute Inc. NC, USA) program, version 9.1.3. Results. The study included 319 patients with allergic rhinitis. Allergic rhinitis was intermittent in 30.7% of cases, persistent in 37.9%, and persistent with seasonal exacerbation in 31.3% of patients. We found that 86.8% of patients had some form of comorbidity. The most common were conjunctivitis (50.2%), almost equal percentage of asthma (29.8%) and chronic rhinosinusitis (28.8%), followed by otitis media with effusion (8.8%), atopic dermatitis (5.2%), urticaria (4.1%), and laryngitis (3.8%). Persistent allergic rhinitis, with persistent nasal obstruction as the dominant symptom, was significantly associated with chronic rhinosinusitis. Positive family history was significantly associated with the occurrence of asthma and allergic rhinitis. Conclusion. The results of our study showed that allergic rhinitis is rarely an isolated condition and it should always be observed in the context of the allergic respiratory syndrome.

scholarly journals Chronic Rhinosinusitis—Could Phenotyping or Endotyping Aid Therapy?

2018 ◽  
Vol 33 (1) ◽  
pp. 83-93 ◽  
Author(s):  
Nuray Bayar Muluk ◽  
Cemal Cingi ◽  
Glenis K. Scadding ◽  
Guy Scadding
Keyword(s):  
Chronic Rhinosinusitis ◽  
Immunoglobulin E ◽  
Treatment Options ◽  
Fungal Sinusitis ◽  
Allergic Fungal Sinusitis ◽  
Clear Cut ◽  
Cysteinyl Leukotriene ◽  
Central Database ◽  
Acquired Immune Deficiency

Objectives We reviewed the phenotyping and endotyping of chronic rhinosinusitis (CRS) and treatment options. Methods We searched PubMed, Google, Google Scholar, and the Proquest Central Database of the Kırıkkale University Library. Results Phenotypes are observable properties of an organism produced by the environment acting upon the genotype, that is, patients with a particular disorder are subgrouped according to common characteristics. Currently, CRS is usually phenotyped as being with (CRSwNP) or without (CRSsNP) nasal polyps. However, this is not immutable as some individuals progress from nonpolyp to polypoid CRS over time. Phenotypes of CRS are also based on inflammatory patterns, generally CRSwNP is eosinophilic, CRSsNP neutrophilic; but there is a spectrum, rather than a clear-cut division into 2 types. An endotype is a subtype of a condition defined by a distinct functional or pathobiological mechanism. Endotypes of CRS can be (1) nontype Th2, (2) moderate type Th2, and (3) severe type Th2 immune reactions, based on cytokines and mediators such as IL4, 5, 13. CRS endotyping can also include a (1) type 2 cytokine-based approach, (2) eosinophil-mediated approach, (3) immunoglobulin E-based approach, and (4) cysteinyl leukotriene-based approach. Subdivisions of CRSwNP can be made into nonsteroidal anti-inflammatory drug-exacerbated respiratory disease, allergic fungal sinusitis, and eosinophil pauci-granulomatous arteritis by testing. General treatment for all CRS is nasal douching. The place of surgery needs careful reconsideration. Endotype-directed therapies include glucocorticosteroids, antibiotics, aspirin, antifungals, anticytokines, and immunoglobulin replacement. The recognition of united airways and the co-occurrence of CRSwNPs and severe asthma should lead to common endotyping of both upper and lower airways in order to better direct therapy. Conclusion Endotyping can allow for the identification of groups of patients with CRS with a high likelihood of successful treatment, such as patients with a moderate type 2 immune reaction or those with acquired immune deficiency.

scholarly journals Aetiological Subclassification of Chronic Rhinosinusitis: A Retrospective Study

2020 ◽  
Author(s):  
Turki M Bin Mahfoz ◽  
Talal Alandejani
Keyword(s):  
Chronic Rhinosinusitis ◽  
Immunoglobulin E ◽  
Statistical Tests ◽  
Fungal Sinusitis ◽  
Allergic Fungal Sinusitis ◽  
Major Health Problem ◽  
Parametric Data ◽  
Asthma And Allergy ◽  
Non Parametric

Introduction: Chronic Rhinosinusitis (CRS) is a major health problem with very high prevalence worldwide. The information available about the pathophysiology of the disease is not enough to allow development of curative therapies. Classification of CRS is based on the presence of asthma and allergy that can be useful to understand the disease aetiology and allow better patient’s care through individualised treatment plans. Aim: To classify CRS cases into subgroups depending mainly on the presence of asthma and allergy in addition to comparing the characteristics of these subgroups. Materials and Methods: A retrospective descriptive study was carried out, and the data of CRS’ patients were collected from medical records of consecutive patients attending the ENT clinic in, King Abdulaziz Medical City, Saudi Arabia. Based on collected data, CRS cases were classified into six subclasses, and patients’ characteristics such as gender and Immunoglobulin E (IgE) values in these subclasses were compared. Data entry and statistical analysis was carried out in Statistical Package for the Social Sciences (SPSS). Mean, Standard Deviation (±SD) for numerical parametric variables and Inter-Quartile Range (IQR) for numerical non-parametric variables was calculated. Appropriate statistical tests like Analysis of Variance (ANOVA) for parametric data and Kruskal Wallis test for non-parametric were applied. Results: The most prevalent subclass was Non-Asthmatic Sinusitis without Allergy (NASsA) 30 (48.4%) followed by, Asthmatic Sinusitis Without Allergy (ASsA) 13 (21.0%), Asthmatic Sinusitis With Allergy (AScA) 6 (9.7%), Non-Asthmatic Sinusitis With Allergy (NAScA) 5 (8.1%) and Allergic Fungal Sinusitis (AFS) 5 (8.1%). The highest levels of total IgE were found in patients with NAScA. It was found that nasal polyps’ presence was significantly linked to higher Computed Tomography (CT) Lund-Macky scores and MASNOT (Modified Arabic Sino-Nasal Outcome Test) scores. Conclusion: Classification of CRS based on the presence of asthma and allergy can be an informative tool for providing better care to CRS patients.

scholarly journals Serum specific IgE responses to inhalant allergens sensitization

2017 ◽  
Vol 26 (3) ◽  
pp. 224-8
Author(s):  
Iris Rengganis ◽  
Suriani Alimuddin ◽  
Agus J. Susanto
Keyword(s):  
Immunoglobulin E ◽  
Specific Ige ◽  
Cross Sectional Study ◽  
Positive Skin Prick Test ◽  
Dust Mites ◽  
Storage Mites ◽  
Cross Sectional ◽  
Positive Skin ◽  
Prick Test ◽  
Inhalant Allergens

Background: Serum specific immunoglobulin E (ssIgE) sensitization to common inhalant allergens has not been studied in Indonesia. This study aimed to evaluate specific IgE production of common inhalant allergens in patients with asthma and/or allergic rhinitis in Jakarta, Indonesia.Methods: This was a cross-sectional study in adult patients with respiratory allergy from September to December 2016 at Cipto Mangunkusumo Hospital, Jakarta. Patients were included if they showed at least one positive skin prick test (SPT) to environmental allergens. Serum specific IgE was assayed by using multiple allergosorbent methods. Inhalant allergens tested were dust mites, pollen, cockroach, animal dander, and mould. Serum IgE level more than 0.35 kU/L was considered positive.Results: One hundred subjects were enrolled (76% women). Dust mites made up 75% of sensitization, followed by cat/dog (31%), cockroach (27%), pollen (24%), and mould (6%). Almost all patients sensitized to cockroach, pollen, cat/dog epithelia and mould were also co-sensitized with dust mites. Twenty two percent of patients were negative to all tested allergens.Conclusion: IgE-sensitization to inhalant allergens varies widely in respiratory allergic patients. House dust and storage mites are the most common allergens. About one-fifth of the subjects did not show specific-IgE sensitization. Thus, this test should always be combined with SPT to diagnose allergy.

scholarly journals Mucosal Eosinophilia and Neutrophilia Are Not Associated With QOL or Olfactory Function in Chronic Rhinosinusitis

2021 ◽  
pp. 194589242098743
Author(s):  
Nyssa F. Farrell ◽  
Jess C. Mace ◽  
David A. Sauer ◽  
Andrew J. Thomas ◽  
Mathew Geltzeiler ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Chronic Rhinosinusitis ◽  
Nasal Polyposis ◽  
Cross Sectional Study ◽  
Olfactory Function ◽  
Sinus Surgery ◽  
Small Subset ◽  
Cross Sectional ◽  
Snot 22

Background Chronic rhinosinusitis (CRS) is often differentiated by histopathologic phenotypes (eosinophilic versus neutrophilic), which may impact disease severity measures and outcomes. As such, it has been suggested that counts of cellular elements be included as part of a standard pathological report following endoscopic sinus surgery (ESS). Objectives This cross-sectional study evaluated associations of mucosal eosinophilia and neutrophilia with measures of quality-of-life (QoL) and olfactory function. Methods Patients with medically refractory CRS completed the SNOT-22 survey and Brief Smell Identification Test (BSIT) at enrollment. In addition, baseline Lund-Mackay computed tomography (CT) and Lund-Kennedy endoscopy scores were collected. Ethmoid mucosa was biopsied during ESS and reviewed using microscopy to quantify densest infiltrate of eosinophils or neutrophils per high-powered-field (HPF). Eosinophilic CRS (eCRS) and neutrophilic CRS (nCRS), both with and without nasal polyposis (NP), were compared across SNOT-22 and BSIT scores. Results 77/168 patients demonstrated mucosal eosinophilia (eCRS) while a total of 42/168 patients demonstrated mucosal neutrophilia (nCRS). After adjusting for polyp status, 35/168 had eCRSsNP, 42/168 eCRSwNP, 75/168 non-eCRSsNP, 16/168 non-eCRSwNP. Additionally, 22/161 were noted to have nCRSsNP, 20/161 nCRSwNP, 84/161 non-nCRSwNP, and 35/161 non-nCRSsNP. A small subset of patients demonstrated both eosinophilia and neutrophilia: 14 CRSwNP and 7 CRSsNP. When evaluating average Lund-Mackay Scores (LMS), significant differences existed between non-eCRSsNP and eCRSsNP (p = 0.006). However, after controlling for nasal polyps, eosinophilia did not significantly associate with differences in the Lund-Kennedy Score. Neutrophilia did not significantly associate with any changes in LMS or LKS after controlling for NP. Eosinophilic and neutrophilic histopathologic subtypes did not significantly associate with differences in baseline SNOT-22 or BSIT measures after controlling for NP. Conclusion Neither the presence of mucosal eosinophilia nor mucosal neutrophilia demonstrated significant associations with SNOT-22 quality-of-life or BSIT olfactory function scores when controlling for comorbid nasal polyposis.

Demonstration of Biofilm in Human Bacterial Chronic Rhinosinusitis

2005 ◽  
Vol 19 (5) ◽  
pp. 452-457 ◽  
Author(s):  
Berrylin J. Ferguson ◽  
Donna B. Stolz
Keyword(s):  
Chronic Rhinosinusitis ◽  
Culture Media ◽  
Cellular Membrane ◽  
Anaerobic Growth ◽  
Bacterial Biofilms ◽  
Topical Steroids ◽  
Fungal Sinusitis ◽  
Allergic Fungal Sinusitis ◽  
Planktonic Bacteria ◽  
Transmission Electron

Background Bacterial biofilms may explain why some patients with bacterial chronic rhinosinusitis (CRS) improve while on antibiotics but relapse after completion of the antibiotic. In the human host, biofilms exist as a community of bacteria surrounded by a glycocalyx that is adherent to a foreign body or a mucosal surface with impaired host defense. Biofilms generate planktonic, nonadherent bacterial forms that may metastasize infection and generate systemic illness. These planktonic bacteria are susceptible to antibiotics, unlike the adherent biofilm. Methods We reviewed four cases of CRS using transmission electron microscopy (TEM) to assay for typical colony architecture of biofilms. Bacterial communities surrounded by a glycocalyx of inert cellular membrane materials consistent with a biofilm were shown in two patients. Results In the two patients without biofilm, a nonbacterial etiology was discovered (allergic fungal sinusitis) in one and in the other there was scant anaerobic growth on culture and the Gram stain was negative. Culture of the material from the biofilm grew Pseudomonas aeruginosa in both patients. Pseudomonas from the biofilm showed a glycocalyx, not present in Pseudomonas cultured for 72 hours on culture media. Both patients’ symptoms with bacterial biofilms were refractory to culture-directed antibiotics, topical steroids, and nasal lavages. Surgery resulted in cure or significant improvement. Conclusion Biofilms are refractory to antibiotics and often only cured by mechanical debridement. We believe this is the first TEM documentation of bacterial biofilms in CRS in humans.

scholarly journals Relationship between Total Imunoglobulin E Level and Intensity of Whipworm Infectionin Primary School Children, Medan, North Sumatera

2020 ◽  
Author(s):  
Endy Juli Anto ◽  
◽  
Leonard Kristian Sinaga ◽  
Jekson Martiar Siahaan ◽  
◽  
...  
Keyword(s):  
Primary School ◽  
Negative Correlation ◽  
School Children ◽  
Immunoglobulin E ◽  
Cross Sectional Study ◽  
Primary School Children ◽  
Cross Sectional ◽  
Total Ige ◽  
Helminth Infections ◽  
Spearman Correlation Test

ABSTRACT Background: Helminth infections remain endemic disease, mainly in tropical developing countries. Immunity against a number of helminth infections has been associated with anti-parasitic immunoglobulin-E (IgE). This study aimed to determine the correlation between total IgE level and intensity of whipworm infection in primary school children, Medan, North Sumatera. Subjects and Method: This was a cross-sectional study conducted at primary school, Tanjung Pura, Langkat, Medan, North Sumatera in Augustus 2019. A total of 19 students was selected for this study. The dependent variable was intensity of whipworm egg. The study subjects were selected by purposive sampling method. The independent variable was total IgE level. The data for dependent variable was measured by Kato-Katz technique. The total IgE serum concentration was measured by ELISA. Data were analyzed by Spearman correlation test. Results: There was a negative correlation between total IgE level and intensity of whipworm infection among primary school children in Medan (r= -0.64; p= 0.003). Conclusion: There is a negative correlation between total IgE level and intensity of whipworm infection among primary school children in Medan. Keywords: whipworm infection, IgE, children Correspondence: Leonard Kristian Sinaga. Faculty of Medicine, Universitas Methodist Indonesia, Medan, Indonesia. Email: [email protected]. Mobile: +6282361343969. DOI: https://doi.org/10.26911/the7thicph.03.76

Occupational exposure influences control of disease in patients with chronic rhinosinusitis

2021 ◽  
Vol 59 (4) ◽  
pp. 380-386
Author(s):  
D.A.E. Dietz de Loos ◽  
S. Ronsmans ◽  
M.E. Cornet ◽  
P.W. Hellings ◽  
V. Hox ◽  
...  
Keyword(s):  
Occupational Exposure ◽  
Chronic Rhinosinusitis ◽  
Nasal Polyps ◽  
Conservative Therapy ◽  
Cross Sectional Study ◽  
Sinus Surgery ◽  
Sectional Study ◽  
Cross Sectional ◽  
Independent Variables ◽  
The Relationship

Background: Chronic rhinosinusitis (CRS) is a frequent condition that is treated by endoscopic sinus surgery (ESS) when medical treatment fails. Irritating or sensitizing airborne agents can contribute to uncontrolled CRS. A prior study showed a linear correlation between occupational exposure and the number of ESS. Methods: In this cross-sectional study we tested the hypothesis that occupational exposure is a risk for undergoing ESS. We sent questionnaires enquiring occupational exposure in patients with CRS with nasal polyps (CRSwNP) or CRS without nasal polyps (CRSsNP). An expert assessed blindly the reported work exposures to inhaled agents. The relationship between occupational exposure on undergoing ESS was analysed. Results: Among all patients who underwent ESS (n=343), 30% reported a relevant occupational exposure, which is significantly higher than the 4.8% found among CRS patients that underwent no prior sinus surgery (n=21). Besides occupational exposure, self-reported doctor-diagnosed asthma were independent variables contributing to the chance of undergoing ESS. Conclusion: In our study we confirm occupational exposure as a risk factor for uncontrolled CRS, if defined by undergoing ESS. In CRS patients with uncontrolled symptoms, despite maximal conservative therapy, the clinician should explore the possible contribution of occupational exposure.

scholarly journals Antibiotic Sensitivity Pattern of Bacterial Isolates in Patients with Chronic Rhinosinusitis in Kaduna, Nigeria

2018 ◽  
Vol 23 (02) ◽  
pp. 152-156
Author(s):  
Emmanuel Musa ◽  
Aliyu Kodiya ◽  
Abdullahi Kirfi ◽  
Onyekwere Nwaorgu
Keyword(s):  
Chronic Rhinosinusitis ◽  
Anaerobic Bacteria ◽  
Antibiotic Sensitivity ◽  
Cross Sectional Study ◽  
Bacterial Isolates ◽  
Statistical Parameters ◽  
Cross Sectional ◽  
Sensitivity Pattern ◽  
Sensitivity Tests ◽  
Aerobic And Anaerobic

Introduction A common practice in the management of patients with chronic rhinosinusitis (CRS), the empirical use of antibiotics may contribute to treatment failure and to the development of antimicrobial resistance. Objective To determine the antibiotic sensitivity pattern of aerobic and anaerobic bacteria associated with CRS. Methods This was a prospective cross-sectional study in which endoscopically guided middle meatal swabs (IBM Spss, version 16.0, Chicago, IL, USA) were aseptically taken from patients diagnosed with CRS after obtaining informed consent and ethical clearance. The samples were sent to the laboratory for qualitative and semiquantitative analysis via gram stain, aerobic, anaerobic cultures and antibacterial sensitivity tests. The collected data was analyzed using SPSS for Windows, version 16 (SPSS Inc, Chicago, IL, USA). Simple statistical parameters and paired sample t-test were used, as appropriate. Results There were 74 (56.92%) bacterial growths, out of which 55 (74.32%) were aerobic and 19 (25.68%) were anaerobic isolates, from a total of 130 patients. About 13 (17.5%–18%) of these bacterial growths yielded a mixed growth of aerobic and anaerobic isolates. The most common bacterial isolates were 26 (35.14%) Staphylococcus aureus, Haemophilus influenzae 9 (12.16%), Streptococcus viridians 8 (10.81%), and Streptococcus pneumoniae 5 (6.76%). Augmentin, ciprofloxacin, and Peflacine were found to be most effective, followed by levofloxacin, Rocephin, erythromycin and Zinat in that order. Conclusion Augmentin, ciprofloxacin and Peflacine have a sensitivity of 100%, while most of the organisms show resistance to Ampiclox, amoxicillin, and Septrin.

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