scholarly journals Allergic fungal sinusitis - new aspects of clinical features, laboratory diagnosis and therapy

2013 ◽  
Vol 141 (9-10) ◽  
pp. 698-704 ◽  
Author(s):  
Valentina Arsic-Arsenijevic ◽  
Aleksandra Barac ◽  
Marina Pekmezovic ◽  
Rajica Stosovic ◽  
Ivica Pendjer
Keyword(s):  
Paranasal Sinuses ◽  
Immunoglobulin E ◽  
Laboratory Finding ◽  
Periodic Acid ◽  
Allergic Bronchopulmonary Aspergillosis ◽  
Mucosal Inflammation ◽  
Fungal Sinusitis ◽  
Allergic Fungal Sinusitis ◽  
Specific Staining ◽  
Allergic Mucin

Allergic fungal sinusitis (AFS) is a chronic non?invasive disease. Hypersensitive immune response is usually initiated by allergens of filamentous fungi Aspergillus, Penicillium, Cladosporium, Fusarium, Bipolaris, Curvularia and Alternaria. AFS is a clinical and immune analogue of the allergic bronchopulmonary aspergillosis (ABPA) as the sinus exudate resembles that of the bronchoalveolar lavage (BAL) in ABPA. Patients with AFS are usually immunocompetent, atopic and males. The most common symptoms are headache, fullness in the paranasal sinuses, and difficult breathing through the nose. Clinically, there is a chronic mucosal inflammation and histopathologic finding shows allergic mucin and eosinophils. Specific staining methods, Gomori?s Methenamine Silver (GMS) or periodic acid?Schiff (PAS), are used for microscopic visualisation of hyphae, which are, in addition to the isolated fungi, most reliable evidence of AFS. Computerized tomography (CT) of paranasal sinuses shows the areas of hyperdensity. In cases where AFS is complicated by the erosion of bone tissue, discontinuation of the sinus bone wall can be seen. Significant laboratory finding, which correlate highly with the AFS, are high immunoglobulin E (IgE) antibodies specific for fungi, detected by the skin prick test or in serum. Treatment is often surgical, and after removal of the allergic mucin, therapy involves oral and nasal corticosteroids, immunotherapy and locally applied antimycotics (with verified fungal etiology). During treatment, the total/specific IgE is monitored - concentration increases with the development of AFS, and decreases during the improvement process. Knowledge of the pathophysiological mechanisms of AFS is scarce, and represents the focus of further research in order to define an optimal diagnostic and therapeutic approach.

scholarly journals Fungal sinusitis clinical presentation, latest management: A Review Update

2015 ◽  
Vol 12 (1) ◽  
pp. 16-19
Author(s):  
Bithi Bhowmik
Keyword(s):  
Paranasal Sinuses ◽  
Disease Process ◽  
High Rate ◽  
Fungus Ball ◽  
Fungal Sinusitis ◽  
Allergic Fungal Sinusitis ◽  
Invasive Fungal Sinusitis ◽  
Radiologic Imaging ◽  
Chronic Invasive

Fungal sinusitis is a relatively common, often misdiagnosed disease process involving the paranasal sinuses. It is a serious condition, as certain forms of fungal sinusitis are associated with a high rate of mortality. Successful treatment requires a prompt diagnosis and frequently relies on radiologic imaging, specifically computed tomography (CT) and magnetic resonance (MR) imaging. The classification of fungal sinusitis is ever changing, but under the most current and widely accepted classification fungal sinusitis is broadly categorized as either invasive or noninvasive. Invasive fungal sinusitis is defined by the presence of fungal hyphae within the mucosa, submucosa, bone, or blood vessels of the paranasal sinuses. Invasive fungal sinusitis is subdivided into acute invasive fungal sinusitis, chronic invasive fungal sinusitis, and chronic granulomatous invasive fungal sinusitis. Conversely, noninvasive fungal sinusitis is defined by the absence of hyphae within the mucosal and other tissues of the paranasal sinuses. Noninvasive fungal sinusitis is subdivided into allergic fungal sinusitis and fungus ball (fungal mycetoma).Journal of Science Foundation, 2014;12(1):16-19

Allergic Mucin With and Without Fungus

2001 ◽  
Vol 125 (11) ◽  
pp. 1442-1447
Author(s):  
Jonathan F. Lara ◽  
J. Daniel Gomez
Keyword(s):  
Tertiary Care ◽  
Fungal Sinusitis ◽  
Allergic Fungal Sinusitis ◽  
Radiographic Findings ◽  
Care Institution ◽  
Tertiary Care Institution ◽  
Allergic Mucin ◽  
And Gender

Abstract Context.—Allergic mucin, a lamellated collection of inspissated inflammatory debris, has been a hallmark of allergic fungal sinusitis. While its identification is a clue for pathologists to search for fungi, and directs clinicians toward specific therapy and follow-up, recent reports describe cases with allergic mucin but without concomitant fungus. The absence of such organisms in otherwise typical allergic mucin brings into question the role of fungi in allergic fungal sinusitis. Objectives.—To study clinical and pathologic differences between patients with allergic mucin in surgical nasal resection specimens and to elucidate the role of fungus in allergic sinusitis. Design.—Patients with histologic evidence of allergic mucin, with and without fungus, were identified and retrieved from the surgical pathology files of a tertiary-care institution. The patients were separated into 2 groups for analysis, and their clinical and pathologic findings were reviewed and compared. Setting.—Tertiary-care institution. Patients.—All patients who underwent sinus mucosal resection between 1992 and 1998. Results.—Clinical presentation and radiographic findings were similar in both groups. Incidence, age, and gender distribution were similar to data reported previously. However, the amount of allergic mucin was much greater in the group with fungus than in the group without fungus, which to our knowledge is an unreported observation to date. Conclusion.—The presence of allergic mucin is not unique to allergic fungal sinusitis, but rather is the result of a process that could have other etiologies. While perhaps not always causative to the disease, the fungus continues to fuel the process and is likely an entrapped bystander. Allergic fungal sinusitis is more appropriately termed allergic mucinous sinusitis or eosinophilic mucinous rhinosinusitis.

Allergic Fungal Sinusitis Associated with Allergic Bronchopulmonary Aspergillosis: An Uncommon Sinobronchial Allergic Mycosis

2007 ◽  
Vol 21 (4) ◽  
pp. 412-416 ◽  
Author(s):  
Jean Jacques Braun ◽  
Gabrielle Pauli ◽  
Philippe Schultz ◽  
André Gentine ◽  
David Ebbo ◽  
...  
Keyword(s):  
Allergic Bronchopulmonary Aspergillosis ◽  
Specific Ige ◽  
Antifungal Drugs ◽  
Sinus Surgery ◽  
Skin Tests ◽  
Fungal Sinusitis ◽  
Allergic Fungal Sinusitis ◽  
Positive Skin ◽  
Oral Corticosteroids ◽  
Blood Eosinophils

Background The identification of allergic fungal sinusitis (AFS) is still controversial and much more recent than that of allergic bronchopulmonary aspergillosis (ABPA). Their association has been reported very rarely in the literature. Methods The aim of this study was to present a review of 6 cases of AFS associated with ABPA from a series of 12 cases of AFS and to compare AFS associated with ABPA and isolated AFS. Results All cases of AFS presented with chronic rhinosinusitis. The six cases with AFS and ABPA were atopic, asthmatic, with pulmonary infiltrates (five cases), central bronchiectasis (four cases), and both (three cases). The mycological and immunoallergological features of isolated AFS and AFS associated with ABPA were similar: eosinophilic allergic mucin with noninvasive fungi hyphae, high levels of blood eosinophils, total IgE, specific IgE, IgG, and positive skin tests to Aspergillus. The association of AFS and ABPA was concomitant (two cases) or remote in time (four cases). The treatment with oral corticosteroids and sinus surgery (six cases) associated with antifungal drugs (four cases) led to resolution in three cases, considerable improvement in one case, and therapeutic failure in two cases (follow-up longer than 5 years in all cases). Conclusion Independently of the signs linked to the organs involved (sinuses and bronchi) the mycological and immunoallergological features were similar for AFS and AFS associated with ABPA. AFS and ABPA can be isolated or associated in a sinobronchial allergic mycosis.

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.

Allergic Mucin Sinusitis without Fungus

1997 ◽  
Vol 11 (2) ◽  
pp. 145-148 ◽  
Author(s):  
Hassan H. Ramadan ◽  
Huma A. Quraishi
Keyword(s):  
Clinical Picture ◽  
Nasal Polyposis ◽  
Clinical Presentation ◽  
Fungal Sinusitis ◽  
Asthma Treatment ◽  
Allergic Fungal Sinusitis ◽  
Fungal Hyphae ◽  
History Of ◽  
Allergic Mucin

Allergic fungal sinusitis (AFS) is a distinct clinical pathologic entity that has been recognized for over a decade. The hallmark of this process is eosinophilic allergic mucin with fungal hyphae on histopathology. We have identified a subset of patients who present with a clinical picture similar to that of AFS patients in which fungus could not be demonstrated pathologically or on culture. We present four cases of allergic mucin sinusitis without fungus. A comparison of the clinical presentation of this group of patients with those with AFS will be discussed. Both groups had nasal polyposis and a history of multiple sinonasal procedures. By contrast, the patients with allergic mucin sinusitis were older than the AFS group. All of the patients with allergic mucin sinusitis also had asthma. Treatment was the same for both groups of patients.

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.

Allergic Fungal Sinusitis: A Review with Four Illustrated Cases

1994 ◽  
Vol 8 (1) ◽  
pp. 13-18 ◽  
Author(s):  
Marc F. Goldstein ◽  
Eliot H. Dunsky ◽  
Donald J. Dvorin ◽  
Raymond W. Lesser
Keyword(s):  
Case Reports ◽  
Surgical Care ◽  
Sinus Surgery ◽  
Fungal Sinusitis ◽  
Nasal Airway ◽  
Allergic Fungal Sinusitis ◽  
Intranasal Steroids ◽  
Oral Corticosteroids ◽  
Allergic Mucin ◽  
Histopathologic Findings

Although paranasal fungal sinusitis is rare, an increased number of Aspergillus and non-Aspergillus related cases of allergic fungal sinusitis have been described since its first report in 1983. The histopathologic findings necessary for a definitive diagnosis rest upon the detection of scattered fungal elements in a matrix of allergic mucin. The clinical spectrum and treatment of allergic fungal sinusitis are detailed within four illustrated case reports. Sinus surgery, followed by meticulous post-surgical care by an allergy and otolaryngology team using oral corticosteroids, and followed by maintenance intranasal steroids and nasal airway irrigations in conjunction with allergy immunotherapy, has resulted in excellent clinical outcomes.

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