Fungal vs non-fungal allergic mucin rhinosinusitis

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.

Download Full-text

Usefulness of Fungiflora Y to detect fungus in a frozen section of allergic mucin

Pathology International ◽

10.1111/j.1440-1827.2007.02147.x ◽

2007 ◽

Vol 57 (9) ◽

pp. 613-617 ◽

Cited By ~ 2

Author(s):

Masatomo Kimura ◽

Ayako Sano ◽

Osamu Maenishi ◽

Hiroyuki Ito

Keyword(s):

Frozen Section ◽

Allergic Mucin

Download Full-text

Allergic Fungal rhino-sinusitis frequency in chronic rhino-sinusitis patients and accuracy of fungal culture in its diagnosis

Pakistan Journal of Medical Sciences ◽

10.12669/pjms.36.3.1661 ◽

2020 ◽

Vol 36 (3) ◽

Author(s):

Nukhbat Ullah Awan ◽

Khalid Muneer Cheema ◽

Fatima Naumeri ◽

Samina Qamar

Keyword(s):

Diagnostic Accuracy ◽

Bone Destruction ◽

Sinus Surgery ◽

Fungal Culture ◽

Creative Commons ◽

Chronic Rhino Sinusitis ◽

Allergic Mucin ◽

Fungal Stain ◽

Culture Positive ◽

Open Access Article

Objective: To determine the frequency of Allergic Fungal Rhino-sinusitis (AFRS) in Chronic Rhino-sinusitis (CRS) patients and the accuracy of fungal culture in diagnosing AFRS. Methods: Immunocompetent patients with CRS and without invasive fungal rhino-sinusitis presenting over a period of 3 years in ENT department of Mayo Hospital, from April 2014 to September 2017 were included in the study. AFRS was diagnosed clinically and on Bent and Kuhn diagnostic criteria. All patients underwent endoscopic sinus surgery. Removed tissue histopathology and fungal culture was done. Diagnostic accuracy of fungal culture in AFRS patients was determined. Results: Out of 216 patients of CRS, 45 (20.8%) had AFRS. Mean age of patients diagnosed with AFRS was 29.49±9.16. Out of 45 patients, 26 were male and 19 were female. Nasal polyps were present in 45 (100%) patients, fungal stain was positive in 39(86.7%). CT scan showed sinus expansion in 28(62.2%) patients, heterogeneous opacity in 45(100%) patients and bone destruction in 13(28.9%). Presence of Allergic Mucin was seen in 45(100%) patients, high IgE levels in 36(80.0%), eosinophilia in 21(46.7%), presence of Charcot Leyden crystals in 27(60.0%). Asymmetrical involvement of sinuses was seen in 30 (66.7%) and co-existent asthma was seen in 18(40.0%). Fungal culture positive patients were 25(55.6%). Diagnostic accuracy of fungal culture was 91.6%. Conclusion: Fungal culture has a key role in confirming diagnosis of AFRS. We also noted that frequency of AFRS is increasing in CRS patients. doi: https://doi.org/10.12669/pjms.36.3.1661 How to cite this:Awan NU, Cheema KM, Naumeri F, Qamar S. Allergic Fungal rhino-sinusitis frequency in chronic rhino-sinusitis patients and accuracy of fungal culture in its diagnosis. Pak J Med Sci. 2020;36(3):---------. doi: https://doi.org/10.12669/pjms.36.3.1661 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Download Full-text

Otopolyposis With Middle Ear Allergic Mucin in a Patient With Allergic Fungal Rhinosinusitis

Annals of Otology Rhinology & Laryngology ◽

10.1177/0003489416660112 ◽

2016 ◽

Vol 125 (10) ◽

pp. 862-865 ◽

Cited By ~ 2

Author(s):

Manvinder S. Kumar ◽

Nicholas J. Panella ◽

Kelly R. Magliocca ◽

Esther X. Vivas

Keyword(s):

Middle Ear ◽

Fungal Rhinosinusitis ◽

Allergic Fungal Rhinosinusitis ◽

Allergic Mucin

Download Full-text

Allergic Mucin Sinusitis without Fungus

American Journal of Rhinology ◽

10.2500/105065897782537269 ◽

1997 ◽

Vol 11 (2) ◽

pp. 145-148 ◽

Cited By ~ 31

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.

Download Full-text

Allergic Bronchopulmonary Aspergillosis, Allergic Aspergillus Sinusitis and their Co-occurrence

The Open Allergy Journal ◽

10.2174/1874838400801010052 ◽

2008 ◽

Vol 1 (1) ◽

pp. 52-61 ◽

Cited By ~ 2

Author(s):

Amit Diwakar ◽

Chandramani Panjabi ◽

Ashok Shah

Keyword(s):

Computed Tomography ◽

At Risk ◽

Severe Disease ◽

Allergic Bronchopulmonary Aspergillosis ◽

Current Approach ◽

Surgical Removal ◽

Oral Corticosteroids ◽

Allergic Mucin ◽

Criteria For Diagnosis

Allergic bronchopulmonary aspergillosis (ABPA), which requires a set of criteria for diagnosis, occurs in atopic individuals, predominantly asthmatics. Oral corticosteroids are the cornerstone for the management of the disease. Allergic Aspergillus sinusitis (AAS), clinico-pathologically similar to ABPA, is also diagnosed with a set of criteria including demonstration of fungal elements in sinus material. Heterogeneous densities on computed tomography of the para-nasal sinuses are caused by the ‘allergic mucin’ in the sinuses. A combination of oral corticosteroids and surgical removal of impacted sinus mucin is the current approach to treatment. Despite common clinico-immunopathological characteristics, the co-occurrence of both these diseases is a rarely reported phenomenon. This could be due to the fact that the two diseases are often encountered by different specialities. Screening all asthmatics for Aspergillus sensitisation could identify those with severe disease and those at risk for developing ABPA. AAS must be excluded in all patients with ABPA and vice-versa.

Download Full-text