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.

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.

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.

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 Role of Fungi in Allergic Fungal Sinusitis and Chronic Rhinosinusitis

2000 ◽  
Vol 75 (5) ◽  
pp. 540-541
Author(s):  
Jens U. Ponikau ◽  
David A. Sherris ◽  
Eugene B. Kern
Keyword(s):  
Chronic Rhinosinusitis ◽  
Fungal Sinusitis ◽  
Allergic Fungal Sinusitis

Nasal Polyp Cell Populations and Fungal-Specific Peripheral Blood Lymphocyte Proliferation in Allergic Fungal Sinusitis

2009 ◽  
Vol 23 (5) ◽  
pp. 453-460 ◽  
Author(s):  
Harshita Pant ◽  
Dimitra Beroukas ◽  
Frank E. Kette ◽  
William B. Smith ◽  
Peter J. Wormald ◽  
...  
Keyword(s):  
T Cells ◽  
Chronic Rhinosinusitis ◽  
Peripheral Blood ◽  
Blood Lymphocyte ◽  
Lymphocyte Proliferation ◽  
Inflammatory Cell ◽  
Cell Populations ◽  
Fungal Sinusitis ◽  
Allergic Fungal Sinusitis ◽  
Fungal Allergy

Background Allergic fungal sinusitis (AFS) is considered a different disease from other polypoid chronic rhinosinusitis diseases (CRS) with eosinophilic mucus (EM) termed eosinophilic mucus chronic rhinosinusitis (EMCRS). To substantiate this, studies on cellular responses to fungi and sinus mucosal inflammatory cell populations in AFS and other EMCRS diseases are required. This study was designed to examine polyp inflammatory cell populations and peripheral blood fungal–specific T-cell responses in AFS, other EMCRS subgroups (defined later), and polypoid CRS without EM. Methods A prospective study was performed. Clinical characteristics, including CRS symptoms, sinus computed tomography (CT) scans, allergy status, intraoperative endoscopy, presence of EM, and fungal culture results were used to define patient groups. Polyps and peripheral blood were examined for populations of eosinophils, lymphocytes (CD4+, CD8+ T cells, natural killer cells, and B cells), and neutrophils using immunohistochemistry, cytospin preparations and flow cytometry. Fungal-specific peripheral blood lymphocyte proliferation was examined in AFS patients, other EMCRS patients, CRS patients, and controls. Results There was no significant difference in the percentage of cell populations and fungal-specific lymphocyte proliferation between AFS and other EMCRS diseases. However, AFS and other EMCRS polyps had a higher percentage of eosinophils and CD8+ T cells whereas CRS polyps had higher CD4+ T cells. Fungal-specific lymphocyte proliferation was significantly greater in AFS and other EMCRS patients regardless of fungal allergy, whereas in CRS and controls, higher proliferation was observed in fungal-allergic individuals. Conclusion These findings question the basis for differentiating AFS from other EMCRS diseases based on fungal allergy and fungi in EM. Fungal-specific cellular response was present in AFS and other EMCRS diseases, different from that associated with fungal allergy, suggesting a nonallergic fungal immune response. Increased CD8+ T cells in EMCRS polyps signify a different type of inflammation to CRS that may be driven by CD8+ T cells.

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

scholarly journals Recurrence Pattern and Complication Rate of Allergic Fungal Sinusitis: A 10-Year Tertiary Center Experience

2020 ◽  
Vol 2020 ◽  
pp. 1-6
Author(s):  
Yazeed Alghonaim ◽  
Abdulrhman Alfayez ◽  
Riyadh Alhedaithy ◽  
Abdullah Alsheikh ◽  
Malak Almalki
Keyword(s):  
Chronic Rhinosinusitis ◽  
Recurrence Rate ◽  
Nasal Obstruction ◽  
Recurrent Disease ◽  
Disease Recurrence ◽  
Fungal Sinusitis ◽  
Allergic Fungal Sinusitis ◽  
Bilateral Disease ◽  
Fungal Rhinosinusitis ◽  
Allergic Fungal Rhinosinusitis

Background. Allergic fungal rhinosinusitis is a noninvasive form of highly recurrent chronic rhinosinusitis. Despite the advancement in medical and surgical strategies, recurrence in AFRS in general poses another challenging problem with reported incidence that eventually can reach more than 60%. Recognition and understanding the pattern of disease recurrence will lead to greater understanding of the disease response in our population. Method. A retrospective cohort study was performed in King Abdulaziz Medical City in Riyadh, Saudi Arabia. All patients diagnosed with chronic rhinosinusitis and underwent functional endoscopic sinus surgery from the period of January 2006 to December 2016 were reviewed. Results. 28 patients were found to have AFRS based on clinical, radiological, and microscopic examination suggestive of allergic fungal rhinosinusitis. Among these patients, 53% of them were female and 46% were male. The age ranged from 13 to 55 years, with a mean age of 31.57 years. 28.57% of the patients presented with recurrent allergic fungal sinusitis. The duration between the surgery and symptoms recurrence was around one year. Male and female patients had similar recurrence rate (50%). At first visit, 95% of the patients with nonrecurrent disease presented with nasal obstruction compared to 87.5% of the patients with recurrent disease. On the other hand, patients with recurrent disease had more nasal discharge (87.5%), postnasal drip (37.5%), facial pressure/pain (50%), headache (50%), nasal polyposis (87.5%), hypertrophy of inferior turbinate (37.5%), and proptosis (12.5%). Nasal obstruction (87.5%) and nasal polyps (87.5%) were the most common presenting symptoms for the disease recurrence. The pattern of disease recurrence in the previously unilateral disease was 18% ipsilateral and 27% bilateral. For the patients who had bilateral disease formerly, 17% (n = 3) of them had recurrent bilateral disease. Conclusion. Allergic fungal rhinosinusitis is a distinct clinical entity. A high recurrence rate is a pathognomonic feature of the disease, despite all the development in medical and surgical trials. This study demonstrated that recurrence rate is lower in our population. However, more studies with a greater number of patients are needed in the future to clearly recognize the pattern of recurrence in patients with AFRS.

scholarly journals INCIDENCE OF ALLERGIC FUNGAL SINUSITIS AMONG PATIENTS WITH CHRONIC RHINOSINUSITIS

2017 ◽  
Vol 4 (72) ◽  
pp. 4296-4299
Author(s):  
Vivek Gupta ◽  
Grace Bhudhiraja ◽  
Mandeep Kaur ◽  
Wassem Qadir Dar
Keyword(s):  
Chronic Rhinosinusitis ◽  
Fungal Sinusitis ◽  
Allergic Fungal Sinusitis
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