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Cameron BH, Gong SW, Corry DB, Luong AU. Update on the Role of Fungus in Allergy, Asthma, and the Unified Airway. Otolaryngol Clin North Am 2024; 57:279-292. [PMID: 37867110 DOI: 10.1016/j.otc.2023.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2023]
Abstract
The united airway refers to the combined upper and lower airways and their interconnected pathophysiologic relationships. Inflammatory airway diseases (chronic rhinosinusitis, asthma, and so forth) have been linked to fungal species through type 2 immune responses. These type 2 immune responses involve the cytokines interleukin (IL)-4, IL-5, IL-13, and a myriad of other inflammatory processes that lead to a spectrum of diseases from allergic bronchopulmonary mycosis to chronic rhinosinusitis. Historically, these diseases have been managed primarily with corticosteroids but recent revelations in the molecular pathophysiology provide opportunities for more diverse treatment options for patients with uncontrolled disease.
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Affiliation(s)
- Brian H Cameron
- Department of Otorhinolaryngology - Head and Neck Surgery, McGovern Medical School at the University of Texas Health Science Center, 6431 Fannin Street, MSB 5.036, Houston, TX, USA
| | - Shaina W Gong
- Department of Otorhinolaryngology - Head and Neck Surgery, McGovern Medical School at the University of Texas Health Science Center, 6431 Fannin Street, MSB 5.036, Houston, TX, USA
| | - David B Corry
- Department of Medicine, Biology of Inflammation Center, Baylor College of Medicine, One Baylor Plaza, Houston, 77030 TX, USA
| | - Amber U Luong
- Department of Otorhinolaryngology - Head and Neck Surgery, McGovern Medical School at the University of Texas Health Science Center, 6431 Fannin Street, MSB 5.036, Houston, TX, USA; Center for Immunology and Autoimmune Diseases, Institute of Molecular Medicine, 1835 Pressler, Houston, TX, 77030 USA.
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2
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Kim J, Zaitchik B, Waugh D. How Does Climate Change Affect the Upper Airway? Otolaryngol Clin North Am 2024; 57:309-317. [PMID: 37923592 DOI: 10.1016/j.otc.2023.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2023]
Abstract
There is mounting evidence that climate change is having a significant influence on exacerbations of airway disease. We herein explore the physical factors of carbon dioxide, temperature increases, and humidity on intensifying allergen and fungal growth, and worsening air quality. The direct influence of these factors on promoting allergic rhinitis, chronic rhinosinusitis, and allergic fungal rhinosinusitis is reviewed.
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Affiliation(s)
- Jean Kim
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, USA; Department of Medicine, Allergy and Clinical Immunology, Johns Hopkins University School of Medicine, Baltimore, USA.
| | - Benjamin Zaitchik
- Department of Earth and Planetary Sciences, Kennedy Krieger School of Arts and Sciences, Johns Hopkins University, 3400 N Charles Street, Olin Hall 301, Baltimore, MD 21218, USA
| | - Darryn Waugh
- Department of Earth and Planetary Sciences, Kennedy Krieger School of Arts and Sciences, Johns Hopkins University, 3400 N Charles Street, Olin Hall 320, Baltimore, MD 21218, USA
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3
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Abstract
Allergy and asthma prevalence vary across different subsets of chronic rhinosinusitis with nasal polyposis. In this article, the authors investigate the management of allergy and asthma within populations of patients with aspirin-exacerbated respiratory disease, allergic fungal rhinosinusitis, and central compartment atopic disease. Topical steroids, nasal rinses, and endoscopic sinus surgery are frequently employed in the management of nasal polyposis. Further, other causes of upper and lower airway inflammation like allergy and asthma should be considered in the overall treatment plan in order to optimize outcomes.
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Affiliation(s)
- Kody G Bolk
- Department of Otolaryngology-Head and Neck Surgery, Emory University Hospital Midtown, 550 Peachtree Street NE, MOT Suite 1135, Atlanta, GA 30308, USA.
| | - Thomas S Edwards
- Department of Otolaryngology-Head and Neck Surgery, Emory University Hospital Midtown, 550 Peachtree Street NE, MOT Suite 1135, Atlanta, GA 30308, USA
| | - Sarah K Wise
- Department of Otolaryngology-Head and Neck Surgery, Emory University Hospital Midtown, 550 Peachtree Street NE, MOT Suite 1135, Atlanta, GA 30308, USA
| | - John M DelGaudio
- Department of Otolaryngology-Head and Neck Surgery, Emory University Hospital Midtown, 550 Peachtree Street NE, MOT Suite 1135, Atlanta, GA 30308, USA
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Marglani OA, Simsim RF. Emerging Therapies in the Medical Management of Allergic Fungal Rhinosinusitis. Indian J Otolaryngol Head Neck Surg 2024; 76:277-287. [PMID: 38440667 PMCID: PMC10909043 DOI: 10.1007/s12070-023-04143-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 08/16/2023] [Indexed: 03/06/2024] Open
Abstract
A non-invasive type of chronic sinusitis named allergic fungal rhinosinusitis (AFRS), which is a variant of allergic bronchopulmonary aspergillosis with nasal obstruction, was first described in 1976. The goal of this article was to provide an overview of various treatment approaches and how they can be used to control AFRS. Since this is an inflammatory disease rather than an invasive fungal infection, the treatment tries to modulate inflammation and reduce disease burden. A comprehensive treatment strategy must incorporate medicinal, surgical, biological, and immunological techniques. Owing to the chronic nature of allergic fungal rhinosinusitis and its high propensity for flare-ups and recurrence, multiple procedures are frequently required. The most likely method of establishing a long-term disease control for AFRS is a comprehensive management strategy that integrates medical, surgical, and immunological care. However, there are still disagreements regarding the exact combinations. In this review, we have mentioned different modalities in the management of AFRS, such as monoclonal antibodies, probiotic Manuka honey, and aPDT among others, some of which are promising but require further research.
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Affiliation(s)
- Osama A. Marglani
- Department of Otolaryngology-Head and Neck Surgery, Faculty of Medicine, Umm Al-Qura University, Mecca, Saudi Arabia
| | - Rehab F. Simsim
- Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia
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Kokoszka M, Stryjewska-Makuch G, Kantczak A, Górny D, Glück J. Allergic Fungal Rhinosinusitis in Europe: Literature Review and Own Experience. Int Arch Allergy Immunol 2023; 184:856-865. [PMID: 37536291 DOI: 10.1159/000531017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 04/27/2023] [Indexed: 08/05/2023] Open
Abstract
Allergic fungal rhinosinusitis (AFRS) is primary, Th2-mediated, chronic rhinosinusitis, which is diagnosed when the criteria defined by Bent and Khun are met. The disease is most common in countries located in the subtropical and tropical regions characterized by high temperatures and high levels of humidity, which favour the wider occurrence of fungi in the environment. The presence of specific IgE antibodies directed against fungal allergens, which is one of the diagnostic criteria, proves the systemic nature of the disease and allows one to distinguish AFRS from eosinophilic fungal rhinosinusitis. There is no unified treatment method for AFRS described in the literature, and relapses are common. Sinus surgery remains the treatment of choice. Oral and topical steroid therapy plays an important role in the treatment process. The effectiveness of antifungal treatment and immunotherapy is unclear. Biological treatment, the results of which are promising, has raised great hopes. The aim of this study was to reveal how often AFRS occurs in European countries, what environmental factors influence its development, and how important it is to specify its diagnostic criteria and treatment methods. We present an overview of the available literature. In addition, we share our own experience and describe two cases of AFRS diagnosed and treated at our centre.
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Affiliation(s)
- Magdalena Kokoszka
- Department of Paediatric Otolaryngology, Head and Neck Surgery, Department of Paediatric Surgery, Upper Silesian Child Health Centre, School of Medicine in Katowice, Medical University of Silesia in Katowice, Katowice, Poland
| | - Grażyna Stryjewska-Makuch
- Department of Laryngology and Laryngological Oncology, Leszek Giec Upper-Silesian Medical Centre of the Silesian Medical University, Katowice, Poland
| | - Ada Kantczak
- Department of Paediatric Otolaryngology, Head and Neck Surgery, Department of Paediatric Surgery, Upper Silesian Child Health Centre, School of Medicine in Katowice, Medical University of Silesia in Katowice, Katowice, Poland
| | - Dorota Górny
- Department of Paediatric Otolaryngology, Head and Neck Surgery, Department of Paediatric Surgery, Upper Silesian Child Health Centre, School of Medicine in Katowice, Medical University of Silesia in Katowice, Katowice, Poland
| | - Joanna Glück
- Chair and Clinical Department of Internal Diseases, Allergology and Clinical Immunology in Katowice, Medical University of Silesia, Katowice, Poland
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Roboubi A, Audousset C, Fréalle É, Brun AL, Laurent F, Vitte J, Mortuaire G, Lefevre G, Cadranel J, Chenivesse C. Allergic bronchopulmonary aspergillosis: A multidisciplinary review. J Mycol Med 2023; 33:101392. [PMID: 37172543 DOI: 10.1016/j.mycmed.2023.101392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 04/20/2023] [Accepted: 05/02/2023] [Indexed: 05/15/2023]
Abstract
Allergic bronchopulmonary aspergillosis (ABPA) is a rare disease characterized by a complex allergic inflammatory reaction of airways against Aspergillus affecting patients with chronic respiratory diseases (asthma, cystic fibrosis). Exacerbation is often the way to diagnose ABPA and marks its evolution by its recurrent character leading to cortico-requirement or long-term antifungal treatment. Early diagnosis allows treatment of ABPA at an initial stage, preventing recurrence of exacerbations and long-term complications, mainly represented by bronchiectasis. This review of the literature aims to present the current state of the art in terms of diagnosis and treatment of ABPA from a multidisciplinary perspective. As there is no clinical, biological nor radiological specific sign, diagnostic criteria are regularly revised. They are mainly based on the elevation of total and specific IgE against Aspergillus fumigatus and the presence of suggestive CT abnormalities such as mucoid impaction and consolidations. ABPA management includes eviction of mold and pharmacological therapy. Exacerbations are treated in first line with a moderate dose of oral corticosteroids. Azole antifungal agents represent an alternative for the treatment of exacerbations and are the preferential strategy to reduce the future risk of exacerbations and for corticosteroids sparing. Asthma biologics may be of interest; however, their place remains to be determined. Avoiding complications of ABPA while limiting the side effects of systemic drugs remains a major challenge of ABPA management. Several drugs, including new antifungals and asthma biologics, are currently being tested and may be useful in the future.
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Affiliation(s)
| | - Camille Audousset
- CHU Lille, Univ. Lille, CNRS, Inserm, Institut Pasteur de Lille, U1019-UMR9017-CIIL-Centre d'Infection et d'Immunité de Lille, Lille, France
| | - Émilie Fréalle
- CHU Lille, Laboratoire de Parasitologie-Mycologie, Univ. Lille, ULR 4515-LGCgE, Laboratoire de Génie Civil et Géo-Environnement, Lille F-59000, France
| | - Anne-Laure Brun
- Hôpital Foch, Service de radiologie diagnostique et interventionnelle, Suresnes, France
| | - François Laurent
- Université de Bordeaux, Centre de recherche Cardio-Thoracique de Bordeaux, INSERM U1045, CIC1401, CHU de Bordeaux, Pessac, France
| | - Joana Vitte
- Aix-Marseille Univ, MEPHI, Marseille, France; IHU Méditerranée Infection, Marseille, France; Desbrest Institute of Epidemiology and Public Health IDESP, Univ Montpellier, INSERM UA 11, Montpellier, France
| | - Geoffrey Mortuaire
- CHU de Lille, Service d'ORL et de chirurgie cervico-faciale, Lille 59000, France; Université de Lille, Inserm, CHU de Lille, U1286, INFINITE-Institute for translational research in inflammation, Lille 59000, France
| | - Guillaume Lefevre
- Univ Lille, U1286 INFINITE - Lille Inflammation Research International Center, CHU Lille, Lille, France
| | - Jacques Cadranel
- Sorbonne Université, APHP-Hopital Tenon, GRC04 Theranoscan Sorbonne Université, Paris, France
| | - Cécile Chenivesse
- Univ. Lille, CHU Lille, CNRS, Inserm, Institut Pasteur de Lille, U1019-UMR9017-CIIL-Centre d'Infection et d'Immunité de Lille, Lille, France; CRISALIS (Clinical Research Initiative in Severe Asthma: a Lever for Innovation & Science), F-CRIN Network, INSERM US015, Toulouse, France.
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Singh A, Subash A, Kumari N, Virk RS. Allergic Fungal Otomastoiditis: A Case Report and Review of Literature. Indian J Otolaryngol Head Neck Surg 2022; 74:3687-3691. [PMID: 36742909 PMCID: PMC9895534 DOI: 10.1007/s12070-020-02318-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 12/08/2020] [Indexed: 02/07/2023] Open
Abstract
Allergic fungal otomastoiditis, a rare known entity has only been published as case reports in literature. There have been 3 cases of adult and 1 case of pediatric allergic fungal otomastoiditis reported as of now. A young male had unilateral otorrhea and hearing difficulty for four years. The audiogram revealed moderate conductive hearing loss and radiograph showed complete opacification of tympanic cavity. He underwent tympano-mastoidectomy, showing polypoidal granulations and thick mucoid discharge. The histopathology was a surprise diagnosis of Allergic fungal otomastoiditis. The clinical and histopathological appearance of this entity matches allergic fungal rhinosinusitis. After extensive review of literature, we propose a working criterion for early identification of allergic fungal otomastoiditis in otolaryngology setting.
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Affiliation(s)
- Abhijeet Singh
- Department of Otolaryngology Head and Neck Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Anand Subash
- Department of Otolaryngology Head and Neck Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Neha Kumari
- Department of Pathology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Ramandeep Singh Virk
- Department of Otolaryngology Head and Neck Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Lumyongsatien J, Cheunsuchon P, Boonyaarunnate T. Allergic fungal rhinosinusitis presented as a unilateral nasal mass: A first case report from Thailand and literature review. Ann Med Surg (Lond) 2022; 84:104855. [PMID: 36582897 PMCID: PMC9793241 DOI: 10.1016/j.amsu.2022.104855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 09/29/2022] [Accepted: 10/30/2022] [Indexed: 11/08/2022] Open
Abstract
Background Allergic fungal rhinosinusitis (AFRS) is a relatively new inflammatory sinonasal disease. Prevalence of the disease is reported to be highly different across Asia. Case presentation A 23-year-old Thai male came to our hospital with left-sided nasal obstruction. Endoscopic examination found a mass originated from the left sphenoethmoidal recess. Incisional biopsy result of the mass indicated an inflammatory process and high level of serum specific IgE to several aeroallergens was found. Based on the biopsy results and other investigations, the diagnosis of AFRS was made and the patient was treated successfully with endoscopic sinus surgery and postoperative systemic/topical steroids. Discussion While AFRS is quite common in some regions, the disease is rarely encountered in Thailand and can be presented as a unilateral lesion, mimicking a tumor mass, which could lead to an incorrect diagnosis and inappropriate treatment. Conclusion Even though AFRS is rarely reported in our country, it still can be found and might be recognized falsely as a neoplastic process. High level of awareness of the disease features could help to minimize inappropriate disease management.
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Affiliation(s)
- Jate Lumyongsatien
- Department of Otorhinolaryngology - Head and Neck Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Thailand,Corresponding author. Department of Otorhinolaryngology - Head and Neck Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Rd, Bangkok Noi, Bangkok, 10700, Thailand.
| | - Pornsuk Cheunsuchon
- Department of Pathology, Faculty of Medicine Siriraj Hospital, Mahidol University, Thailand
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Bracanovic D, Janovic A, Antic S, Rajkovic K, Bracanovic M, Tomic Spiric V, Dragutinovic N, Jadzic J, Barac A. "CT and CT image-based texture image analysis in radiological diagnostics of allergic fungal rhinosinusitis". Mycoses 2022; 65:551-559. [PMID: 35293035 DOI: 10.1111/myc.13438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2021] [Revised: 03/03/2022] [Accepted: 03/04/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND This prospective study is focused on evaluating radiological properties of AFRS. We analysed specific CT features related to the presence of AFRS, as well as explored the possible usefulness of the texture image analysis (TIA) as an additional diagnostical parameter. METHODS The CT images of maxillary sinuses of 37 adult patients diagnosed with chronic rhinosinusitis were analysed for homogeneity, high-attenuation areas, density of the soft tissue mass, bony wall thickness and density. TIA included assessment of uniformity, contrast, homogeneity, and entropy of sinus contetnt. RESULTS In the F+ group soft tissue mass was significantly more non-homogeneous, high-attenuation areas were more prevalent, while soft tissue densities were higher. The sinus wall showed a tendency toward decreased thickness and significantly higher density in the F+ group. Among TIA parameters only homogeneity was significantly lower in the F+ group. CONCLUSIONS Presence of fungi should be suspected when the sinus is filled with a non-homogenous soft tissue content of a high CT density not necessarily presented as clearly visible hyperattenuation material. Additional criteria in radiological diagnostics of AFRS should encompass assessment of sinus bony wall density. TIA may serve as a tool for quantitative assessment of subjective CT features such as homogeneity of the soft tissue mass for investigative purposes. However, other TIA parameters showed limited potential.
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Affiliation(s)
- Djurdja Bracanovic
- Department of Diagnostic Radiology, Faculty of Dental Medicine, University of Belgrade, 6 Rankeova, 11 000, Belgrade, Serbia
| | - Aleksa Janovic
- Department of Diagnostic Radiology, Faculty of Dental Medicine, University of Belgrade, 6 Rankeova, 11 000, Belgrade, Serbia
| | - Svetlana Antic
- Department of Diagnostic Radiology, Faculty of Dental Medicine, University of Belgrade, 6 Rankeova, 11 000, Belgrade, Serbia
| | - Katarina Rajkovic
- High Technical and Technological School for Professional Studies, Krusevac, Serbia
| | - Milos Bracanovic
- Clinic for emergency surgery, Clinical Center of Serbia, 2 Pasterova, 11 000, Belgrade, Serbia
| | - Vesna Tomic Spiric
- Clinic for Allergology and Immunology, Clinical Center of Serbia, 26 dr Koste Todorovica, 11 000, Belgrade, Serbia
| | - Natasa Dragutinovic
- Department of Gastroenterology, Hepatology and GI Endoscopy, University Children's Hospital, Serbia
| | - Jelena Jadzic
- Laboratory for Anthropology, Institute for Anatomy, Faculty of Medicine, University of Belgrade, Dr. Subotica no. 4/2, Belgrade, Serbia
| | - Aleksandra Barac
- Clinic for Infectious and Tropical Diseases, Clinical Center of Serbia, 16 Bulevar Oslobodjenja, 11 000, Belgrade, Serbia
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Al-Qahtani K, Altamimi FN, Al-Harbi MH, Islam T, Al-Zendi NA, Aldajani NF. The Evaluation of the Sensitivity and Specificity of a New Endoscopic Diagnostic Sign of Allergic Fungal Rhinosinusitis: Intrapolypoidal White Particles. J Maxillofac Oral Surg 2021; 20:612-618. [PMID: 34776694 DOI: 10.1007/s12663-020-01357-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2019] [Accepted: 03/25/2020] [Indexed: 10/24/2022] Open
Abstract
Purpose The diagnostic criteria of allergic fungal rhinosinusitis focus on characteristic clinical, radiographic, histopathologic findings and immunologic characteristics of the disease. None of these are useful for a prompt outpatient diagnosis of the condition. No clear endoscopic signs (pathognomonic) of polyps in allergic fungal rhinosinusitis are mentioned in the literature. Objective The objective of this study is to describe and evaluate the sensitivity and specificity of an endoscopic sign the intrapolypoidal white particles for the diagnosis of allergic fungal rhinosinusitis in outpatient setting. Methodology In a descriptive, cross-sectional study, 46 chronic rhinosinusitis patients were examined by endoscope in the outpatient clinic. The endoscopic images of the nasal polypi were captured preoperatively. During endoscopic surgery, a sample of nasal polypi was taken for fungal staining and culture. Results of histopathology were compared to the impression of rhinologist on the images of nasal polypi captured preoperatively. Results The most common endoscopic features were the expansion of sinus (24, 52.2%) and intrapolypoidal white particles (50%). Intrapolypoidal white particles were calculated to have 85.71% sensitivity, 65.63% specificity, 52.17% positive predictive value, 91.3% negative predictive value and 71.74% diagnostic accuracy. Conclusion This study offers a new endoscopic sign, intrapolypoidal white particles for diagnosing allergic fungal rhinosinusitis.
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Affiliation(s)
- Khalid Al-Qahtani
- Deparment of Otolaryngology-Head and Neck Surgery, College of Medicine, King Abdul Aziz University Hospital, King Saud University, PO Box No-245, Riyadh, 11411 Kingdom of Saudi Arabia
| | - Fahad Nasser Altamimi
- Deparment of Otolaryngology-Head and Neck Surgery, College of Medicine, King Abdul Aziz University Hospital, King Saud University, PO Box No-245, Riyadh, 11411 Kingdom of Saudi Arabia.,Deparment of Otolaryngology-Head and Neck Surgery, King Saud Medical City, Riyadh, Kingdom of Saudi Arabia
| | - Mohammed Humaidan Al-Harbi
- Department of Otolaryngology-Head & Neck Surgery, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Tahera Islam
- College of Medicine and Research Center, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Nouf Abdulkalq Al-Zendi
- Deparment of Otolaryngology-Head and Neck Surgery, College of Medicine, King Abdul Aziz University Hospital, King Saud University, PO Box No-245, Riyadh, 11411 Kingdom of Saudi Arabia
| | - Nader Fajhan Aldajani
- Department of Otolaryngology-Head & Neck Surgery, King Fahad Medical City, Riyadh, Saudi Arabia
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Alotaibi NH, Aljasser LA, Arnaout RK, Alsomaili S. A case report of allergic fungal rhinosinusitis managed with Dupilumab. Int J Surg Case Rep 2021; 88:106479. [PMID: 34688069 PMCID: PMC8536527 DOI: 10.1016/j.ijscr.2021.106479] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 10/01/2021] [Accepted: 10/03/2021] [Indexed: 12/02/2022] Open
Abstract
Introduction Allergic fungal rhinosinusitis (AFRS) is a subtype of chronic rhinosinusitis with nasal polyps. It is characterized by eosinophilic mucin, which results from an inflammatory reaction to non-invasive fungal hyphae in the rhino-sinuses. It is clinically recognizable due to the criteria set by Bent and Kuhn. The treatment approach is multimodal, and the main treatment approach is surgical debridement, followed by a course of oral and/or topical corticosteroids to decrease recurrence post-surgery. This case report aims to illustrate the effect of Dupilumab, on the number of relapse episodes in a patient and the associated parameters. Case presentation Herein we report a case of a 40-year-old woman referred to our institution as a case of refractory AFRS for which she underwent four functional endoscopic sinus surgeries (FESS) and was on maximum medical treatment. She presented with complaints of facial fullness and pain, headache, and purulent discharge. After another trial of surgery which did not control her symptoms, she was assessed for criteria to start biological treatment. The symptoms were successfully controlled after initiation of the agent, and she was followed up using multiple subjective and objective measures. Conclusion AFRS is a non-invasive immune-mediated sub-clinical entity of chronic rhinosinusitis. A multimodal approach to its treatment based on surgical debridement with medical therapy has shown positive outcomes. In this case we present significant improvement after administering Dupilumab; therefore, suggesting its addition to the treatment regimen of refractory AFRS. Allergic fungal rhinosinusitis is a subtype of chronic rhinosinusitis with nasal polyps. The distinguishing feature of allergic fungal rhinosinusitis is high immunoglobulin E. Multimodal approach with the mainstay being surgery is the treatment method followed for allergic fungal rhinosinusitis.
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Affiliation(s)
- Naif H Alotaibi
- Department of Otolaryngology-Head & Neck, King Faisal Specialist Hospital and Research Center (KFSH&RC), Riyadh, Saudi Arabia; Department of Surgery, College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | | | - Rand K Arnaout
- Section of Allergy/Immunology, Department of Medicine, King Faisal Specialist Hospital and Research Center (KFSHR&RC), Riyadh, Saudi Arabia; Department of Medicine, College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Safia Alsomaili
- Section of Allergy/Immunology, Department of Medicine, King Faisal Specialist Hospital and Research Center (KFSHR&RC), Riyadh, Saudi Arabia
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12
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Widhiono DF, Sutikno B. A rare case of allergic fungal rhinosinusitis in Indonesian elderly: A case report and diagnostic procedure. Ann Med Surg (Lond) 2021; 66:102400. [PMID: 34113441 PMCID: PMC8170073 DOI: 10.1016/j.amsu.2021.102400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 05/06/2021] [Accepted: 05/11/2021] [Indexed: 11/29/2022] Open
Abstract
Background Allergic fungal rhinosinusitis (AFRS) is a rare case. Case presentation A 63-year-old-man presented right nasal congestion one year ago. There was a polyp in the right nasal cavity supported CTScan showed a solid mass with central hyperattenuating of ±8.4 × 2.4 × 4.4 cm. Total IgE value was 1,227 IU/ml, while Aspergillus specific IgE and Mucorous specific IgE using the micro-Elisa technique were negative or less than 0.35 IU/ml. The skin prick test was positive on exposure to house dust, cotton, chicken meat, and cow's milk. Mucosal polypoid and allergic mucin were found during functional endoscopic sinus surgery (FESS). Histopathology showed inflammatory cells of eosinophils. Discussion These results lead to a diagnosis of AFRS according to the Bent and Kuhn criteria. The highest incidence rate is in adolescents and young adults but it occurs in the elderly. So, some of the signs and symptoms of AFRS in adolescents and young adults do not appear. Conclusion AFRS can only be diagnosed during FESS when mucins are found, this case appear in the elderly to be very interesting. •Allergic Fungal Rhinosinusitis (AFRS) is a rare case in otorhinolaryngology. •Diagnosis of AFRS can only be obtained during functional endoscopy sinus surgery (FESS). •Hypersensitivity type 1, polyp nasi, typical CT Scan finding, and mucin during FESS were found.
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Affiliation(s)
- Drean Ferrys Widhiono
- Department of Otorhinolaryngology Head and Neck Surgery, Faculty of Medicine, Universitas Airlangga - Dr. Soetomo General Academic Hospital, Surabaya, Indonesia
| | - Budi Sutikno
- Department of Otorhinolaryngology Head and Neck Surgery, Faculty of Medicine, Universitas Airlangga - Dr. Soetomo General Academic Hospital, Surabaya, Indonesia
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Didehdar M, Khoshbayan A, Vesal S, Darban-Sarokhalil D, Razavi S, Chegini Z, Shariati A. An overview of possible pathogenesis mechanisms of Alternaria alternata in chronic rhinosinusitis and nasal polyposis. Microb Pathog 2021; 155:104905. [PMID: 33930423 DOI: 10.1016/j.micpath.2021.104905] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 04/16/2021] [Accepted: 04/16/2021] [Indexed: 01/23/2023]
Abstract
Chronic Rhinosinusitis (CRS) is a multifactorial disease, and different etiologies like metabolism and immunity disorders, bacterial superantigens, biofilms, and fungal allergens are known to develop this disease, especially the CRS with nasal polyps. Alternaria alternata (Alternaria) is one of the most prevalent airborne fungal species in the nasal discharge, which might have vigorous immunologic activities in nasal epithelial cells and play an essential role in the pathogenesis of CRS. Moreover, the interaction between this fungus and the innate and adaptive immune systems leads to the development of chronic inflammation. This inflammation may consequently instigate the CRS and nasal polyposis. The attenuation of surfactant protein synthesis or intracellular reserves and mucus hypersecretion could prevent the clearance of Alternaria from sinuses and may be correlated with colonization and re-infection of airborne fungi. Furthermore, higher expression of cathelicidin, thymic stromal lymphopoietin, toll-like receptors, and T helper 2-dominant immune responses can result in an IgE-mediated pathway activation and eosinophils degranulation. Moreover, higher local Alternaria-specific IgE was shown to be correlated with eosinophilic cationic proteins and might relate to nasal polyps. However, the role of genetic and environmental factors affecting CRS and nasal polyposis is not well studied. Likewise, further animal and clinical studies are required to better understand the role of Alternaria in CRS disease. The current article reviews the recent findings around the Alternaria-induced CRS and nasal polyposis.
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Affiliation(s)
- Mojtaba Didehdar
- Department of Medical Parasitology and Mycology, Arak University of Medical Sciences, Arak, Iran
| | - Amin Khoshbayan
- Department of Microbiology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Soheil Vesal
- Department of Molecular Genetics, Faculty of Basic Sciences and Advanced Technologies in Biology, University of Science and Culture, Tehran, Iran
| | - Davood Darban-Sarokhalil
- Department of Microbiology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Shabnam Razavi
- Department of Microbiology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran; Microbial Biotechnology Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Zahra Chegini
- Department of Microbiology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Aref Shariati
- Department of Microbiology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran.
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Lisac RR, Garber M, Mirza A, Shah CC. Allergic fungal rhinosinusitis presenting with intracranial spread along large sphenoidal emissary foramen. Med Mycol Case Rep 2021; 32:10-13. [PMID: 33511029 PMCID: PMC7817427 DOI: 10.1016/j.mmcr.2021.01.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Revised: 12/30/2020] [Accepted: 01/03/2021] [Indexed: 11/30/2022] Open
Abstract
Abstract A 13-year-old girl was admitted for headache, right periorbital swelling and erythema. CT imaging demonstrated right orbital preseptal cellulitis, severe pansinusitis and suspected epidural abscess. Brain MRI and sinus CT confirmed an epidural abscess in the right middle cranial fossa and a second extra-cranial abscess in the right infratemporal fossa along with large right sphenoidal emissary foramen. Drainage from sinus surgery confirmed allergic fungal rhinosinusitis. She was treated with prednisone and voriconazole. Allergic fungal rhinosinusitis can rarely extend intracranially. Sphenoid emissary foramen can act as a potential communication channel between sphenoid sinus and intracranial compartment. Emissary vein of Vesalius traverses the sphenoidal emissary foramen. Emissary vein of Vesalius connects the pterygoid plexus to the cavernous sinus. Allergic fungal rhinosinusitis generates fibrino-purulent material with “peanut butter” appearance.
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Affiliation(s)
- Robert R Lisac
- University of Florida College of Medicine - Jacksonville, Jacksonville, FL, USA
| | - Matthew Garber
- University of Florida College of Medicine - Jacksonville, Jacksonville, FL, USA
| | - Ayesha Mirza
- University of Florida College of Medicine - Jacksonville, Jacksonville, FL, USA
| | - Chetan C Shah
- University of Florida College of Medicine - Jacksonville, Jacksonville, FL, USA.,Nemours Children's Specialty Care - Jacksonville, Jacksonville, FL, USA.,Wolfson Children's Hospital, Jacksonville, FL, USA.,Mayo Clinic, Jacksonville, FL, USA
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15
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Ueyama M, Mizuno K, Hirose D, Kamei K, Ohta K. A case of allergic fungal rhinosinusitis caused by Schizophyllum commune identified in both patient's nasal sputum and veranda's soil samples. J Infect Chemother 2021; 27:759-65. [PMID: 33388231 DOI: 10.1016/j.jiac.2020.12.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 12/08/2020] [Accepted: 12/15/2020] [Indexed: 11/20/2022]
Abstract
This is a case report of allergic fungal rhinosinusitis caused by Schizophyllum commune (S. commune) identified in a patient's nasal mucus and environmental soil sample using (r)DNA sequencing. Although filamentous basidiomycetes, including S. commune, are known as environmental pathogens causing allergic respiratory diseases worldwide, many patients with infections caused by S. commune have not been correctly diagnosed. Repeated exposures to environmental floating fungi supposedly make an easy sensitization and colonization of fungi in the nasal passages, resulting in the onset of allergic fungal rhinosinusitis due to S. commune in our living environments. This report indicates the importance of reconsidering allergic respiratory diseases associated with our living environments.
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Abstract
Allergic fungal rhinosinusitis (AFRS) represents a subtype of chronic rhinosinusitis with nasal polyposis that exhibits a unique, often striking clinical presentation. Since its initial description more than a quarter century ago, a more sophisticated understanding of the pathophysiology of AFRS has been achieved and significant advancements in improving clinical outcomes made. This review focuses on the latest developments involving the pathophysiology and clinical management of this fascinating disease.
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Affiliation(s)
- Matthew A Tyler
- Department of Otolaryngology-Head and Neck Surgery, University of Minnesota Medical School, 516 Delaware Street Southeast, # 8A, Minneapolis, MN 55455, USA
| | - Amber U Luong
- Department of Otorhinolaryngology-Head & Neck Surgery, McGovern Medical School at the University of Texas Health Science Center, Texas Sinus Institute, 6431 Fannin Street, MSB 5.036, Houston, TX 77030, USA; Center for Immunology and Autoimmune Diseases, Institute of Molecular Medicine, McGovern Medical School at the University of Texas Health Science Center, Houston, TX, USA.
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17
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Brescia G, Franz L, Alessandrini L, Parrino D, Barion U, Marioni G. Prognostic role of blood eosinophil and basophil levels in allergic fungal rhinosinusitis (AFRS). Am J Otolaryngol 2020; 41:102301. [PMID: 31732306 DOI: 10.1016/j.amjoto.2019.102301] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Accepted: 09/09/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE Allergic fungal rhinosinusitis (AFRS) forms a subset of chronic rhinosinusitis with nasal polyps (CRSwNP) that is mainly characterized by eosinophilic nasal polyps, allergic mucin detected in the sinuses at surgery, and specific features on computerized tomography. Which biological markers predict disease recurrence in AFRS is still not clear, and the role of blood inflammatory cells in predicting recurrent polyps after surgery has yet to be investigated. The aim of this study was to newly investigate the prognostic role (in terms of recurrence rate) of preoperative blood eosinophil and basophil levels in AFRS. MATERIALS AND METHODS A consecutive series of 17 adult patients who underwent endoscopic sinus surgery for AFRS was retrospectively assessed. RESULTS Sinonasal polyps recurred in 7 of 17 patients. Considering the whole cohort, a significant positive correlation emerged between blood eosinophil and basophil counts, but not between blood and tissue eosinophil counts. Statistical analysis found significantly higher blood eosinophil and basophil levels in AFRS patients who relapsed than in those who did not. CONCLUSIONS Considering the current difficulty of identifying more effective, personalized approaches to postoperative disease management in AFRS, our preliminary data support the impression that blood eosinophil and basophil levels warrant testing in further prospective and larger (preferably multi-institutional) investigations as part of the preoperative work-up for patients with AFRS in order to administer dedicated postoperative medical treatments for patients at higher risk of relapse.
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18
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Tanveer U, Gul A, Aqil S. Incidence and Recurrence of Allergic Fungal Sinusitis at Tertiary Care Facility. Indian J Otolaryngol Head Neck Surg 2019; 71:1832-1836. [PMID: 31763255 DOI: 10.1007/s12070-017-1218-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2017] [Accepted: 10/03/2017] [Indexed: 11/28/2022] Open
Abstract
To assess the incidence and recurrence of patients of allergic fungal sinusitis after administration of topical steroids for 24 months this is a cross-section study. Total 90 patients diagnosed with nasal pathology were enrolled from January 2011 to December 2015 at Liaquat National Hospital, various sign and symptoms were tabulated. Patients clinical, radiological and histopathological reports were analyzed. Post operative steroid dose and recurrence rate was noted. Post stratification, Chi-square test and Fisher's exact test was applied to see the association between CT Scan and endoscopic findings and recurrence considering P value ≤ 0.05 as significant. Total 90 patients of either sex aged between 12 and 63 years fulfilled the inclusion criteria and were enrolled in the study. The results showed that among all study patients, 53(58.9%) were male and 37(41.1%) were female. Common presenting symptoms included nasal obstruction, nasal discharge & headache followed by proptosis. From 90 cases, 73(81.2%) had chronic rhinosinusitis and 17(18.9%) cases had Aspergillus. Postoperatively patients were given topical steroids and recurrence was seen in twelve (17.8%). All were aspergillus positive. The incidence of AFRS is (17) 18.9% of CRS which is slightly higher as reported in previous literature. Endoscopic finding may differ from CT scan finding. Patients presented with CRS should receive steroids for at least 2 years to prevent recurrence.
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Affiliation(s)
- Uzma Tanveer
- Department of Otolaryngology - Head and Neck Surgery, Liaquat National Hospital and Medical College, National Stadium Road, Karachi, 74800 Pakistan
| | - Amna Gul
- Department of Otolaryngology - Head and Neck Surgery, Liaquat National Hospital and Medical College, National Stadium Road, Karachi, 74800 Pakistan
| | - Shakil Aqil
- Department of Otolaryngology - Head and Neck Surgery, Liaquat National Hospital and Medical College, National Stadium Road, Karachi, 74800 Pakistan
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Cheng KJ, Zhou ML, Liu YC, Zhou SH. Allergic fungal rhinosinusitis accompanied by allergic bronchopulmonary aspergillosis: A case report and literature review. World J Clin Cases 2019; 7:3821-3831. [PMID: 31799310 PMCID: PMC6887612 DOI: 10.12998/wjcc.v7.i22.3821] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 09/30/2019] [Accepted: 10/05/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Concomitant allergic fungal rhinosinusitis (AFRS) and allergic bronchopulmonary aspergillosis (ABPA) are extremely rare, with no more than 20 cases reported in the English literature.
CASE SUMMARY A 52-year-old female patient complained of right-sided nasal obstruction, rhinorrhea, sneezing, epistaxis, and hyposmia for a period of around 5 mo. Nasal examination detected paleness and edema of the nasal mucous membrane and a polyp in the right middle meatus. A computed tomography (CT) scan of the sinuses revealed a ground-glass opacity filling the right maxillary and ethmoid sinuses, along with bone absorption in the medial wall of the right maxillary sinus. Magnetic resonance images were obtained with T1-weighted, T2-weighted, and gadolinium-enhanced T1-weighted sequences. A well-defined mass, located in the right maxillary and ethmoid sinuses and displaying obvious hypointense features, was observed on both T1- and T2-weighted images, with peripheral enhancement on gadolinium-enhanced T1-weighted images. The patient also has a 20-year history of cough and dyspnea. Chest CT revealed columned and cystiform bronchiectasis in the bilateral bronchus, surrounded by a large number of spotted and funicular high-density lesions. The level of serum total IgE was > 5000 kU/L. Serum IgE levels related to house dust and aspergillus showed a positive result, with the values being 3.5 kU/L and 1.2 kU/L. We performed functional endoscopic sinus surgery under local anesthesia. After surgery, topical glucocorticoids and saline irrigation were applied in the nasal cavity until the present time. An oral glucocorticoid (methylprednisolone 16 mg/d) and antifungal agent (itraconazole 200 mg/d) were also used for a period of 4 wk. Montelukast was prescribed at 10 mg/d until the present time. An endoscopic examination showed that the patient was recovering well at 3 mo after surgery.
CONCLUSION Since different specialists treat ABPA and AFRS, their coexistence may be overlooked. AFRS accompanied by ABPA requires surgical therapy combined with medical control to improve the symptoms.
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Affiliation(s)
- Ke-Jia Cheng
- Department of Otolaryngology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310003, Zhejiang Province, China
| | - Min-Li Zhou
- Department of Otolaryngology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310003, Zhejiang Province, China
| | - Yong-Cai Liu
- Department of Otolaryngology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310003, Zhejiang Province, China
| | - Shui-Hong Zhou
- Department of Otolaryngology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310003, Zhejiang Province, China
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20
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Makihara S, Kariya S, Naito T, Matsumoto J, Okano M, Nishizaki K. Low Incidence of Allergic Fungal Rhinosinusitis in Japanese Patients. Clin Med Insights Ear Nose Throat 2019; 12:1179550619870758. [PMID: 31467479 PMCID: PMC6704409 DOI: 10.1177/1179550619870758] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/20/2019] [Accepted: 07/27/2019] [Indexed: 01/06/2023]
Abstract
Background: Allergic fungal rhinosinusitis (AFRS) is a noninvasive fungal disease of the sinuses with a very high recurrence rate. A very small number of Japanese cases have been reported. Material and methods: The subjects were 6 patients with AFRS out of 429 patients who underwent endoscopic sinus surgery at Kagawa Rosai Hospital between December 2011 and November 2017. We retrospectively examined the clinical features and outcomes of these 6 patients. Results: The incidence of AFRS was 1.4% (6/429). Allergic fungal rhinosinusitis was unilateral in 5 cases and bilateral in 1. Computed tomography revealed hyperdense areas representing allergic mucin, but no patient exhibited bone erosion. Magnetic resonance imaging showed hypointense or no signal regions at the locations of allergic mucin. Postoperatively, 1 patient developed recurrence. Because the recurrent patient had no significant symptoms, he refused further surgery and received drug therapy. Preoperative eosinophil counts and total IgE levels were elevated in all patients; postoperatively, both remained high in the patient who developed recurrence. Postoperative treatments included steroid therapy and nasal irrigation. Conclusions: Allergic fungal rhinosinusitis is less prevalent in Japan than in Western nations. Peripheral blood eosinophil and serum IgE values may be used as the biomarkers. Significance: Allergic fungal rhinosinusitis is prone to recurrence. Postoperative treatment including steroid therapy is important in the management of AFRS.
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Affiliation(s)
- Seiichiro Makihara
- Department of Otolaryngology-Head & Neck Surgery, Kagawa Rosai Hospital, Kagawa, Japan
| | - Shin Kariya
- Department of Otolaryngology-Head & Neck Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Tomoyuki Naito
- Department of Otolaryngology-Head & Neck Surgery, Kagawa Rosai Hospital, Kagawa, Japan
| | - Junya Matsumoto
- Department of Otolaryngology-Head & Neck Surgery, Kagawa Rosai Hospital, Kagawa, Japan
| | - Mitsuhiro Okano
- Department of Otolaryngology-Head & Neck Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan.,Department of Otolaryngology, School of Medicine, International University of Health and Welfare, Narita, Japan
| | - Kazunori Nishizaki
- Department of Otolaryngology-Head & Neck Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
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21
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Brescia G, Zanotti C, Parrino D, Barion U, Marioni G. Nasal polyposis pathophysiology: Endotype and phenotype open issues. Am J Otolaryngol 2018; 39:441-444. [PMID: 29550078 DOI: 10.1016/j.amjoto.2018.03.020] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Accepted: 03/06/2018] [Indexed: 11/16/2022]
Abstract
PURPOSE Endotyping chronic rhinosinusitis with nasal polyps (CRSwNP) poses a challenge for rhinologists nowadays. Phenotyping CRSwNP proved inappropriate as an approach to their classification because of their common clinical features. Endotyping, being based on the pathogenic mechanism, provides a precise picture more appropriate for use in clinical practice. Patients' treatment and follow-up can thus be tailored to cope with the degree of aggressiveness of a specific CRSwNP endotype. The aim of this study was to analyze the available information about the main currently accepted endotypes of CRSwNP; furthermore, we reported and commented evidence regarding some clinical conditions associated with nasal polyposis which could be related with new endotypes. MATERIALS AND METHODS Pubmed and Scopus electronic database were searched. The main available studies about CRSwNP endotyping published predominantly in the last 5 years were critically analyzed. RESULTS The pathophysiological features of some asthma-related CRSwNP (allergic fungal rhinosinusitis, aspirin-exacerbated respiratory disease) are quite well understood, including them among known endotypes of CRSwNP. On the other hand, because of their known pathophysiological mechanisms, some well-known diseases associated with aggressive forms of CRSwNP, such as eosinophilic granulomatosis with polyangiitis, primary ciliary dyskinesia and cystic fibrosis, should be investigated as potentially related with CRSwNP endotypes. CONCLUSIONS CRSwNP comprises several inflammatory endotypes defined by different pathogenic mechanisms. These endotypes correlate with the disease's clinical manifestations and behavior. A thorough understanding of CRSwNP endotypes will enable targeted medical therapies and tailored follow-up protocols.
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Affiliation(s)
- Giuseppe Brescia
- Department of Neuroscience DNS, Otolaryngology Section, Padova University, Padova, Italy.
| | - Claudia Zanotti
- Department of Neuroscience DNS, Otolaryngology Section, Padova University, Padova, Italy
| | - Daniela Parrino
- Department of Neuroscience DNS, Otolaryngology Section, Padova University, Padova, Italy
| | - Umberto Barion
- Department of Neuroscience DNS, Otolaryngology Section, Padova University, Padova, Italy
| | - Gino Marioni
- Department of Neuroscience DNS, Otolaryngology Section, Padova University, Padova, Italy
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22
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Verma RK, Patro SK, Francis AA, Panda NK, Chakrabarti A, Singh P. Role of preoperative versus postoperative itraconazole in allergic fungal rhinosinusitis. Med Mycol 2018; 55:614-623. [PMID: 27838640 DOI: 10.1093/mmy/myw125] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2016] [Accepted: 10/27/2016] [Indexed: 01/02/2023] Open
Abstract
Antifungals used as adjuvant to surgery in AFRS (Allergic Fungal Rhinosinusitis) have shown varying success in delaying recurrences. Itraconazole has been used both as preoperative and postoperative adjuvant. This study investigates the role of itraconazole in AFRS and compares its role between preoperative and postoperative administration of the drug. Patients were randomly divided into groups as: Group 1 (n = 25), received 4 weeks itraconazole in the preoperative period and operated subsequently, Group 2 (n = 25), received 4 weeks itraconazole in the postoperative period, Group 3 (n = 50), matched patients of AFRS, who didn't receive itraconazole. All the groups received oral steroids in tapering doses staring from 1 mg/kg for 6 weeks in the postoperative period. Symptomatic (SNOT 20), radiologic (Lund Mackay, LM) scores and endoscopic (Kupferberg's NE Grades) were noted. Primary postoperative follow-up was for 24 weeks with routine CT scans and nasal endoscopies, followed by which all the patients were followed with nasal endoscopies only with CT scans when required. Both preoperative and postoperative itraconazole showed significant improvement in the SNOT, LM, and Kupferberg's grades in the follow-up period. Preoperative itraconazole therapy showed significantly better results compared to postoperative itraconazole therapy though the recurrence rates were similar in both groups. Itraconazole is a better preoperative adjunct in AFRS than postoperative.
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Affiliation(s)
- Roshan K Verma
- Department of Otolaryngology, Head and Neck surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India- 160012
| | - Sourabha K Patro
- Department of Otolaryngology, Head and Neck surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India- 160012
| | - Abhilash Alex Francis
- Department of Otolaryngology, Head and Neck surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India- 160012
| | - Naresh K Panda
- Department of Otolaryngology, Head and Neck surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India- 160012
| | - Arunaloke Chakrabarti
- Department of Medical Microbiology, Post Graduate Institute of Medical Education and Research, Chandigarh, India- 160012
| | - Paramjeet Singh
- Department of Radio diagnosis, Post Graduate Institute of Medical Education and Research, Chandigarh, India- 160012
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AlQahtani A, Alshaikh N, Alzarei A, Musleh A, Alamri A, Alqahtani A, Alfawwaz F, Alshammari F, Aloulah M, Marglani O, Alsaleh S, Alandejani T, Mokarbesh H. Contralateral sinus involvement of surgically treated unilateral allergic fungal rhinosinusitis. Eur Arch Otorhinolaryngol 2017; 274:3097-3101. [PMID: 28501959 DOI: 10.1007/s00405-017-4604-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Accepted: 05/09/2017] [Indexed: 10/19/2022]
Abstract
Recurrence of allergic fungal rhinosinusitis (AFRS) is well recognized. However, there is scarcity in the literature describing involvement of the non-diseased sinuses. We aimed to evaluate the recurrence forms of unilateral AFRS as well as to study the possible predictor factors of developing the disease in the contralateral side. Patients with exclusive unilateral AFRS from (2010 to 2015) were enrolled in multi-institutional case-control study. All patients were evaluated after endoscopic sinus surgery for recurrence. Patient's records were reviewed for demographics, medical treatment, and clinical, radiological, and surgical data. A total of 68 patients were identified. Delayed contralateral involvement after the initial surgery was found in 30.8% with mean duration of recurrence 16.9 months. A significant association was found with the presence of pre-operative contralateral symptoms and signs of inflammation (OR 3.49, 95% CI 1.19-10.22, p value 0.02). Post-operative use of budesonide irrigation was associated with less contralateral involvement (OR 0.11, 95% CI 0.01-0.87, p value 0.01). Association of other variables like: comorbidities, perioperative use of systemic steroid, radiological signs, extent of surgery, additional surgery to the contralateral side, and post-operative use of systemic steroids did not show statistical significance. Involvement of the contralateral sinuses in 30% of unilateral AFRS cases is considered significant. The non-diseased sinuses should be involved in the routine endoscopic examination and post-operative treatment. Further studies are necessary to investigate the possibility of prophylactic surgical intervention of the non-diseased sinuses.
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Affiliation(s)
- Abdulaziz AlQahtani
- Department of Otolaryngology Head and Neck Surgery, Prince Sultan Military Medical City, Riyadh, Saudi Arabia.
| | - N Alshaikh
- Department of Otolaryngology Head and Neck Surgery, Dammam Medical Complex, Dammam, Saudi Arabia
| | - A Alzarei
- Department of Otolaryngology Head and Neck Surgery, King Khalid University, Aseer Central Hospital, Abha, Saudi Arabia
| | - A Musleh
- Department of Otolaryngology Head and Neck Surgery, King Khalid University, Aseer Central Hospital, Abha, Saudi Arabia
| | - A Alamri
- Department of Otolaryngology Head and Neck Surgery, King Salman Hospital, Riyadh, Saudi Arabia
| | - A Alqahtani
- Department of Otolaryngology Head and Neck Surgery, Khamis Mushait General Hospital, Khamis Mushite, Saudi Arabia
| | - F Alfawwaz
- Department of Otolaryngology Head and Neck Surgery, King Fahad Medical City, Riyadh, Saudi Arabia
| | - F Alshammari
- Department of Otolaryngology Head and Neck Surgery, King Khalid Hospital, Hail, Saudi Arabia
| | - M Aloulah
- Department of Otolaryngology Head and Neck Surgery, King Saud University Medical City, King Abdulaziz Hospital, Riyadh, Saudi Arabia
| | - O Marglani
- Department of Otolaryngology Head and Neck Surgery, Umm Al-Qura University, Makkah, Saudi Arabia
| | - S Alsaleh
- Department of Otolaryngology Head and Neck Surgery, King Saud University Medical City, King Abdulaziz Hospital, Riyadh, Saudi Arabia
| | - T Alandejani
- Department of Otolaryngology Head and Neck Surgery, King Saud bin Abdulaziz University for Health Sciences, King Abdulaziz Medical City, Jeddah, Saudi Arabia
| | - H Mokarbesh
- Department of Otolaryngology Head and Neck Surgery, Prince Mohammed bin Naser Hospital, Jazan, Saudi Arabia
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24
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Dai Q, Duan C, Liu Q, Yu H. Effect of nebulized budesonide on decreasing the recurrence of allergic fungal rhinosinusitis. Am J Otolaryngol 2017; 38:321-324. [PMID: 28185668 DOI: 10.1016/j.amjoto.2017.01.034] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Revised: 01/28/2017] [Accepted: 01/31/2017] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate the clinical efficacy and the effects on decreasing the recurrence of AFRS (allergic fungal rhinosinusitis) of a budesonide inhalation suspension delivered via transnasal nebulization to patients following endoscopic sinus surgery. SUBJECTS AND METHODS Thirty-five patients were recruited into this study. Final diagnoses were reached using Bent and Kuhn's criteria. The eligible patients were randomly divided into two groups: the budesonide transnasal nebulization group (group A) and the topical nasal steroids group (group B). Nasal symptoms, Lund-Mackay scores, and Kupferberg grades were evaluated before surgery, after surgery and during the follow-up to assess the effects of these two approaches. RESULTS A total of 30 patients with AFRS who were eligible were included in the study. Four of the 15 patients in group B (26.67%) developed recurrent disease, whereas no patients in group A developed recurrent disease. This difference was statistically significant (p=0.032). CONCLUSION Nebulized budesonide is an effective and safe treatment for patients with AFRS following endoscopic sinus surgery, as evidenced by the reduced recurrence rate observed in the budesonide transnasal nebulization group relative to the topical nasal steroids group.
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25
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Abstract
Allergic fungal sinusitis (AFS) or rhinosinusitis (AFRS) is a form of polypoid chronic rhinosinusitis that is believed to be due to hypersensitivity to fungal antigens. The disease is characterized by type 1 hypersensitivity to fungal allergens, dramatically elevated total serum IgE, accumulation of thick eosinophil-laden mucin with non-invasive fungal hyphae within the paranasal sinuses, nasal polyposis, and sinus bony remodeling. Because of many clinicopathologic similarities to allergic bronchopulmonary aspergillosis (ABPA), these conditions can be considered analogous examples of disease in the unified airway. However, these conditions rarely occur together and their treatment differs. The treatment of AFRS relies upon surgical removal of fungal hyphae in eosinophilic mucin, while antifungal therapy is used to clear fungi from the airways in ABPA. Several uncontrolled studies suggest there may be some benefit to antifungal agents in AFRS, but randomized trials of topical and systemic antifungal therapies have not shown beneficial results in chronic rhinosinusitis (CRS). Antifungal treatment within the sinonasal cavities does not appear to be an effective approach for most chronic sinusitis, and antifungal therapy for AFRS is unproven.
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Abstract
Fungal rhinosinusitis (FRS) comprises a spectrum of disease processes that vary in clinical presentation, histologic appearances, and biological significance. FRS can be acute or chronic and is most commonly classified as non-invasive or invasive based on whether fungi have invaded into tissue. This manuscript will review the pathologic classification of FRS.
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Patro SK, Verma RK, Panda NK, Chakrabarti A. Understanding paediatric allergic fungal sinusitis: Is it more aggressive? Int J Pediatr Otorhinolaryngol 2015; 79:1876-80. [PMID: 26363894 DOI: 10.1016/j.ijporl.2015.08.032] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Revised: 08/20/2015] [Accepted: 08/21/2015] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To study and characterize the features of AFRS in children as compared to adults. METHODS 50 consecutive patients of AFRS attending our outpatient department were included in the study from July 2011 to December 2013. They were divided into two groups (A and B) according to age being ≤14 years and >14 years. Clinical history and examination included anterior rhinoscopy, SNOT 20 scores, CT of Nose and PNS (para nasal sinuses) (Lund Mackay scores), diagnostic nasal endoscopy (Kupferberg's grades), punch biopsy from nasal polyp, serum IgE, absolute eosinophil counts (AEC) and Aspergillus skin hypersensitivity test was done in all patients for conformation of AFRS. Bent and Kuhn's criteria were used for diagnosis. Sweat chloride levels were done in all patients of group A. RESULTS Group A had 12 patients and group B had 38. Mean duration of symptoms was significantly less in children as compared to adults (p<0.05). All patients of both groups had nasal polyposis at presentation. Unilateral disease and multisinus involvement was more common in children (6/12) as compared to adults. Proptosis (2/12) and telecanthus (4/12) was more common in children (group A) as compared to adults (group B). LM (Lund Mackay) scores and serum IgE were significantly high in children as compared to adults. Follow up CT scans showed early evidence of recurrence in children as compared to adults (p<0.05). CONCLUSION AFRS was seen to be more aggressive in children with increased fungal load when compared with adults. Typically, AFRS in children was less responsive to treatment with increased recurrence rates.
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Affiliation(s)
- Sourabha K Patro
- Department of Otolaryngology, Head and Neck Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Roshan K Verma
- Department of Otolaryngology, Head and Neck Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India.
| | - Naresh K Panda
- Department of Otolaryngology, Head and Neck Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Arunaloke Chakrabarti
- Department of Microbiology, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India
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Tsukatani T, Ogawa H, Anzawa K, Kobayashi E, Hasegawa H, Makimura K, Yoshizaki T, Ueda N. Schizophyllum commune-induced allergic fungal rhinosinusitis and sinobronchial mycosis. Med Mycol Case Rep 2015; 8:10-3. [PMID: 25756007 PMCID: PMC4348453 DOI: 10.1016/j.mmcr.2015.02.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2014] [Revised: 02/09/2015] [Accepted: 02/23/2015] [Indexed: 12/28/2022] Open
Abstract
We present 32- and 38-year-old males with Schizophyllum commune-induced allergic fungal rhinosinusitis (AFRS). S. commune-induced AFRS was diagnosed by clinical and radiographic findings, positive specific IgE antibodies against S. commune as measured by the ImmunoCAP system, and sequencing analysis of the fungus. Our two cases with S. commune-induced AFRS for the first time showed evidence for type 1 hypersensitivity to S. commune as determined by using specific IgE antibodies against S. commune, and the fungus was identified by sequence analysis.
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Affiliation(s)
- Toshiaki Tsukatani
- Department of Otorhinolaryngology, Public Central Hospital of Matto Ishikawa, Hakusan, Ishikawa 924-8588, Japan
| | - Haruhiko Ogawa
- Division of Pulmonary Medicine, Ishikawa-ken Saiseikai Kanazawa Hospital, Kanazawa, Ishikawa, Japan
| | - Kazushi Anzawa
- Division of Dermatomycology (Novartis Pharma), Medical Research Institute, Kanazawa Medical University, Uchinada, Ishikawa, Japan
| | - Eiji Kobayashi
- Department of Otorhinolaryngology, Public Central Hospital of Matto Ishikawa, Hakusan, Ishikawa 924-8588, Japan
| | - Hiroki Hasegawa
- Department of Otorhinolaryngology, Public Central Hospital of Matto Ishikawa, Hakusan, Ishikawa 924-8588, Japan
| | - Koichi Makimura
- Laboratory of Space and Environmental Medicine, Teikyo University, Hachioji, Tokyo, Japan
| | - Tomokazu Yoshizaki
- Department of Otorhinolaryngology, Head and Neck Surgery, Kanazawa University, Kanazawa, Ishikawa, Japan
| | - Norishi Ueda
- Department of Pediatrics, Public Central Hospital of Matto Ishikawa, Hakusan, Ishikawa, Japan
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Agarwal K, Kathuria S, Sundar G, Singh P, Khanna G, Chowdhary A. A case of allergic fungal rhinosinusitis due to Ceratocystis adiposa. Diagn Microbiol Infect Dis 2013; 78:196-8. [PMID: 24315117 DOI: 10.1016/j.diagmicrobio.2013.10.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2013] [Revised: 10/25/2013] [Accepted: 10/27/2013] [Indexed: 11/19/2022]
Abstract
Ceratocystis adiposa known as phytopathogen of conifers has not been recognized so far as a human pathogen. Herein, we report for the first time a case of allergic fungal rhinosinusitis due to C. adiposa. The fungus was identified by sequencing internal transcribed spacer of rDNA and D1/D2 of larger subunit region.
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Affiliation(s)
- Kshitij Agarwal
- Department of Pulmonary Medicine, Vallabhbhai Patel Chest Institute, University of Delhi, Delhi, India
| | - Shallu Kathuria
- Department of Medical Mycology, Vallabhbhai Patel Chest Institute, University of Delhi, Delhi, India
| | - Gandhi Sundar
- Department of Medical Mycology, Vallabhbhai Patel Chest Institute, University of Delhi, Delhi, India
| | - Prithviraj Singh
- Department of Otorhinolaryngology, Post Graduate Institute of Medical Education and Research and Dr Ram Manohar Lohia Hospital, Guru Gobind Singh Indraprastha University, New Delhi, India
| | - Geetika Khanna
- Department of Pathology, Vardhman Mahavir Medical College and Safdarjung Hospital, Guru Gobind Singh Indraprastha University, New Delhi, India
| | - Anuradha Chowdhary
- Department of Medical Mycology, Vallabhbhai Patel Chest Institute, University of Delhi, Delhi, India.
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Abstract
An uncommon case of allergic fungal rhinosinusitis presented to the ophthalmology outpatient department of our hospital with complaints of blurred vision in the right eye of a few days duration and vague complaints of pain around the eyes. The visual acuity on examination was grossly reduced in the right eye and normal in the left eye. Color vision was normal. Anterior segment examination including pupils was normal. Dilated fundus examination was normal except for temporal pallor in the right optic disc. Automated perimetry and magnetic resonance imaging (MRI) scan of brain and orbit were done. The imaging report showed a bilateral pansinusitis with pressure on the right optic nerve. Perimetry showed a superior field defect on the right side. ENT consultation and computed tomography (CT) with contrast helped to diagnose this as a case of allergic fungal rhinosinusitis. The patient was started on systemic steroids under the care of the ENT surgeon. After a few days, pre-operative assessment showed a gross improvement of visual acuity. Endoscopic sinus surgery was done to remove the polyps and thick mucus material. Histopathologic examination confirmed allergic fungal mucin. Days after surgery, the visual acuity improved further and repeat perimetry showed gross improvement in the visual field. Good history taking and a detailed ophthalmic examination, keeping in mind the probable causes of loss of vision of few days duration with no findings other than a decreased visual acuity and a suspicious disc, were key to the early diagnosis and investigation in this case. This helped in early referral and management of the case before permanent damage and irreversible visual loss occurred. The optic nerve is a cranial nerve which, once damaged permanently, will not regenerate. The amount of sinus involvement was extensive on both sides and invariably the left optic nerve would have been involved in a few days, if intervention was delayed.
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Affiliation(s)
- Jiji Tresa Cyriac
- Department of Ophthalmology, Gulf Medical College Hospital and Research Centre, Gulf Medical University, Ajman, UAE
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