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Treadwell S, Green M, Gowda G, Levetin E, Carlson JC. Fungal Sensitization and Human Allergic Disease. Curr Allergy Asthma Rep 2024:10.1007/s11882-024-01144-y. [PMID: 38575791 DOI: 10.1007/s11882-024-01144-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] [Accepted: 03/19/2024] [Indexed: 04/06/2024]
Abstract
PURPOSE OF THE REVIEW Fungal sensitizations have been associated with hypersensitivity reactions with variable levels of evidence available to link types of fungi with human disease. We conducted systematic reviews of the literature to identify the strength of evidence linking lesser-studied fungi for which there are commercially available extracts to identify populations in which they were useful in clinical practice. RECENT FINDINGS Excluding five fungi for which hundreds of articles were identified, there are 54 articles on the remaining fungi with clinical data. For 12 of the fungi, the prevalence of fungal sensitization varies in different hypersensitivity disorders due to factors related to geographic areas, age, and other underlying medical conditions. There were no studies linking seven genera to human disease. Most of the commercially available fungal extracts are uncommonly associated with hypersensitivity reactions in humans. Specific extracts may be useful in particular disease states such as allergic fungal sinusitis or allergic bronchopulmonary mycosis, or when routine testing fails to identify a cause of uncontrolled disease, such as in asthma.
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Affiliation(s)
- Scout Treadwell
- Tulane University School of Medicine, 1430 Tulane Avenue New, Orleans, LA, 70112, USA
| | - Maxwell Green
- Tulane University School of Medicine, 1430 Tulane Avenue New, Orleans, LA, 70112, USA
| | - Geetha Gowda
- Tulane University School of Medicine, 1430 Tulane Avenue New, Orleans, LA, 70112, USA
| | - Estelle Levetin
- University of Tulsa, 800 S. Tucker Drive, Tulsa, OK, 74104, USA
| | - John C Carlson
- Ochsner Health Center, 1401 Jefferson Hwy, New Orleans, LA, 70121, USA.
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Kim KH, Kim H, Lim SY, Koh IC. Periantral fungal abscess after zygoma reduction: a case report. Arch Craniofac Surg 2023; 24:288-291. [PMID: 38176763 PMCID: PMC10766502 DOI: 10.7181/acfs.2023.00353] [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: 07/06/2023] [Revised: 09/04/2023] [Accepted: 12/18/2023] [Indexed: 01/06/2024] Open
Abstract
This case report describes our treatment of a persistent periantral abscess in a 35-year-old woman. The abscess developed following a zygoma-reduction surgery, during which a preexisting fungal ball had not been addressed. Our comprehensive treatment approach included functional endoscopic sinus surgery, fungal ball removal, abscess drainage, and debridement. Two weeks postoperatively, the patient's symptoms had resolved. A 6-month postoperative follow-up revealed no signs of recurrence or complications, and the patient reported satisfactory functional and aesthetic results. This case underscores the importance of thorough preoperative evaluations and raises awareness about the potential risks of untreated asymptomatic pathologies, which can potentially progress and lead to further complications.
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Affiliation(s)
- Keun Hyung Kim
- Department of Plastic and Reconstructive Surgery, Myunggok Medical Research Center, Konyang University Hospital, Konyang University College of Medicine, Daejeon, Korea
| | - Hoon Kim
- Department of Plastic and Reconstructive Surgery, Myunggok Medical Research Center, Konyang University Hospital, Konyang University College of Medicine, Daejeon, Korea
| | - Soo Yeon Lim
- Department of Plastic and Reconstructive Surgery, Myunggok Medical Research Center, Konyang University Hospital, Konyang University College of Medicine, Daejeon, Korea
| | - In Chang Koh
- Department of Plastic and Reconstructive Surgery, Myunggok Medical Research Center, Konyang University Hospital, Konyang University College of Medicine, Daejeon, Korea
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Dubois A, Simon F, Alanio A, Guillonnet A, Kaci R, Herman P, Lecanu JB, Verillaud B. Allergic fungal rhinosinusitis and eosinophilic mucin chronic rhinosinusitis: Differential diagnostic criteria. A two-center comparative study following STROBE methodology. Eur Ann Otorhinolaryngol Head Neck Dis 2023; 140:267-270. [PMID: 37833161 DOI: 10.1016/j.anorl.2023.10.007] [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: 10/15/2023]
Abstract
OBJECTIVES Allergic fungal rhinosinusitis (AFRS) and eosinophilic mucin chronic rhinosinusitis (EMRS) are two forms of chronic sinusitis distinguished by the presence (AFRS) or absence (EMRS) of fungal elements in sinus mucin. Detection of the fungal elements, however, is complex and it is difficult to say whether EMRS is in fact an entity distinct from AFRS. The aim of the present study, based on a retrospective series of AFRS and EMRS, was to identify the specific clinical and radiological elements distinguishing between the two. MATERIALS AND METHODS A 2-center retrospective observational study following STROBE guidelines included patients managed for AFRS or EMRS between 2009 and 2022. Clinical, mycological, pathologic and radiological data were collected. Type of treatment and disease progression were also analyzed. Intergroup comparison used Student's test for mean values of quantitative variables, with calculation of P-values, and Pearson's Chi2 test or Fisher's exact test for categoric variables, with calculation of relative risk and 95% confidence intervals. RESULTS The AFRS group comprised 41 patients and the EMRS group 34. Demographic data were comparable between groups. EMRS showed a higher rate of asthma (79.4 vs. 31.4%; P<0.001), more severe nasal symptomatology (rhinorrhea, P=0.01; nasal obstruction, P=0.001), and more frequent bilateral involvement (85.3 vs. 58.5%; P=0.021). AFRS showed more frequent complications (19 vs. 0%; P=0.006). Radiologically, mucin accumulation was greater in AFRS, filling the sinus in 84.2% of cases, versus 26.3% (P<0.001), with more frequent sinus wall erosion (19 vs. 5.8%; P=0.073). The recurrence rate was higher in EMRS: 38.2 vs.21.9% (P=0.087). CONCLUSION The present retrospective study found a difference in clinical and radiological presentation between AFRS and EMRS, with EMRS more resembling the presentation of severe nasal polyposis.
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Affiliation(s)
- A Dubois
- Service d'ORL et chirurgie cervico-faciale, hôpital Lariboisière, Assistance publique-Hôpitaux de Paris, Paris, France; Service d'ORL et chirurgie cervico-faciale, institut Arthur-Vernes, Paris, France
| | - F Simon
- Service d'ORL pédiatrique et chirurgie cervico-faciale, hôpital Necker-Enfants Malades, Assistance publique-Hôpitaux de Paris, Paris, France; Université Paris Cité, Paris, France
| | - A Alanio
- Université Paris Cité, Paris, France; Laboratoire de parasitologie-mycologie, groupe hospitalier Saint-Louis-Lariboisière-Fernand-Widal, Assistance publique-Hôpitaux de Paris, Paris, France; Molecular Mycology Unit, CNRS UMR2000, Institut Pasteur, Paris, France; National Reference Center for Invasive Mycoses and Antifungals, Institut Pasteur, Paris, France; IHU Imagine, Paris, France
| | - A Guillonnet
- Service de neuroradiologie diagnostique et interventionnelle, hôpital Lariboisière, Assistance publique-Hôpitaux de Paris, Paris, France
| | - R Kaci
- Service d'anatomopathologie, hôpital Lariboisière, Assistance publique-Hôpitaux de Paris, Paris, France
| | - P Herman
- Service d'ORL et chirurgie cervico-faciale, hôpital Lariboisière, Assistance publique-Hôpitaux de Paris, Paris, France; Université Paris Cité, Paris, France; Inserm U1131, Paris, France
| | - J-B Lecanu
- Service d'ORL et chirurgie cervico-faciale, institut Arthur-Vernes, Paris, France
| | - B Verillaud
- Service d'ORL et chirurgie cervico-faciale, hôpital Lariboisière, Assistance publique-Hôpitaux de Paris, Paris, France; Université Paris Cité, Paris, France; Inserm U1131, Paris, France.
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Abstract
PURPOSE To investigate the different clinical manifestations in Egyptian patients with orbital complications of rhinosinusitis (RS) according to the pathology within the paranasal sinuses. METHODS The medical records of patients presented with chronic RS between August 2018 and December 2020 were retrospectively reviewed. RESULTS This study included 64 patients: 28 patients with subperiosteal abscess (SPA), 10 with allergic fungal RS, 6 with isolated fungal RS, 6 with invasive fungal RS, and 14 with mucocele. The most common manifestation was proptosis, limitation of ocular motility, periorbital swelling, and pain. A relative afferent pupillary defect was present in all cases of invasive fungal sinusitis. Surgical interventions were performed in 63 out of 64 cases. All the ophthalmological manifestations were reversible except for patients with invasive fungal rhinosinusitis. CONCLUSION Orbital complications of RS may require early surgical intervention with multidisciplinary counseling between ophthalmologists, otorhinolaryngologists, radiologists, and neurologists.
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Affiliation(s)
- Dina Tadros
- Department of Ophthalmology, Faculty of Medicine, University of Tanta, Tanta, Egypt
| | - Mohamed O Tomoum
- Department of Otorhinolaryngology, Faculty of Medicine, University of Tanta, Tanta, Egypt
| | - Heba M Shafik
- Department of Ophthalmology, Faculty of Medicine, University of Tanta, Tanta, Egypt
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Raiesi O, Hashemi SJ, Yarahmadi M, Getso MI, Raissi V, Amiri S, Borjian Boroujeni Z. Allergic fungal rhinosinusitis caused by Neoscytalidium dimidiatum: A case report: Allergic fungal rhinosinusitis due to Neoscytalidium dimidiatum. J Mycol Med 2021; 32:101212. [PMID: 34758426 DOI: 10.1016/j.mycmed.2021.101212] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 10/04/2021] [Accepted: 10/08/2021] [Indexed: 11/23/2022]
Abstract
Neoscytalidium dimidiatum is a rare dematiaceous fungus that was first described in 1916 as Dothiorella mangiferae. From the standpoint of epidemiology and therapy, early detection of fungal rhinosinusitis (FRS), the causative agents, and their associated risk factors can improve the therapeutic outcome and decrease the mortality rates among patients. In this study, we report a 34-year-old Iranian female patient with allergic bronchopulmonary aspergillosis (ABPA), who presented to our facility with an 8-year history of chronic fungal sinusitis, drug-resistant asthma, pneumonia, bronchitis, post-nasal discharge, nasal obstruction, nasal polyposis, and anemia. The patient was subjected to diagnostic nasal endoscopy and computed tomography (CT) scan of paranasal sinuses, as well as routine, complementary mycological, and molecular methods, which confirmed the diagnosis of allergic fungal rhinosinusitis in patients with ABPA. Neoscytalidium dimidiatum was isolated from the sinus of the patient. Results of in vitro susceptibility tests indicated that the case isolate was susceptible to amphotericin B and itraconazole at concentrations which are commonly achieved in patients receiving recommended dosages for invasive mycoses (0.25 to 0.75 mg/kg of body weight daily for amphotericin B and 100 to 400 mg daily for itraconazole) and resistant in vitro to caspofungin, voriconazole, and posaconazole. The patient was successfully treated with amphotericin B / itraconazole + postoperative oral corticosteroids (OCS). Neoscytalidium dimidiatum infection should be considered as a possible additional factor in the etiology of AFRS, especially in immunocompromised patients.
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Nair AA, Tooley AA. Eosinophilic mucin chronic rhinosinusitis with orbital involvement: management strategies based on clinical presentation. Indian J Ophthalmol Case Rep 2021; 1:156-158. [PMID: 34661198 PMCID: PMC8516334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Allergic fungal sinusitis (AFS) and eosinophilic mucin chronic rhinosinusitis (EMCRS) are subtypes of a chronic rhinosinusitis with eosinophilia that have different diagnostic criteria but are phenotypically similar. Ophthalmic complications may be the presenting symptoms. Treatment of ophthalmic complications is typically directed at reducing the inflammatory burden in the sinuses and rarely requires direct surgical intervention. However, atypical cases with associated subperiosteal abscess may necessitate orbital surgery. The authors present 2 cases of EMCRS with orbital involvement - one that responded to the traditional treatment of oral corticosteroids and functional endoscopic sinus surgery (FESS), and the other requiring surgical drainage of a subperiosteal abscess in order to describe the management strategies based on clinical presentation.
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Abstract
In recent years, mold has been blamed for many symptoms or a constellation of symptoms. These symptoms are usually vague and subjective and difficult or impossible to measure or quantify. Moreover, there is no scientific evidence that mold has anything to do with these symptoms. In particular, the concept of toxic mold syndrome has permeated the public consciousness, and mycotoxins have falsely been associated with autoimmune diseases and a variety of other conditions. In fact, there is no evidence that the presence of mycotoxins in the air is enough to cause any disease known to man. Molds legitimately can cause allergies and can be a trigger for asthma. Certain specific molds such as Aspergillus can be a cause of hypersensitivity pneumonitis. In immunocompromised hosts, both dermatologic and systemic infections can result from various fungi and can be associated with significant morbidity or even mortality. However, the existence of toxic mold syndrome has been disproven, despite the numerous disreputable practices such as testing homes for mold spores, measuring "mycotoxins" in the urine, and testing patients for IgG to mold. In truth, none of these techniques have been validated, nor do they have any relevance to any clinical disease. All that these tests that are being performed by laboratories of disrepute does is to further propagate misinformation and inflict unnecessary and often exorbitant costs on patients desperate for a clinical diagnosis, right or wrong, for their constellation of maladies.
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Affiliation(s)
- Christopher Chang
- Division of Rheumatology, Allergy and Clinical Immunology, University of California at Davis, Davis, CA, 95616, USA. .,Division of Pediatric Immunology and Allergy, Joe DiMaggio Children's Hospital, Hollywood, FL, 33021, USA.
| | - M Eric Gershwin
- Division of Rheumatology, Allergy and Clinical Immunology, University of California at Davis, Davis, CA, 95616, USA.
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8
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Abstract
Allergic fungal sinusitis (AFS) arises from a host hypersensitivity reaction to fungi residing within the sino-nasal tract. Computed tomography imaging may show heterogenous sinus opacification with bony erosion and expansion into the orbits. With advanced orbital involvement there is a risk of optic neuropathy and irreversible vision loss. We present a patient with AFS who presented with bilateral proptosis and early optic neuropathy. Radiologically, there was evidence of bony erosion and orbital wall compression. Following oral corticosteroids and full-house endoscopic sinus surgery, these changes reversed considerably. This case shows that bony and anatomical orbital changes from AFS are reversible with adequate surgical treatment.
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Affiliation(s)
- Allister Lee
- Department of Ophthalmology, Royal Brisbane and Women's Hospital, Brisbane, Australia.,Department of Otolaryngology, Royal Brisbane and Women's Hospital, Brisbane, Australia.,Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - David Ellul
- Department of Otolaryngology, Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - Jennifer Sommerville
- Faculty of Medicine, University of Queensland, Brisbane, Australia.,Department of Medical Imaging, Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - James Earnshaw
- Department of Otolaryngology, Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - Timothy J Sullivan
- Department of Ophthalmology, Royal Brisbane and Women's Hospital, Brisbane, Australia.,Faculty of Medicine, University of Queensland, Brisbane, Australia
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Althomaly DH, AlMomen AA. Pediatric alternating allergic fungal rhinosinusitis: A case report and literature review. Int J Surg Case Rep 2018; 54:60-62. [PMID: 30529947 PMCID: PMC6289938 DOI: 10.1016/j.ijscr.2018.11.015] [Citation(s) in RCA: 2] [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: 10/02/2018] [Revised: 11/04/2018] [Accepted: 11/10/2018] [Indexed: 11/29/2022] Open
Abstract
Allergic fungal rhinosinusitis nature in children is more aggressive when compared to adults. Endoscopic sinus surgery is an important therapeutic step in the treatment of allergic fungal rhinosinusits. The reason for this contralateral development of AFRS not clear, but it may be part of the natural disease process. Involvement of the contralateral sinuses in children is uncommon. The normal uninvolved sinus should be involved in the routine endoscopic examination and the post-operative treatment in order to minimize the risk of disease recurrence.
Objectives to report the alternating nature of allergic fungal rhinosinusitis in children in the Eastern part of Saudi Arabia and to review the experience of King Fahad Specialist Hospital in the diagnosis and management of alternating allergic fungal rhinosinusitis in children. An 8 years old Saudi girl with alternating allergic fungal rhinosinusitis was diagnosed and managed. The patient was diagnosed to have unilateral left allergic fungal rhinosinusitis and underwent endoscopic sinus surgery and cleaning of the left sinuses from polyps, mud and mucin. One year postoperatively the patient developed AFRS in the contralateral right side. Conclusion involvement of the contralateral sinuses in children with AFRS is uncommon. The normal uninvolved sinus should be involved in the routine endoscopic examination and the post-operative treatment in order to minimize the risk of disease recurrence.
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Affiliation(s)
- Danah H Althomaly
- Medical intern, Imam Abdulrahman Bin Faisal University, Khobar, Saudi Arabia.
| | - Ali A AlMomen
- Consultant ENT, Rhinology and Endoscopic Skull Base Surgery at King Fahad Specialist Hospital, Dammam, Saudi Arabia
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10
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Abstract
There are possibly millions of mold species on earth. The vast majority of these mold spores live in harmony with humans, rarely causing disease. The rare species that does cause disease does so by triggering allergies or asthma, or may be involved in hypersensitivity diseases such as allergic bronchopulmonary aspergillosis or allergic fungal sinusitis. Other hypersensitivity diseases include those related to occupational or domiciliary exposures to certain mold species, as in the case of Pigeon Breeder's disease, Farmer's lung, or humidifier fever. The final proven category of fungal diseases is through infection, as in the case of onchomycosis or coccidiomycosis. These diseases can be treated using anti-fungal agents. Molds and fungi can also be particularly important in infections that occur in immunocompromised patients. Systemic candidiasis does not occur unless the individual is immunodeficient. Previous reports of "toxic mold syndrome" or "toxic black mold" have been shown to be no more than media hype and mass hysteria, partly stemming from the misinterpreted concept of the "sick building syndrome." There is no scientific evidence that exposure to visible black mold in apartments and buildings can lead to the vague and subjective symptoms of memory loss, inability to focus, fatigue, and headaches that were reported by people who erroneously believed that they were suffering from "mycotoxicosis." Similarly, a causal relationship between cases of infant pulmonary hemorrhage and exposure to "black mold" has never been proven. Finally, there is no evidence of a link between autoimmune disease and mold exposure.
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Abstract
Chronic rhinosinusitis with nasal polyposis (CRSwNP) represents a subset of chronic sinusitis with various causes. Some forms of the disease are driven by allergy, often in association with asthma. Refractory CRSwNP can be associated with cystic fibrosis and other clinical syndromes. More recent literature is presented regarding roles of innate immunity and superantigens. Effective treatment of CRSwNP requires careful endoscopic sinus surgery followed by an individualized treatment plan that often includes oral and topical steroids. Recidivism of polyps is common, and patients require long-term follow-up.
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Affiliation(s)
- Benjamin P Hull
- Department of Otolaryngology-Head & Neck Surgery, Vanderbilt University, 1215 21st Ave S, 7209 MCE-S, Nashville, TN 37232-8605, USA
| | - Rakesh K Chandra
- Department of Otolaryngology-Head & Neck Surgery, Vanderbilt University, 1215 21st Ave S, 7209 MCE-S, Nashville, TN 37232-8605, USA.
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González-Díaz SN, Arias-Cruz A, Rivero-Arias DM, Partida-Ortega AB, Elizondo-Villarreal B, Ibarra-Chávez JA, Ramos-Valencia L, Monge-Ortega OP, Macouzet-Sánchez C, Salinas-Díaz MR. [Cross-reactivity in allergic fungal sinusitis. Case report]. ACTA ACUST UNITED AC 2016; 63:316-9. [PMID: 27560920 DOI: 10.29262/ram.v63i3.166] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND The presence of allergic mucin in allergic fungal sinusitis (AFS) is a manifestation that identifies it as a hypersensitivity process. AFS has a phenomenon of cross-reactivity to IgE-bound proteins having at least two shared epitopes. CLINICAL REPORT A 13-year-old male with nasal obstructive symptoms of three years of evolution. An obstructive mass was identified in the sinuses through physical examination and CT. In endoscopic surgery, the left nostril polyp was identified with the macroscopic appearance of allergic mucin; the polyp was resected. Final histopathological examination using periodic acid-Schiff and Grocott's methenamine silver staining indicated Aspergillus. Two weeks after surgery, percutaneous tests showed sensitization to Alternaria, Helminthosporium sativum, and Deramatophagoides farianae with negativity to Aspergillus fumigatus. CONCLUSIONS The absence of significant titers of specific IgE antibodies to Aspergillus fumigatus was the evidence that the hypersensitivity response was triggered by a pathogen other than that isolated in histopathological study, which coupled with positive tests for other fungi may be explained by the cross-reactivity phenomenon in a phenomenon of likely hypersensitivity.
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Affiliation(s)
- Sandra Nora González-Díaz
- Universidad Autónoma de Nuevo León. Centro Regional de Alergia e Inmunología Clínica, Monterrey, Nuevo León, México.
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Tong J, Jefferson N, Chaganti J, Fraser CL. Compressive Optic Neuropathy from Allergic Fungal Sinusitis. Neuroophthalmology 2015; 39:236-239. [PMID: 27928361 DOI: 10.3109/01658107.2015.1056380] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2015] [Revised: 05/25/2015] [Accepted: 05/26/2015] [Indexed: 11/13/2022] Open
Abstract
Ophthalmic manifestations of allergic fungal sinusitis (AFS) are rare, but can occur in advanced disease. A 32-year-old man with advanced AFS presented with severe bilateral vision loss and restricted ocular motility. Magnetic resonance imaging and histological analysis confirmed active chronic AFS. Functional endoscopic sinus surgery was performed, with adjunctive steroid therapy. Although AFS is a reasonably well-recognised entity, severe disease causing bilateral visual deficits is rarely encountered. This can confound the diagnosis and appropriate treatment. Ophthalmologists should thus be aware of compressive optic neuropathy as a complication of advanced AFS to prompt early treatment and mitigate visual loss.
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Affiliation(s)
- Jessica Tong
- Department of Ophthalmology, St. Vincent's Hospital , Sydney, Darlinghurst, New South Wales, Australia
| | - Niall Jefferson
- Department of Ear, Nose and Throat, St. Vincent's Hospital , Sydney, Darlinghurst, New South Wales, Australia
| | - Joga Chaganti
- Department of Neuroradiology, St. Vincent's Hospital , Sydney, Darlinghurst, New South Wales, Australia , and
| | - Clare L Fraser
- Save Sight Institute , Sydney, New South Wales, Australia
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14
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Abstract
Fungal sinusitis is characterized into invasive and noninvasive forms. The invasive variety is further classified into acute, chronic and granulomatous forms; and the noninvasive variety into fungus ball and allergic fungal sinusitis. Each of these different forms has a unique radiologic appearance. The clinicopathologic and corresponding radiologic spectrum and differences in treatment strategies of fungal sinusitis make it an important diagnosis for clinicians and radiologists to always consider. This is particularly true of invasive fungal sinusitis, which typically affects immuno compromised patients and is associated with significant morbidity and mortality. Early diagnosis allows initiation of appropriate treatment strategies resulting in favorable outcome.
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Affiliation(s)
- Eytan Raz
- Department of Radiology, NYU School of Medicine, 660 First Avenue, 2nd Floor, New York, NY 10016, USA
| | - William Win
- Department of Radiology, NYU School of Medicine, 660 First Avenue, 2nd Floor, New York, NY 10016, USA
| | - Mari Hagiwara
- Department of Radiology, NYU School of Medicine, 660 First Avenue, 2nd Floor, New York, NY 10016, USA
| | - Yvonne W Lui
- Department of Radiology, NYU School of Medicine, 660 First Avenue, 2nd Floor, New York, NY 10016, USA
| | - Benjamin Cohen
- Department of Radiology, NYU School of Medicine, 660 First Avenue, 2nd Floor, New York, NY 10016, USA
| | - Girish M Fatterpekar
- Department of Radiology, NYU School of Medicine, 660 First Avenue, 2nd Floor, New York, NY 10016, USA.
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15
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Abstract
UNLABELLED BACKGROUNd: We report a case of allergic fungal sinusitis (AFS) involving the lacrimal sac and review the current English literature. A literature search for AFS involving the lacrimal sac revealed two reports with only one of the two cases demonstrating histological evidence of fungal elements. This is just the third such case and only the second reported case with histopathologic confirmation of fungal elements by Gomori methenamine silver (GMS) stain. MATERIALS AND METHODS A PubMed database search was performed using combinations of the following key words: allergic fungal sinusitis, lacrimal sac, nasolacrimal duct, ophthalmology, epiphora, orbit. A 70-year-old white man with a history of chronic conjunctivitis and nasal polyps presenting with chronic epiphora was found to have dacryostenosis on the left side. A CT scan of the orbits revealed mucoperiosteal thickening completely obliterating the frontal, ethmoid and sphenoid sinuses. RESULTS A left external dacryocystorhinostomy (DCR) was performed and the lacrimal sac contents were studied histopathologically. Microscopic examination of the lacrimal sac contents disclosed allergic mucin with laminated aggregates of eosinophils in various stages of degeneration, Charcot-Leyden crystals and rare noninvasive fungal hyphae confirming the diagnosis of AFS. Fungal elements stained positively with Gomori methenamine silver stain. CONCLUSION Although rarely reported, AFS can affect the lacrimal sac. AFS should be suspected in patients with a history of recurrent refractory sinusitis, recurrent dacryocystitis and nasal polyposis. Early diagnosis is important for adequate treatment and prevention of recurrence.
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Affiliation(s)
- Kristina Y Pao
- Wills Eye Institute at Thomas Jefferson University , Philadelphia, PA , USA
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16
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Doellman MS, Dion GR, Weitzel EK, Reyes EG. Immunotherapy in allergic fungal sinusitis: The controversy continues. A recent review of literature. Allergy Rhinol (Providence) 2013; 4:e32-5. [PMID: 23772324 PMCID: PMC3679565 DOI: 10.2500/ar.2013.4.0045] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [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] [Indexed: 12/19/2022]
Abstract
Allergic fungal sinusitis (AFS), also referred to as allergic fungal rhinosinusitis (AFRS), is a noninvasive, eosinophilic form of recurrent chronic allergic hypertrophic rhinosinusitis. AFS has distinct clinical, histopathological, and prognostic findings that differentiate it from other forms of sinusitis. The core pathogenesis and optimum treatment strategies remain debated. Concerns surround the use of immunotherapy for AFS because allergen-specific immunoglobulin G (IgG) induced by immunotherapy could theoretically incite a Gell and Coombs type III (complex mediated) reaction. Type I hypersensitivity is established by high serum levels of allergen-specific IgE to various fungal antigens and positive Bipolaris skin test results. Type III hypersensitivity is established by an IgG-mediated process defined by the presence of allergen-specific IgG that forms complexes with fungal antigen inducing an immunologic inflammatory response. These reveal the multiple immunologic pathways through which AFS can impact host responses. Recent literature establishing benefits of fungal immunotherapy and no evidence of type III–mediated reactions, severe local reactions, or delayed reactions, indicate that application of AFS desensitization is a reasonable therapeutic strategy for this difficult to manage entity. Our review should encourage further clinical acceptance of AFS desensitization because the existing literature on this subject shows benefits of fungal immunotherapy and no evidence of type III–mediated reactions, severe local reactions, or delayed reactions.
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Affiliation(s)
- Mary S Doellman
- Department of Otolaryngology Head and Neck Surgery, San Antonio Military Medical Center, San Antonio Military Medical Center, San Antonio, Texas, and
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Alsagoob AA, Taguri AH, Al-Ahmary AY, Sari LM. Asthenopia as the presenting symptom in advance allergic fungal sinusitis. Saudi J Ophthalmol 2012; 26:339-41. [PMID: 23961016 DOI: 10.1016/j.sjopt.2012.02.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 07/28/2011] [Accepted: 02/04/2012] [Indexed: 10/14/2022] Open
Abstract
A 14-year-old male presented to the ophthalmology clinic with a history of asthenopia. Laboratory, radiological and histopathological studies confirmed the diagnosis of allergic fungal sinusitis resulting in lateral displacement of the medial rectus muscles. Symptoms improved and near point of convergence recovered after surgical endoscopic decompression of the ethmoidal and maxillary sinuses.
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Affiliation(s)
- Abdullah A Alsagoob
- Department of Surgery, Imam Abdulrahman Bin Faisal Hospital, Dammam, Saudi Arabia
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Panjabi C, Shah A. Allergic Aspergillus sinusitis and its association with allergic bronchopulmonary aspergillosis. Asia Pac Allergy 2011; 1:130-7. [PMID: 22053309 PMCID: PMC3206248 DOI: 10.5415/apallergy.2011.1.3.130] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [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: 09/05/2011] [Accepted: 09/21/2011] [Indexed: 12/12/2022] Open
Abstract
Allergic Aspergillus sinusitis (AAS) is a three decade old clinicopathologic entity in which mucoid impaction akin to that of allergic bronchopulmonary aspergillosis (ABPA) occurs in the paranasal sinuses. Features such as radiographic evidence of pansinusitis, passage of nasal plugs and recurrent nasal polyposis in patients with an atopic background is suggestive of AAS. Histopathlogic confirmation from the inspissated mucus is a sine qua non for the diagnosis. Heterogeneous densities on computed tomography of the paranasal sinuses are caused by the 'allergic mucin' in the sinuses. Many patients give a history of having undergone multiple surgical procedures for symptomatic relief. The current approach to treatment appears to include an initial surgical debridement followed by postoperative oral corticosteroids for long durations. Although both ABPA and AAS are classified as Aspergillus-related hypersensitivity respiratory disorders, their co-occurrence appears to be an infrequently recognised phenomenon. This could perhaps be attributed to the fact that these two diseases are often treated by two different specialties. A high index of suspicion is required to establish the diagnoses of ABPA and AAS. All patients with asthma and/or rhinosinusitis along with sensitisation to Aspergillus antigens are at an increased risk of developing ABPA and/or AAS. ABPA must be excluded in all patients with AAS and vice versa. Early diagnosis and initiation of appropriate therapy could plausibly alter the course of the disease processes and prevent the possible development of long term sequelae.
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Affiliation(s)
- Chandramani Panjabi
- Department of Respiratory Medicine, Vallabhbhai Patel Chest Institute, University of Delhi, Delhi 110 007, India
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Glass D, Amedee RG. Allergic fungal rhinosinusitis: a review. Ochsner J 2011; 11:271-275. [PMID: 21960761 PMCID: PMC3179194] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023] Open
Abstract
BACKGROUND Allergic fungal rhinosinusitis (AFRS) is a relatively new and incompletely understood clinical entity with characteristic clinical, radiographic, and histopathologic findings. AFRS is often misdiagnosed. Recognition and understanding of this unique disease will lead to efficient diagnosis and treatment of this curable process. METHODS The following is a review, conducted via a PubMed English language search, of the current diagnosis, pathogenesis, and treatment of AFRS. RESULTS AFRS is an immune-modulated disease entity. The Bent and Kuhn diagnostic criteria are the standard for diagnosis of this disease that occurs because of an incompletely understood allergic mechanism. Multimodality treatment relies heavily on surgical therapy along with corticosteroid use and immunotherapy. CONCLUSIONS AFRS is a unique disease process that differs from other forms of sinusitis and as such requires that physicians understand its diagnosis and management to provide care for patients with this condition.
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Affiliation(s)
- Daniel Glass
- Department of Otolaryngology, Head and Neck Surgery, Tulane University School of Medicine, New Orleans, LA
| | - Ronald G. Amedee
- Department of Otolaryngology, Head and Neck Surgery, Ochsner Clinic Foundation, New Orleans, LA
- The University of Queensland School of Medicine, Ochsner Clinical School, New Orleans, LA
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