Allergic fungal sinusitis: diagnosis and treatment

Kühn, Frederick A.; Swain, Ron E.

doi:10.1097/00020840-200302000-00001

Cited by 60 publications

(53 citation statements)

References 15 publications

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“…The association of Trichophyton with asthma [67] and improvement in asthma with antifungal treatment [88] both suggest a possible link between chronic infection and asthma. Resolution or improvement of chronic fungal sinusitis may improve asthma [89][90][91]. It may be that mould-associated asthma is more common after years of mucosal inflammation due to asthma.…”

Section: Fungi and Bronchiectasismentioning

confidence: 99%

The link between fungi and severe asthma: a summary of the evidence

Denning

O’Driscoll²,

Hogaboam³

et al. 2006

European Respiratory Journal

712

631

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There is current evidence to demonstrate a close association between fungal sensitisation and asthma severity. Whether such an association is causal remains to be confirmed, but this is explored by means of a detailed literature review. There is evidence from two randomised controlled trials that, in the example of allergic bronchopulmonary aspergillosis (ABPA), treatment with systemic antifungal therapy can offer a therapeutic benefit to ,60% of patients. ABPA is only diagnosed if a combination of clinical and immunological criteria is achieved. It is not known whether such cases are a discrete clinical entity or part of a spectrum of the pulmonary allergic response to fungi or fungal products.This paper describes the epidemiological evidence that associates severity of asthma with fungi and discusses possible pathogenetic mechanisms. Many airborne fungi are involved, including species of Alternaria, Aspergillus, Cladosporium and Penicillium, and exposure may be indoors, outdoors or both. The potential for a therapeutic role of antifungal agents for patients with severe asthma and fungal sensitisation is also explored.Not only are many patients with severe asthma desperately disabled by their disease, but, in the UK alone, asthma accounts for 1,500 deaths per yr. The healthcare costs of these patients are enormous and any treatment option merits close scrutiny. Within this report, the case for the consideration of a new term related to this association is put forward. The current authors propose the term ''severe asthma with fungal sensitisation''. However, it is recognised that enhanced and precise definition of fungal sensitisation will require improvements in diagnostic testing.

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Section: Fungi and Bronchiectasismentioning

confidence: 99%

The link between fungi and severe asthma: a summary of the evidence

Denning

O’Driscoll²,

Hogaboam³

et al. 2006

European Respiratory Journal

712

631

View full text Add to dashboard Cite

show abstract

“…It is one of the diagnostic criteria for allergic fungal rhinosinusitis. 20 Aspirin-sensitive respiratory disease is another condition with a strong association of polyps, rhinosinusitis, and asthma. It occurs when one has an allergy to aspirin or other nonsteroidal anti-inflammatory agents.…”

Section: Relationships Between Asthma and Upper Airway Diseasementioning

confidence: 99%

Comorbidities of asthma and the unified airway

Stachler

2015

Int Forum Allergy Rhinol

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“…It occurs mainly in immunocompetent patients, in contrast to invasive fungal diseases that usually involve an immunocompromised host. In 2003, Kuhn and Swain [7] described five major and six minor criteria for diagnosis of AFS in adults. The former were: (1) type I IgE-mediated hypersensitivity; (2) nasal polyposis; (3) characteristic CT findings; (4) allergic mucin; and (5) positive fungal smear and/ or culture.…”

Section: Discussionmentioning

confidence: 99%

“…It occurs mainly in immunocompetent patients, in contrast to invasive fungal diseases that usually involve an immunocompromised host. In 2003, Kuhn and Swain [7] described five major and six minor criteria for diagnosis of AFS in adults. The former were: (1) type I IgE-mediated hypersensitivity; very rare infection which can cause infection in both noninvasive and invasive form and also considering the willingness for the revision surgeries in elderly patient; he was started on intravenous Voriconazole for nine days which proved to be quite effective.…”

Section: Discussionmentioning

confidence: 99%

Chrysosporium : An Uncommon Fungus in Chronic Rhinosinusitis

Kamath

Prasad

Shenoy

et al. 2015

JCDR

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A healthy 70-year-old male patient, who was a farmer by occupation presented to us with complaints of recurrent right sided nasal block, right sided retro-orbital pain and multiple episodes of epistaxis of three months duration. There was no history of tuberculosis, diabetes mellitus or other immunocompromised states. The diagnostic nasal endoscopy did not reveal any gross abnormality except for a deviated nasal septum to right, minimal mucosal discharge on right nasal cavity and polypoidal mucosa over right middle turbinate. His serum IgE was 305 UI/ml. CT scan of the Nose and Paranasal Sinuses showed a soft tissue density obliterating the right sphenoid sinus and right posterior ethmoid air cells with widened sphenoethmoidal recess [Table/ Fig-1]. Functional Endoscopic Sinus Surgery was done to clear out the disease from sinuses. Intraoperatively fungal debris and mucin with mucosal hypertrophy was found in the right posterior ethmoid sinus and sphenoid sinus which was sent for microbiological examination. There were no complications intraoperatively or postoperatively and the patient was discharged in the third postoperative day. Microbiological examination confirmed the presence of the fungus on Potassium Hydroxide preparation. The fungus grew on Sabouraud's dextrose agar after one week of incubation as white cottony growth with reverse light brown. On Lactophenol cotton blue preparation hyaline, septate hyphae with terminal one celled ovoid smooth walled conidia were present [ Chrysosporium: An Uncommon Fungus in Chronic Rhinosinusitis aBstRaCt Chronic rhinosinusitis is one of the commonest health problem encountered in rhinology. Of these allergic fungal rhinosinusitis forms a significant group of patients. Patients commonly present with typical symptoms of sinusitis and the diagnosis is often made after imaging and/ or intraoperatively. We report a rare case of allergic fungal sinusitis (AFS) caused by Chrysosporium species in a 70-year-old male with no comorbidities. The fungus was isolated from allergic mucin collected from the sinuses. Therapy with intravenous Voriconazole was given leading to good relief for the patient, and no recurrences have occurred till date. Infections caused by Chrysosporium species are very rare, and is very rarely been reported to cause sinusitis in humans. DisCussionChronic rhinosinusitis is a major cause of morbidity in our current era affecting more than 14% of adults and children [1]. Acute rhinosinusitis is usually unimicrobial whereas chronic form will have multiple microorganisms [1]. Chronically infected sinuses are often inhabitant for fungus which is difficult to completely eradicate hence adding complications or morbidities [2]. Incidence of AFS is 5-10% of all cases of chronic rhinosinusitis which requires surgery [3]. It represents an allergic/hypersensitivity disorder and is the commonest form of fungal rhinosinusitis [4]. Members of the dematiaceous family are commonly implicated like alternaria, curvularia, fusarium, rhizopus, drechslera and excerohilum [5].A...

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Allergic fungal sinusitis: diagnosis and treatment

Cited by 60 publications

References 15 publications

The link between fungi and severe asthma: a summary of the evidence

The link between fungi and severe asthma: a summary of the evidence

Comorbidities of asthma and the unified airway

Chrysosporium : An Uncommon Fungus in Chronic Rhinosinusitis

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