Antifungal Therapy in the Treatment of Chronic Rhinosinusitis: A Meta-Analysis

Sacks, Peta Lee; Harvey, Richard J.; Rimmer, Janet; Gallagher, Richard; Sacks, Raymond

doi:10.2500/ajra.2012.26.3710

Cited by 46 publications

(33 citation statements)

References 36 publications

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“…8 Se desarrolló interés creciente por el manejo de estos pacientes con antifúngico sistémico como itraconazol, con base en el beneficio que reportaba para pacientes con ABPA; 9 sin embargo, su eficacia en RAF no ha sido establecida y actualmente no se recomienda su uso. 10 Por otro lado, la inmunoterapia se ha convertido de forma reciente en una herramienta terapéutica valiosa en estos pacientes, segura y efectiva, con la capacidad de disminuir las dosis de esteroide tópico sistémico y las tasas de re-intervención. 11 El paciente reportado inició tratamiento con inmunoterapia específica subcutánea y continúa hasta la fecha de elaboración de este reporte con fluticasona.…”

Section: Discussionunclassified

Reactividad cruzada en sinusitis alérgica fúngica. Reporte de caso

González-Díaz

Arias-Cruz

Rivero-Arias

et al. 2016

RAM

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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 IgEbound proteins having at least two shared epitopes. Case 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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Section: Discussionunclassified

Reactividad cruzada en sinusitis alérgica fúngica. Reporte de caso

González-Díaz

Arias-Cruz

Rivero-Arias

et al. 2016

RAM

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“…Within the review, sixteen of the included studies reported objective outcomes in the form of endoscopic findings. The endoscopic findings were either reported as part of validated scoring scales (1,7,(16)(17)(18)(19)21,22,(25)(26)(27)(28) or nonvalidated systems (15,20,23,24,30) . Seven studies reported endoscopic improvement (15,(17)(18)(19)(22)(23)(24) , whereas the remainder of the studies reported no benefit (endoscopic) from antifungal agents.…”

Section: Discussionmentioning

confidence: 99%

“…Disease specific QOL scores were collated within a meta-analysis (1) , which reported no significant improvement in QOL with the use of topical AMB when compared to the placebo. When assessed individually (without the studies which excluded AFS) there was still no benefit reported.…”

Section: Non-validated Symptom Scoresmentioning

confidence: 99%

The value of antifungal therapy in allergic fungal rhinosinusitis

Sg¹,

Bn²

2014

Rhin

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Background: Allergic fungal rhinosinusitis (AFS) is considered to part of the disease spectrum of chronic rhinosinusitis, which affects between five to fifteen per cent of the population. Currently, there is uncertainty relating to the pathological process and therefore optimal management of AFS. Studies assessing antifungal use have shown mixed results. The aim of this review is to assess the effect of antifungals on patients with AFS. Methods:A systematic review of the literature to include all published trials searching Pubmed, Medline (Ovid), CINAHL (EBSCO) and the Cochrane central register of controlled trials (CENTRAL) databases. Results:Sixteen studies (two systematic reviews, two meta-analysis, four randomised controlled trials, five prospective cohort studies and three retrospective studies) were included in this review. There was found to be no overall benefit of topical or oral antifungals upon endoscopic findings or patient reported outcome measures in AFS. There were no statistically significant differences in adverse effect profiles between treatment and control groups. Conclusion:There is limited evidence to support the use of topical or oral antifungal agents in patients with AFS. Future research recommendations include large multicentre randomised trials with better matched patient groups and appropriate dosage and timing of antifungals.

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“…Amfoterisin B sistemik antifungal tedavide sıklıkla kullanılmasına rağmen nefrotoksik oluşu, elektrolit dengesizliği oluşturması, kullanımdan sonraki ateş titreme, taşipne gibi ciddi yan etkileri kullanımını kısıtlamaktadır (10). Son yıllarda amfoterisin B yerine kullanılan ikinci nesil azol türevlerinden vorikonazol ile sistemik tedavinin başarılı olduğunu gösteren yayınlar mevcuttur (11,12). Vorikonazol candida, aspergillus, kriptokok ve diğer mantar türlerine etkilidir.…”

Section: Discussionunclassified

Difficulty of Differential Diagnosis: Granulomatous Diseases of Nasal Cavity and Paranasal Sinuses

Ergün¹,

Cabbarzade²,

Günaydın³

et al. 2013

Turk Arch Otolaryngol

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GirişGranülomatöz cevap, vücudun "yabancı" olarak tanımladığı ancak ortadan kaldıramadığı antijenlere kar-şı verdiği kronik seyirli bağışıklık yanıtıdır. Makrofajlar, lenfositler, fibroblastlar ve antijenin tipine göre nötrofil, eozinofil gibi bağışıklık hücreleri de granülom oluşumuna katılır (1). Burun boşluğu ve paranazal sinüslerin birçok farklı granülomatöz hastalığı vardır. Bunlar inflamatuar hastalıklar ve vaskülitler, enfeksiyöz ve neoplastik hastalıklar olarak sınıflanabilir. Bu bölgede yabancı cisim reaksiyonları, travma ve kokain kullanımı da unutulmamalıdır (1, 2). Bu yazıda, dört yıldır nazal kavite içinde ve son aylarda da premaksiller bölge cildinde iyileşmeyen yarası nedeniyle araştırılan kronik fungal infeksiyonu olan hastanın tanı ve tedavisinde karşılaşılan güçlükler sunulmuş ve nazal kavite ve paranazal sinüslerdeki granülomatöz hastalıklarında ayırıcı tanı yaklaşımı literatür bilgileri eşliğinde ortaya koyulmuştur. Olgu SunumuAltmış iki yaşında bayan hasta kliniğimizde, dört yıldır sağ burun içinde iyileşmeyen yara ve son dört aydır sağ premaksiller alanda ortaya çıkan kabuklu, vejetan ve büyümekte olan lezyon şikayeti ile Dahiliye Bölümü'nün konsültasyonu üzerine görüldü.Hastanın bu şikayetle dış merkezlerde yaklaşık üç yıldır incelendiği ve hastaya değişik merkezlerde iki kez biyopsi yapılan biyopsilerin sırasıyla enfekte piyojenik granülom ve granülomatöz iltihap olarak ra- Ayırıcı Tanı Güçlüğü: Burun Boşluğu ve Paranazal Sinüslerin Granülomatöz HastalığıOnur Ergün, Cavid Cabbarzade, Rıza Önder Günaydın, Serdar Özer, Nilda Süslü Department of Otorhinolaryngology and Head and Neck, Faculty of Medicine, Hacettepe University, Ankara, Turkey Case Report Olgu SunumuInfectious diseases are important causes of granulomatous diseases of the nasal cavity and paranasal sinuses. The most frequent bacterial agents responsible for granulomatous infections are Mycobacterium species (spp.) and Actinomyces spp. In the case of fungal pathogens, Aspergillus spp. are the most frequent. Mucor spp., Cryptococcus spp. and Histoplasma spp. are the other fungal microorganisms causing granulomatous reactions. In this case report, a patient suffering from a chronic nasal cavity lesion for 4 years with a recently developed premaxillary skin lesion is presented. Despite many biopsies having been performed and pathological studies conducted, a definitive diagnosis and an effective treatment could not be achieved. Finally, Aspergillus growth was observed in the fungal growth media when the material of the last skin biopsy was sent to microbiology as well as pathology. The patient was diagnosed as "chronic nasal fungal infection" and voricanozole treatment was initiated. Nine months after therapy, symptoms were almost totally resolved. In order to prevent similar difficulties of differential diagnosis, biopsy materials should be sent for aerobic, tuberculosis and fungal cultivation, as well as pathological examination, in order not to miss infectious diseases from the aetiology.Key Words: Aspergillus, nasal cavity, fun...

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Antifungal Therapy in the Treatment of Chronic Rhinosinusitis: A Meta-Analysis

Abstract: ABSTRACT

Cited by 46 publications

References 36 publications

Reactividad cruzada en sinusitis alérgica fúngica. Reporte de caso

Reactividad cruzada en sinusitis alérgica fúngica. Reporte de caso

The value of antifungal therapy in allergic fungal rhinosinusitis

Difficulty of Differential Diagnosis: Granulomatous Diseases of Nasal Cavity and Paranasal Sinuses

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