Fungal Sinusitis: an Update

Morpeth, James F.; Rupp, Ned T.; Dolen, William K.; Bent, John P.; Kühn, Frederick A.

doi:10.1016/s1081-1206(10)63411-4

Cited by 124 publications

(57 citation statements)

References 53 publications

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“…12 Many studies evaluating the diagnostic criteria, and treatment regimen have appeared in literature. [6][7][8][13][14] The diagnostic criteria for AFRS includes (1) chronic rhinosinusitis confirmed radiologically by CT scan of paranasal sinuses; (2) Presence of allergic fungal mucin with predominant eosinophils; (3) Presence of fungus confirmed by the culture of mucin or histology. 15,16 Studies have reported an incidence varying from 40-65%.…”

Section: Discussionmentioning

confidence: 99%

“…6 Some studies added, type I hypersensitivity reaction diagnosed by history, positive skin test or serology as other prerequisites for diagnosing AFRS. 7 In 1994, Bent and Kuhn published their diagnostic criteria centered on the histologic, radiographic, and immunologic characteristics of the disease. 8 Others have proposed several sets of criteria that have served to further the discussion of an investigation into this unique disease; however, the Bent and Kuhn criteria (Table 1) are largely regarded as the standard for diagnosis today.…”

Section: Introductionmentioning

confidence: 99%

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Allergic fungal rhinosinusitis: an overview on pathogenesis, early diagnosis and management

Suri

Bhavya

2018

Int J Otorhinolaryngol Head Neck Surg

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Background: The objective of the study was to evaluate the criteria for diagnosing allergic fungal rhinosinusitis and to maintain permanent drainage and ventilation, while preserving the integrity of the mucosa. Methods: This is a prospective study of 50 patients with allergic fungal sinusitis with or without polyposis all of whom were treated with endoscopic debridement. Mucous sample collection, nasal secretion culture, surgical specimen handling, and histological evaluation of surgical specimens are described. All patients treated with endoscopic sinus surgery, debridement, post-operative use of steroids and antifungal therapy. Results: Fungal mucin was found in all 50 cases, histology and fungal cultures confirmed the diagnosis. Out of 50 patients, 29 were females and 21 were males, with a mean age of 32 years. The most common symptom was nasal discharge 41 (82%) cases, nasal obstruction in 38 (76%) cases, headache and facial pain in 32 (72%) cases, 7 (14%) patients had bronchial asthma. Symptoms of nasal obstruction and nasal discharge were improved in 46 (92%) cases. All preoperative versus postoperative changes in AFRS associated complaints reached statistical significance of p value <0.001 except in patients with asthma. Conclusions: Comprehensive management with endoscopic sinus surgery, oral steroids and antifungals reduces the recurrence or need for revision surgery. Long term follow up is very important.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Allergic fungal rhinosinusitis: an overview on pathogenesis, early diagnosis and management

Suri

Bhavya

2018

Int J Otorhinolaryngol Head Neck Surg

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“…Seven patients aged 22 years-45 years old were atopic (serum IgE ≥ 120 KU/L) and suffered chronic allergic rhinitis and asthma; the other 5 patients aged 33 years-54 years old were not atopic (serum IgE 40 ± 18 KU/L) and no other respiratory complaints [8][9][10][11][12][13][14][15][16][17][18][19]. The former revealed positive skin tests to the Ba extract with a wheal & flare reaction ≥ 5 mm meanwhile the latter group did not show any positive result and behave as a control group [20][21][22][23][24][25].…”

Section: Descriptionmentioning

confidence: 99%

IgE and IgG Antibodies against Bipolaris Australiensis (Ba) in Allergic Fungal Sinusitis

FA¹

2015

Clin Microbiol

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DescriptionTwelve adult patients suffering an allergic fungal sinusitis were checked by skin-testing with a Ba extract (13 mg/mL of proteins detected by the Bradford technique) and their sera were submitted to an ELISA-IgE and IgG methods following Phadebas recommendations [1][2][3][4][5][6][7]. Seven patients aged 22 years-45 years old were atopic (serum IgE ≥ 120 KU/L) and suffered chronic allergic rhinitis and asthma; the other 5 patients aged 33 years-54 years old were not atopic (serum IgE 40 ± 18 KU/L) and no other respiratory complaints [8][9][10][11][12][13][14][15][16][17][18][19]. The former revealed positive skin tests to the Ba extract with a wheal & flare reaction ≥ 5 mm meanwhile the latter group did not show any positive result and behave as a control group [20][21][22][23][24][25]. The atopic group was weekly subcutaneous vaccinated with the Ba extract (1 mg/dose/week) and after 3 years they revealed significant decrease of their IgE-anti-Ba levels and a marked increase of their IgG-anti-Ba values correlated with a significant improvement of their respiratory condition [26][27][28][29][30][31][32]. On the other hand, the control group was not vaccinated by ethical considerations, showed no changes in their serum values and suffered the recurrence of their illness [33][34][35][36][37][38][39][40][41]. The usefulness of specific immune-therapy with Ba is reinforced for the treatment of allergic fungal sinusitis. An experimental model with guinea-pigs was developed by the daily aerosolization of the protein-peak of Ba obtained by Sephadex G-50 column fractionation [42][43][44][45][46][47][48][49]. After 12 weeks a typical hypersensitivity pneumonitis was obtained with intense interstitial infiltrates of the lungs, solitary granulomas and foamy cells. It was also checked the presence of IgE-anti-Ba antibodies by the Ovary-Bier's test and of IgG-anti-Ba by the Ouchterlony technique [50][51][52]. It was demonstrated that the fungus Ba or Cochliobolus species is a potent antigen that inducing a chronic inflammatory process requires aggressive chirurgical and pharmacological treatments reinforced by immune-therapy [53,54].

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“…The immunologic role of the fungus and the host is still an area of ongoing research. Patients with classic AFS satisfying the Bent-Kuhn criteria 13 for the diagnosis of AFS was used for subset analysis.…”

Section: Criteria For Considering Studies For This Reviewmentioning

confidence: 99%