Case Of Allergic Fungal Rhinosinusitis Research Articles

Itraconazole versus steroids in post operative cases of allergic fungal rhinosinusitis: a randomized controlled trial

This study was aimed to compare the effect of oral steroids and itraconazole in reducing the recurrence in allergic fungal rhinosinusitis (AFRS) patients undergoing ESS. In this randomized controlled trial, 50 patients of both sexes aged between 15-60 years with AFRS were subjected to functional endoscopic sinus surgery (ESS). In the post-operative period, patients were randomly divided into 2 groups containing 25 patients each. Group A received systemic steroid followed by topical steroid. Group B received oral itraconazole. Patients were followed at the end of 6, 10 and 14 weeks after surgery. Sinonasal outcome test 22 (SNOT-22) Lund Kennedy endoscopic score (LKES), AEC and serum total IgE were repeated at each post-operative visit and compared with the preoperative values. Repeat NCCT nose and PNS was done at 14th week to look for recurrence. Statistically significant difference was seen between the two groups in AEC, LKES and SNOT-22 with group A showing more significant improvement than group B, but not in serum IgE and Lund Mackay computed tomography (LMCT) score. The group A had 24% (n=6) recurrence rate, while group B had 44% (n=11) recurrence rate. The difference in the two groups in recurrence was not statistically significant. We evaluated multiple parameters including radiological and endoscopic scores to find the difference between the two drugs and found steroid to be superior than itraconazole.

A case of allergic fungal rhinosinusitis with extensive skull base bone defects on imaging studies

A case of allergic fungal rhinosinusitis with extensive skull base bone defects on imaging studies

FREQUENCY OF BONE EROSION ON COMPUTERIZED TOMOGRAPGHY SCAN IN ALLERGIC FUNGAL RHINOSINUSITIS

Objective: To analyze the frequency and sites of bone erosion on computerized tomograghy scan in Allergic Fungal Rhinosinustis in Pakistan.
 Study Design: Retrospective observational study.
 Place and Duration of Study: Department of ENT, Combined Military Hospital Lahore, Malir Karachi and Rawalpindi, from Jan 2010 to Dec 2019.
 Methodology: Total 230 cases of Allergic Fungal Rhinosinusitis were screened, out of which 85 patients having bone erosions on computerized tomograpghy scan were included in the study. Bone erosion in different paranasal sinuses and their sub sites were evaluated. Depending upon the number of bone erosion, patients were divided into three categories as mild, moderate and severe. Those having erosion at a single site were labelled as mild, those with two sub sites of erosion as moderate and those with more than two subsites of erosion were labelled as severe cases.
 Results: Detailed evaluation of computerized tomography scan of paranasal sinuses revealed bone erosion in 85/230 (36.9%) cases. Mean affected age was 23.96 ± 12.71 years. There were 52 (61.1%) males and 33 (38.9%) females. Ethmoid sinus was the most commonly involved sinus to have bone erosions 55 (38.19%) followed by maxillary sinus 38 (26.38%) then sphenoid sinus 27 (18.75%) and lastly frontal sinus 24 (16.6%). Out of 85 patients 48 (56.1%) were having mild, 22 (25.8%) moderate and 15 (17.6%) had severe disease.
 Conclusion: Allergic Fungal Rhinosinusitis has high frequency of bone erosion. Computerized tomography scan is an important and effective investigation in finding these bony erosions and ethmoid sinus is the.....

English

BACKGROUND Fungal rhinosinusitis (FRS) is an increasingly common pathology in chronic rhinosinusitis and is often diagnosed late. The present study intended at analysing and understanding the clinical, pathological, microbiological, radiological characteristics of the disease in a tertiary hospital in Kerala. METHODS Case records of patients with pathologic or microbiologic diagnosis of FRS were retrospectively studied from January 2015 to January 2021, with reference to their demography, clinical presentation, comorbidities, and imaging features. The treatment aspects were also studied. RESULTS A total of 36 patients with pathological or microbiologic evidence of FRS were studied. There were 58 % cases of allergic FRS, 33 % cases of fungal ball and 8.3 % cases of invasive FRS. 58 % of patients were females, 77 % patients had nasal block as their presenting symptom, and 66 % of patients had duration of symptoms between 1-6 months. In radiological imaging, the maxillary sinus was most commonly involved. Treatment was always surgical removal. Allergic FRS (AFRS) needed prolonged topical steroids and invasive FRS needed systemic antifungals. CONCLUSIONS Our study suggests the importance of early diagnosis of FRS in all chronic rhinosinusitis patients by a high index of clinical suspicion. Tissue samples from the nose and sinuses should be studied for pathology and microbiology in all suspected cases to reach a diagnosis. Radiological imaging can aid in concluding diagnosis. Surgical options, supported by medical management play a vital role in the effective management of the disease. KEY WORDS Fungal rhinosinusitis, Allergic fungal rhinosinusitis, Fungal ball, Invasive fungal rhinosinusitis

Evaluation of the Role of Immunotherapy in Allergic Fungal Rhinosinusitis

Background: Allergic fungal rhinosinusitis (AFRS) is a distinct form of chronic rhinosinusitis. Type I hypersensitivity to inhaled fungal allergens has been implicated as key pathogenesis. Immunotherapy as one of the therapeutic options is still controversial. Objective: to evaluate the role of immunotherapy in the management of AFRS patients not responding to medical treatment 3 months following endoscopic surgery. Methodology: A total of 35 patients diagnosed as resistant AFRS were included in this prospective study. Patients were diagnosed following clinical, radiological, and endoscopic examination of nose and paranasal sinuses. Specimens were collected during endoscopy and subjected to microscopic examination and fungal culture. Skin prick test and assessment of total IgE level were performed for all patients. Sublingual immunotherapy (SLIT) was initiated for all patients for 6 months. Clinical efficacy of SLIT was assessed using the 20-item sino-nasal outcome test (SNOT-20) score. Results: Aspergillus spp. was the most frequent fungus isolated (74.3%) from patients. All patients were sensitized to mixed fungi. Elevated total IgE (> 100 IU/mL) was found in all patients with 40% of them had peripheral eosinophilia. A significant improvement (p < 0.001) was recorded in the SNOT-20 score of examined patients recording a mean of 1.2 ± 0.3, 6 months after SLIT compared to 1.93 ± 0.44 before immunotherapy initiation. Conclusion: Immunotherapy appears to be a good adjunctive therapy for the management of resistant cases of AFRS.

Implication of osteoplastic flap for frontal sinus surgery in the endoscopic era

<p class="abstract">In the present era where functional endoscopic sinus surgery is the mainstay of management for any frontal sinus disease, we present a case series comprising six cases of various frontal sinus pathology that were managed with an external approach using a bicoronal osteoplastic flap technique of which three cases were of inverted papilloma, one case of allergic fungal rhinosinusitis, one case of frontal mucocele and a case of road traffic accident with frontal bone and nasal bone fracture. The cases had a mean follow-up period of 6 months. There was no recurrence of disease and no significant postoperative complications have been reported during the follow-up period so far. Osteoplastic anterior wall approach to the frontal sinus has proved to be one of the most effective, simple, and reliable procedures with excellent success rate and good cosmesis.</p>

A Case of Allergic Fungal Rhinosinusitis in a Child with Bony Facial Abnormalities

A Case of Allergic Fungal Rhinosinusitis in a Child with Bony Facial Abnormalities

A Case of Allergic Fungal Rhinosinusitis with Concurrently Occuring Fungus Ball

A Case of Allergic Fungal Rhinosinusitis with Concurrently Occuring Fungus Ball

Rinosinusitis alérgica por Curvularia inaequalis (Shear) Boedijn

Curvularia inaequalis (Shear) Boedijn is a fungus dematiaceo, saprophyte and plant pathogen found mainly in tropical and subtropical areas, associated with various organic substrates. Rarely been identified in systemic infections, skin and there is only one report of allergic rhinosinusitis described above. A case of allergic fungal rhinosinusitis by Curvularia inaequalis (Shear) Boedijn in which diagnosis was considered the signs and symptoms, sinus CT and cultivation of mucin.The patient was treated with endoscopic surgical toilet, plus use of inhaled steroids and itraconazole systemic. With good clinical response, is asymptomatic at one year.

Chapter 7: Allergic fungal rhinosinusitis.

Allergic fungal rhinosinusitis (AFRS) is a type of chronic rhinosinusitis in which patients classically exhibit nasal polyps, type I IgE-mediated hypersensitivity, characteristic findings on computed tomography scans, eosinophilic mucin, and positive fungal stain. New research has sought to further understand the pathophysiology of AFRS. However, this has also led to debate about the classification and predominance of this interesting disease process. Historically, patients with AFRS are immunocompetent. The disease is most prevalent in the southeast and south central United States and typically presents with sinus pressure, hyposmia, and congestion. Radiographically, cases of AFRS have a distinct appearance, often exhibiting unilateral heterogeneously dense material, which may erode and expand the paranasal sinus bony walls. Treatment typically consists of surgery, sinonasal irrigations, and topical and systemic steroids, all with the effort to decrease the fungal load and antigenic response. Immunotherapy is also often included in the treatment regimen for AFRS.

A Case of Allergic Fungal Rhinosinusitis with Bony Erosion and Expansion into the Anterior Skull Base and Orbit

A Case of Allergic Fungal Rhinosinusitis with Bony Erosion and Expansion into the Anterior Skull Base and Orbit

Oral Itraconazole as an Adjunct to Steroids in AFRS

Objective: To evaluate itraconazole therapy in allergic fungal rhinosinusitis. Method: Prospective randomized study in 75 cases of allergic fungal rhinosinusitis. The subjects were randomized to 2 groups. All the patients were subjected to endoscopic sinus surgery. The specimen was analyzed for mycological profile and histopathological characteristics. Those assigned to group A were given oral steroids and those in group B were given oral steroids and itraconazole for 3 months. These patients underwent follow-up examination at 6 weeks, 12 weeks, and 24 weeks with postoperative nasal endoscopic examination and computerized tomography. Random blood sugar estimation and liver function tests were done to watch for side effects. Ten patients were lost to follow-up during the study period. Hence statistical analysis was done in 65 patients; 39 subjects in group A and 26 in group B. Results: Fungal smear was positive in 84.6% of subjects. Aspergillus flavus was commonly isolated. Patients receiving adjunct itraconazole therapy had a better cavity healing at 12-24 weeks of follow-up compared to those receiving steroids ( P = .027). Patients with intraorbital extension had lesser chance of recurrences on oral itraconazole compared to steroids ( P = .018). Itraconazole therapy was found to be beneficial in recalcitrant cases ( P = .050). No side effects were observed with itraconazole. Conclusion: Itraconazole as an adjunct to corticosteroids has no advantage at 6 months of follow-up. However, it results in better cavity healing. Itraconazole was found to be beneficial in preventing recurrences in recalcitrant cases and patients with intraorbital extension.

アレルギー性真菌性鼻副鼻腔炎の 1 例

背景 : アレルギー性真菌性鼻副鼻腔炎 (allergic fungal rhinosinusitis : AFRS) は真菌に対するアレルギー反応が原因とされる再発率の高い難治性鼻副鼻腔炎である. 本邦では AFRS の存在があまり認識されておらずまれな疾患と考えられている. 今回 AFRS を経験し副鼻腔内容物を材料とする塗抹細胞診が実施されたので報告する.症例 : 42 歳, 女性. 2 年前に左副鼻腔真菌症と診断され手術されたが完全な治癒にはいたらず, 今回その再発と考えられる真菌性汎副鼻腔炎となり内視鏡手術が施行された. 副鼻腔からピーナツバター様物質が採取されその組織標本に散在する菌糸を含むアレルギー性ムチンが確認された. その 1 週間後, 前頭洞から鼻腔内に漏出した同様の検体の塗抹標本で組織標本同様にアレルギー性ムチンがみられ少数の真菌が散在していた.結論 : 副鼻腔炎からの検体において細胞診での背景が粘液の場合, AFRS を念頭におき, アレルギー性ムチンを確認することが重要である. 細胞診標本は組織標本より厚みがあり, 菌を見出す確率が高く, また菌糸形態の観察に有用である.

Optic neuropathy due to allergic fungal rhinosinusitis

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.

Allergic fungal rhinosinusitis: detection of fungal DNA in sinus aspirate using polymerase chain reaction

This study investigated allergic fungal rhinosinusitis cases, and aimed to compare the detection of fungi in sinus aspirate by culture and by polymerase chain reaction assay, and to relate the presence of fungi in the nasal sinuses to the type of fungal allergen causing disease. Sixty-eight cases of allergic fungal rhinosinusitis underwent fungal culture and polymerase chain reaction assay for universal fungal, aspergillus and bipolaris DNA. Aspergillus-specific immunoglobulin E levels were measured in sinus aspirate, and total serum immunoglobulin E levels were calculated. A control group of 10 cases was included in the study. Of the 68 allergic fungal rhinosinusitis cases, only 42 (61.7 per cent) had positive fungal cultures; of the 10 controls, only three (30 per cent) had positive cultures. Species from the dematiaceous family were most commonly grown, being isolated in 30 cases (71.4 per cent). Bipolaris was the most commonly isolated species (18 cases) followed by curvularia (11 cases) and alternaria (one case). Polymerase chain reaction assay detected fungal DNA in all the allergic fungal rhinosinusitis cases and also in four controls (40 per cent). Ten patients (of 68; 14.7 per cent) were positive for Aspergillus fumigatus specific immunoglobulin E. The mean concentration of this immunoglobulin was 11.32 +/- 4.12 IU/ml in patients and 0 IU/ml in controls, a statistically significant difference. Detection of fungal DNA in nasal aspirate by polymerase chain reaction was superior to fungal cultures as a method of detecting fungal growth. In allergic fungal rhinosinusitis, fungal growth is not always accompanied by an allergic reaction.

Controversies surrounding the categorization of fungal sinusitis

Though rhinosinusitis is a common disorder, controversies surround the categorization of chronic rhinosinusitis (CRS) and the role of fungus in CRS. The diagnosis of each category is important for optimum therapy and predicting the course. Based on histopathological findings, fungal rhinosinusitis (FRS) can be broadly divided into two categories: the invasive and non-invasive depending on invasion of the mucosal layer. Three types of FRS are tissue-invasive: acute invasive, chronic invasive, & granulomatous. The two non-invasive FRS disorders are fungal ball, and fungus related eosinophilic rhinosinusitis including allergic fungal rhinosinusitis (AFRS). The distinction of granulomatous from chronic invasive type is not beyond controversy as both types have a chronic course and predominant orbital involvement. Maximum confusion surrounds the entity of fungus-related eosinophilic rhinosinusitis, and the definition of AFRS. In the diagnosis of AFRS, the detection of fungi in allergic mucin is considered important, although hyphae are sparse in sinus content. This leads to confusion in definition of this entity, especially with the description of two more closely related entities--eosinophilic fungal rhinosinusitis (EFRS) and eosinophilic mucin rhinosinusitis (EMRS). Recently reports of histologic invasion in possible cases of AFRS were also documented. Currently, there are more questions than answers concerning the categorization of FRS.

Allergic fungal rhinosinusitis caused byNeosartorya hiratsukaefrom India

We report here a case of allergic fungal rhinosinusitis caused by Neosartorya hiratsukae. This fungus was never previously been isolated from any case with fungal rhinosinusitis. The identification of this agent was confirmed by comparing the nucleotide sequence of the ITS region of ribosomal DNA with that in the GenBank DNA database. Identification of N. hiratsukae on the basis of colony morphology and microscopic feature may be difficult due to similarities with a few Aspergillus species. Scanning electron microscopy or DNA sequence analysis is essential for the accurate identification.