Abstract
Fungal load colonization may modify the classic eosinophilic inflammation in allergic fungal rhinosinusitis (AFRS). We aimed to evaluate the impact of fungal load on diagnosis and outcome of AFRS. In the present cohort study fungal load differences were determined prospectively according to Gomori methenamine silver (GMS) fungal stained (histopathological and cytological examination) with the tenacious mucus, cheesy clay-like materials and sinus mucosa/polyps in 12 AFRS patients. Two groups with different fungal loads, AFRS with (six patients) and without (six patients) high fungal loads (HFL) were evaluated for nasal endoscopic score, paranasal sinuses CT score, histopathological and immunohistochemical changes. Endoscopic outcome scoring differences were evaluated for 1 year after endoscopic sinus surgery and 1 month oral corticosteroids treatment. No differences were observed between both groups (AFRS with/without HFL) concerning the total CT score and opacification features (P > 0.05). Eosinophils and CD3 + CD8 + T cell were dominant in both groups. More edema and less fibrosis were observed in HFL group. Gliotoxin producers Aspergilli were present in all HFL in comparison to 5/6 (83.3 %) in cases without HFL. Fewer patients 1/6 (16.6 %) and less number of recurrences/year 0.1 ± 0.4 occurred in the AFRS with HFL compared to the AFRS without HFL [5/6 (83.3 %) and 1.16 ± 0.7) (P = 0.021 and 0.023, respectively]. In addition to mucus and mucosal tissues, cheesy clay-like materials must be assessed in AFRS cases. Although patients of AFRS with HFL had negligible clinical differences from ordinary AFRS without HFL, they had better outcome after treatment.
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deShazo RD, Chapin K, Swain R (1997) Fungal sinusitis. N Eng J Med 337:254–259
Chakrabarti A, Denning DW, Ferguson BJ, Ponikau J, Buzina W, Kita H, Marple B, Panda N, Vlaminck S, Kauffmann-Lacroix C, Das A, Singh P, Taj-Aldeen SJ, Kantarcioglu AS, Handa KK, Gupta A, Thungabathra M, Shivaprakash MR, Bal A, Fothergill A, Radotra BD (2009) Fungal rhinosinusitis: a categorization and definitional schema addressing current controversies. Laryngoscope 119:1809–1818
Hutcheson PS, Schubert MS, Slavin RG (2010) Distinctions between allergic fungal rhinosinusitis and chronic rhinosinusitis. Am J Rhinol Allergy 24:405–408
Bent JP, Kuhn FA (1994) Diagnosis of allergic fungal sinusitis. Otolaryngol Head Neck Surg 111:580–588
Orlandi RR, Thibeault SL, Ferguson BJ (2007) Microarray analysis of allergic fungal sinusitis and eosinophilic mucin rhinosinusitis. Otolaryngol Head Neck Surg 136:707–713
Hamilos DL (2010) Allergic fungal rhinitis and rhinosinusitis. Proc Am Thorac Soc 7:245–252
Bhagat R, Shah A, Jaggi OP, Khan ZU (1993) Concomitant allergic bronchopulmonary aspergillosis and allergic Aspergillus sinusitis with an operated aspergilloma. J Allergy Clin Immunol 91:1094–1096
Schubert MS, Goetz DW (1998) Evaluation and treatment of allergic fungal sinusitis. I. Demographics and diagnosis. J Allergy Clin Immunol 102:387–394
Graham SM, Ballas ZK (1998) Preoperative steroids confuse the diagnosis of allergic fungal sinusitis. J Allergy Clin Immunol 101:139–140
Noble JA, Crow SA, Ahearn DG, Kuhn FA (1997) Allergic fungal sinusitis in the southeastern USA: involvement of a new agent Epicoccum nigrum Ehrenb. ex Schlecht. 1824. J Med Vet Mycol 35:405–409
Stark PC, Celedon JC, Chew GL, Ryan LM, Burge HA, Muilenberg ML, Gold DR (2005) Fungal levels in the home and allergic rhinitis by 5 years of age. Environ Health Perspect 113:1405–1409
Lund VJ, Kennedy DW (1995) Quantification for staging sinusitis. The staging and therapy group. Ann Otol Rhinol Laryngol 167:17–21
Lund VJ, Mackay IS (1993) Staging in rhinosinusitis. Rhinology 31:183–184
Ragab A, Clement P, Vincken W, Nolard N, Simones F (2006) Fungal cultures of different parts of the upper and lower airways in chronic rhinosinusitis. Rhinology 44:19–25
Kupferberg SB, Bent JP, Kuhn FA (1997) Prognosis for allergic fungal sinusitis. Otolaryngol Head Neck Surg 117:35–41
Hohl TM, Rivera A, Pamer EG (2006) Immunity to fungi. Curr Opin Immunol 18:465–472
Schütze N, Lehmann I, Bönisch U, Simon JC, Polte T (2010) Exposure to mycotoxins increases the allergic immune response in a murine asthma model. Am J Respir Crit Care Med 181:1188–1199
Kupfahl C, Michalka A, Lass-Flörl C, Fischer G, Haase G, Ruppert T, Geginat G, Hof H (2008) Gliotoxin production by clinical and environmental Aspergillus fumigatus strains. Int J Med Microbiol 298:319–327
Zinreich SJ, Kennedy DW, Malat J, Curtin HD, Epstein JI, Huff LC, Kumar AJ, Johns ME, Rosenbaum AE (1988) Fungal sinusitis: diagnosis with CT and MR imaging. Radiology 169:439–444
Reddy CE, Gupta AK, Singh P, Mann SB (2010) Imaging of granulomatous and chronic invasive fungal sinusitis: comparison with allergic fungal sinusitis. Otolaryngol Head Neck Surg 143:294–300
Klossek JM, Serrano E, Péloquin L, Percodani J, Fontanel JP, Pessey JJ (1997) Functional endoscopic sinus surgery and 109 mycetomas of the paranasal sinuses. Laryngoscope 107:112–117
Grosjean P, Weber R (2007) Fungus balls of the paranasal sinuses: a review. Eur Arch Otorhinolaryngol 264:461–470
Chen JC, Ho CY (2012) The significance of computed tomographic findings in the diagnosis of fungus ball in the paranasal sinuses. Am J Rhinol Allergy 26:117–119
Ragab A, Samaka RM (2013) immunohistochemical dissimilarity between allergic fungal and non fungal chronic rhinosinusitis. Am J Rhinol Allergy (in press)
Schubert MS, Goetz DW (1998) Evaluation and treatment of allergic fungal sinusitis. I. Demographics and diagnosis. J Allergy Clin Immunol 102:387–394
Rupa V, Jacob M, Mathews MS, Seshadri MS (2010) A prospective, randomised, placebo controlled trial of postoperative oral steroid in allergic fungal sinusitis. Eur Arch Otorhinolaryngol 267:233–238
Waxman JE, Spector JG, Sale SR, Katzenstein AA (1987) Allergic Aspergillus sinusitis: concepts in diagnosis and treatment of a new clinical entity. Laryngoscope 97:261–266
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Ragab, A., Samaka, R.M. & Salem, M. Impact of fungal load on diagnosis and outcome of allergic fungal rhinosinusitis. Eur Arch Otorhinolaryngol 271, 93–101 (2014). https://doi.org/10.1007/s00405-013-2467-3
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DOI: https://doi.org/10.1007/s00405-013-2467-3