PRESENTATION AND DIAGNOSIS OF ALLERGIC FUNGAL SINUSITIS

Authors

  • Zakir ullah
  • Ghareeb Nawaz
  • Syed Fazle Sattar

Abstract

Background: Allergic fungal sinusitis (AFS) is a form of fungal disease that has recently beenconsidered a distinct clinicopathologic entity. Other forms of fungal sinusitis include acute-fulminant(invasive), chronic indolent (invasive) and mycetoma (non-invasive). Objectives were to assess thepresentation and to describe the diagnostic techniques for allergic fungal sinusitis in our setup.Method: Descriptive study was conducted in the Department of ENT and Head & Neck Surgery,Khyber Medical College and Khyber Teaching Hospital, Peshawar from January 2002 to April 2008.Twenty-three cases of allergic fungal sinusitis (ASF) were selected for the study. Data like, name,age, sex, address, clinical features, labs (Eosinophil count) and imaging studies (CT and/or MRI)were recorded, including the pre- and postoperative treatment, operative findings and postoperativeresults, recurrence of disease were also recorded. Surgical procedures were performed on all casesfollowed by medical treatment. Results: Study revealed that AFS is a disease of younger age, mainlyoccurring in 2nd & 3rd decade of life, with male to female ratio 1:1.3. Allergic rhinitis (91%) andnasal polyposis (91%) were important associated factors. Nasal obstruction (96%), nasal discharge(91%), post-nasal discharge (87%) and unilateral multi sinus extension were important clinicalfeatures. Increased eosinophil count and increased IgE level was found in 78% cases.Histopathological analysis showed fungal hyphae in all cases and aspergillus was predominantorganism on culture. Orbital erosion was seen in 78% and skull base erosion was observed in 9%.Recurrence of disease was seen in nine cases. Conclusion: Allergic fungal sinusitis (AFS) is adisease of young immunocompetent adults. Nasal obstruction, nasal discharge, nasal allergy andproptosis were the most common presentations. Initial diagnosis of allergic fungal sinusitis requireshigh index of suspicion in patients presenting with chronic rhinosinusitis, such cases should beproperly evaluated. Differentiation from invasive forms of fungal sinus disease is crucial.Keyword: Sinusitis, Allergic Fungal Sinusitis, Skull base erosion, Orbital erosion, Fungal

References

Torres C, Ro JY, El-Naggar AK Sim SJ, Weber RS, Ayala

AG. Allergic fungal sinusitis: A clinicopathologic study of 16

cases. Hum Pathol 1996;27:793–9.

Millar JW, Johnston A, Lamb D. Allergic a spergillosis of the

maxillary sinuses, Prod Scot Thor Soc 1981;36:710–3.

Katzenstein AA, Sale SR and Greenburger PA. Allergic

Aspergillus sinusitis: a newly recognized form of sinusitis, J.

Allergy Clin. Immunol 1983;72(1):89–93.

Bent JP 3rd, Kuhn FA. Diagnosis of allergic fungal sinusitis.

Otolaryngol Head Neck Surg 1994;111:580–8.

DeShazo RD, Swain RE, Diagnostic criteria for allergic fungal

sinusitis. J Allergy Clin Immunol 1995;96:24–35.

Schubert MS, Medical treatment of allergic fungal sinusitis. Ann

Allergy Asthma Immunol 2000;85:90–101.

Ramadan HH and Quraishi HA. Allergic mucin sinusitis without

fungus, Am J Rhinol 1997;11:145–7.

Ferguson BJ. Eosinophilic mucin rhinosinusitis: a distinct

clicopathological entity, Laryngoscope 2000;110:799–813.

Manning SC, Schaefer SD, Close LG, Vuitch F. Culture positive

allergic fungal sinusitis. Arch Otollaryngol Head Neck Surg

;117:174–8.

Handley GH, Vissher DW, Katzenstein ALA, Peter GE. Bone

erosion in allergic fungal sinusitis. Am J Rhinol 1990;4:149–53.

Hartwick RW, Batsakis JG. Pathology consultation. Sinus

aspergillosis and allergic fungal sinusitis. Ann Otol Rhinol

Laryngol 1991;100: 427–30.

Ghegan MD, Lee F, Schlosser RJ. Incidence of skull base and

orbital erosion in allergic rhinosinusitis. Otolaryngology-Head

and Neck Surgery 2006;134:592–5.

Carter KD, Graham SN, Ophthalmic manifestation of allergic

fungal sinusitis. Am J Ophthalmol 1999:127(2):189–95.

Wise SK, Ventatraman G, Wise JC, JM Delgaudio. Ethnic and

gender differences in bone erosion in AFS. Am J Rhinol

;18:397–404.

Schubert MS. Allergic fungal sinusitis. Otolaryngol Clin N Am

;37: 301–26.

Panda NK, Balaji P, Chakrabarti A, Sharma SC, Reddy CE.

Paranasal aspergillosis: its categrization to develop a treatment

protocol. Mycoses; 2004:47:277–83.

Gupta AK, Gosh S, Gupta AK. Sinonasal aspergillosis in

immunocompetent Indian children. Mycoses 2003;46:455–61.

J Ayub Med Coll Abbottabad 2010;22(1)

http://www.ayubmed.edu.pk/JAMC/PAST/22-1/Zakirullah.pdf 57

Manning SC, Mabry RL, Schaefer SD, Close LG. Evidence of

IgE-mediated hypersensitivity in allergic fungal sinusitis.

Laryngoscope 1993;103:717–21.

Thahim K, Jawaid MA, Marfani MS. Presentation and

management of allergic fungal sinusitis. J Coll Physicians Surg

Pak 2007;17:23–7.

Schubert MS, Goetz DW. Evaluation and treatment of allergic

fungal sinusitis. II. Treatment and follow-up. J Allergy Clin

Immunol 1998;102:395–402.

Gupta AK, Basnal S, Gupta A, Mathur N. Is fungal infestation of

paranasal sinuses more aggressive in padiatric population?

International journalof paediatric Otolaryngology 2006;70:603–8

Schubert MS, Goetz DW, Evaluation and treatment of allergic

fungal sinusitis. I. Demographics and diagnosis. J Allergy Clin

Immunol 1998;102:387–94.

Mian MY, Kamal SA, Senthilkumaran G, Abdullah A, Pirani M.

Allergic fungal rhinosinusitis: Current status. Pak J Otolaryngol

;18(3):36–40.

Iqbal J, Raza SN, Naqvi NU, Azeem QA, Rahat ZM. Endoscopic

sinus surgery versus intranasal polypectomy for ethmoidal nasal

polyposis. Pak J Otolaryngol 2007;23(1):3–5.

Sohail MA, Al Khabori MJ, Hyder J, Verma A. Allergic fungal

sinusitis: Can we predict the recurrence? Otolaryngol Head Neck

Surg 2004;131:704–10.

Marple BF, Mabry RL. Allergic fungal sinusitis: Learning from

our failures. Am J Rhinol 2000;14:223–6.

Lund VJ, Say L. Radiology in focus. Fungal sinusitis. J Otol

Laryngol 2000;114:76–80.

Marple BF. Allergic fungal rhinosinusitis: current theories and

management strategies. Laryngoscope 2001;111:1006–19.

Marbry LA, Manning S. Radioallergosorbent microscreen and

total immunoglobulin E in allergic fungal sinusitis. Otolaryngol

Head Neck Surg 1995;113:721–3.

Ferguson BJ. What role do systemic steroid, immunotherapy and

antifungal drugs play in the therapy of allergic fungal

rhinosinusitis? Arch Otolaryngol Head Neck Surg

;124:1174–8.

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Published

2010-03-01