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Salil A, Joy N, Faizal B. A prospective study comparing itraconazole alone versus systemic steroids alone as adjuncts to topical steroids in the post-operative management of allergic fungal rhinosinusitis. Clin Otolaryngol 2023; 48:356-362. [PMID: 36478077 DOI: 10.1111/coa.14014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 11/10/2022] [Accepted: 11/20/2022] [Indexed: 12/12/2022]
Abstract
OBJECTIVES The objective of this study was to compare the efficacy of itraconazole and systemic steroids as an adjuvant to topical steroids in post-operative patients with allergic fungal rhinosinusitis (AFRS) using both subjective and objective outcome measurements. DESIGN A prospective comparative study. SETTING A tertiary care centre. PARTICIPANTS Sixty patients diagnosed with AFRS were included. Patients with chronic systemic illness and those undergoing revision surgery were excluded. Post-operative patients were divided into two groups of 30 each which received itraconazole 400 mg OD or methylprednisolone in tapering doses over 6 weeks. MAIN OUTCOME MEASURES The outcomes were measured at the end of 6 weeks-Kupferberg endoscopic staging, absolute eosinophilic count (AEC), serum immunoglobulin (IgE), and Sino Nasal Outcome Test-20 scores. RESULTS Our study showed no statistical significance in outcomes between the two groups treated with itraconazole and methylprednisolone regarding recurrence, AEC, IgE and quality of life assessment (p < 0.01). CONCLUSION Itraconazole was comparable to methylprednisolone in preventing disease recurrence in the post-operative management of AFRS. It may be a viable alternative to replacing systemic steroids where the latter may be contraindicated. Itraconazole given at a dose of 400 mg once daily for 6 weeks was a safe dose.
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Affiliation(s)
- Amala Salil
- Department of ENT, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeedham University, Kochi, India
| | - Nedha Joy
- Department of ENT, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeedham University, Kochi, India
| | - Bini Faizal
- Department of ENT, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeedham University, Kochi, India
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Carney AS, Tan LW, Adams D, Varelias A, Ooi EH, Wormald PJ. Th2 Immunological Inflammation in Allergic Fungal Sinusitis, Nonallergic Eosinophilic Fungal Sinusitis, and Chronic Rhinosinusitis. ACTA ACUST UNITED AC 2018. [DOI: 10.1177/194589240602000204] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background Noninvasive fungal sinusitis is a heterogenous group of conditions including allergic fungal sinusitis (AFS) and nonallergic eosinophilic fungal sinusitis (NEFS). Th2-mediated cascades have been postulated to be the major inflammatory response in patients with AFS although other mechanisms also may be involved. The detailed mucosal Th2 cytological status of NEFS still has not been studied in great depth. Methods Using a meticulous patient selection algorithm over a 2-year period, infundibular mucosal tissue from patients with AFS, NEFS, chronic rhinosinusitis (CRS), and normal controls was studied (n = 59). Immunohistochemistry for mast cells, eosinophils, and immunoglobulin E (IgE) cells was performed and cell counts per unit area were measured. Results Mast cell, eosinophil, and IgE+ cell numbers were significantly raised in patients with AFS, NEFS, and CRS when compared with controls. There was no significant difference between cell numbers in patients with AFS and NEFS. Conclusion Patients with AFS exhibit a classic Th2 inflammatory response in nasal mucosal tissue with NEFS and CRS patients showing evidence of a similar Th2 cascade, including the presence of IgE+ cells.
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Affiliation(s)
- A. Simon Carney
- Department of Otolaryngology–Head and Neck Surgery, Flinders Medical Center and Flinders University, Australia
| | - Lor-Wai Tan
- Department of Otolaryngology–Head and Neck Surgery, Queen Elizabeth Hospital and Adelaide University, Australia
| | - Damian Adams
- Department of Otolaryngology–Head and Neck Surgery, Queen Elizabeth Hospital and Adelaide University, Australia
| | - Antiopi Varelias
- Department of Otolaryngology–Head and Neck Surgery, Queen Elizabeth Hospital and Adelaide University, Australia
| | - Eng Hooi Ooi
- Department of Otolaryngology–Head and Neck Surgery, Queen Elizabeth Hospital and Adelaide University, Australia
| | - Peter-John Wormald
- Department of Otolaryngology–Head and Neck Surgery, Queen Elizabeth Hospital and Adelaide University, Australia
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Abstract
Background Ponikau used a novel collection and culturing method to recover fungi from nasal secretion in patients with chronic rhinosinusitis. The same method had been used previously in Europe with a similar result. However, the use of Ponikau's method has not been reported in Asia. Methods Fifty-one patients with chronic rhinosinusitis who were scheduled for functional endoscopic sinus surgery were enrolled in this study. One day before functional endoscopic sinus surgery, swab specimens were obtained from middle meatuses and were sent to the microbiology laboratory for routine bacterial and fungal cultures. Then, the same nasal cavity was lavaged with 20 mL of sterile water. The exhaled fluid was collected and processed using the Ponikau method. Skin testing with Candida extract was done also in all patients. The results obtained by different culture methods were compared. Results Bacteria grew from 45 of 51 swab specimens. The culture rate was 88.2%. Fungi were cultured from 6 of 51 swab specimens (11.8%) and from 25 of 51 lavage specimens (49%). The fungal culture rates were significantly different between swab and lavage specimens (p < 0.001). Candida was the most common cultured fungi in the lavaged specimens. Conclusions The study showed that Ponikau's method resulted in a higher fungal culture rate than that obtained with the swab method, but the culture rate was lower than the bacterial culture rate. Additional study is needed to investigate the role of fungi in the pathogenesis of chronic rhinosinusitis.
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Affiliation(s)
- Rong-San Jiang
- Department of Otolaryngology, Taichung Veterans General Hospital, and Department of Medicine, Chung-Shan Medical University, Taiwan, Republic of China
| | - Mao-Chang Su
- Department of Otolaryngology, Chung-Shan Medical University Hospital, and Department of Medicine, Chung-Shan Medical University, Taiwan, Republic of China
| | - Jen-Fu Lin
- Department of Clinical Microbiology, Taichung Veterans General Hospital, Taiwan, Republic of China
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Barac A, Ong DSY, Jovancevic L, Peric A, Surda P, Tomic Spiric V, Rubino S. Fungi-Induced Upper and Lower Respiratory Tract Allergic Diseases: One Entity. Front Microbiol 2018; 9:583. [PMID: 29666610 PMCID: PMC5891636 DOI: 10.3389/fmicb.2018.00583] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Accepted: 03/14/2018] [Indexed: 02/06/2023] Open
Abstract
Introduction:Aspergillus can cause different allergic diseases including allergic bronchopulmonary aspergillosis (ABPA) and allergic fungal rhinosinusitis (AFRS). ABPA is allergic pulmonary disease against Aspergillus antigens. AFRS is a type of chronic rhinosinusitis (CRS) presented as hypersensitivity reactions to the fungal presence in sinuses. The aim of the present study was to clarify if ABPA and AFRS could be considered as a common disease entity. Methodology: The prospective cohort study included 75 patients with ABPA. Patients were divided into two groups and compared with each other: (i) patients with CT confirmation of rhinosinusitis and presence of fungi in sinuses (ABPA+AFRS group) and (ii) patients without CT or without mycological evidence of AFRS (ABPA group). Results: Findings of this study were: (i) AFRS was confirmed in 80% of patients with ABPA; (ii) all ABPA+AFRS patients had allergic mucin while fungal hyphae were present in 60% sinonasal aspirate; (iii) ABPA+AFRS patients had more often complicated CRS with (nasal polyps) NP (p < 0.001) and more severe forms of CRS; (iv) culture of sinonasal aspirate revealed fungal presence in 97% patients with ABPA+AFRS; (v) patients with ABPA+AFRS had more common positive skin prick test (SPT) for A. fumigatus (p = 0.037), while patients without AFRS had more common positive SPT for Alternaria alternata and Penicillium notatum (p = 0.04 and p = 0.03, respectively); (vi) 67% of ABPA patients had Aspergillus induced AFRS; (vii) larger number of fungi was isolated from the air-samples obtained from homes of patients with ABPA+AFRS than from the homes of patients without AFRS, while the most predominant species were A. fumigatus and A. niger isolated from almost 50% of the air-samples. Conclusion: The pathogenesis of ABPA and AFRS is similar, and AFRS can be considered as the upper airway counterpart of ABPA. Fungi-induced upper and lower respiratory tract allergic diseases present common entity. Next studies should clarify the mechanism by which fungi turn from “normal flora” into trigger of immunological reactions, resulting in ABPA or AFRS as well as to find new approaches for its' diagnosis and treatment.
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Affiliation(s)
- Aleksandra Barac
- Clinic for Infectious and Tropical Diseases, Clinical Centre of Serbia, Belgrade, Serbia.,Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - David S Y Ong
- Department of Medical Microbiology and Infection Prevention, Franciscus Gasthuis and Vlietland, Rotterdam, Netherlands.,Department of Epidemiology, University Medical Centre Utrecht, Utrecht, Netherlands
| | - Ljiljana Jovancevic
- Department of Otorhinolaryngology, Clinical Centre of Vojvodina, Novi Sad, Serbia.,Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
| | - Aleksandar Peric
- Department of Otorhinolaryngology, Military Medical Academy, Belgrade, Serbia
| | - Pavol Surda
- Department of Otorhinolaryngology, Guy's and St Thomas' University Hospital, London, United Kingdom
| | - Vesna Tomic Spiric
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia.,Clinic for Allergology and Immunology, Clinical Centre of Serbia, Belgrade, Serbia
| | - Salvatore Rubino
- Department of Biomedical Sciences, University of Sassari, Sassari, Italy
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Hashemian F, Hashemian F, Molaali N, Rouini M, Roohi E, Torabian S. Clinical effects of topical antifungal therapy in chronic rhinosinusitis: a randomized, double-blind, placebo-controlled trial of intranasal fluconazole. EXCLI JOURNAL 2016; 15:95-102. [PMID: 27065776 PMCID: PMC4822190 DOI: 10.17179/excli2015-678] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/13/2015] [Accepted: 01/26/2016] [Indexed: 02/03/2023]
Abstract
Several studies have been in favor of fungi as a possible pathogenesis of chronic rhinosinusitis (CRS); however, to date, there is no scientific consensus about the use of antifungal agents in disease management. The aim of the present study was to investigate the efficacy of intranasal fluconazole in improving disease symptoms and objective outcomes of patients with CRS. A randomized, double-blind, placebo-controlled study was conducted on 54 patients who were diagnosed with CRS and had not been responsive to routine medical treatments. They were randomly assigned to receive either fluconazole nasal drop 0.2 % or placebo in addition to the standard regimen for a duration of 8 weeks. Patients' outcomes were evaluated according to Sino-Nasal Outcome Test 20 (SNOT-20), endoscopic scores, and Computed Tomography (CT) scores. No statistically significant difference was found in SNOT-20 (p = 0.201), endoscopic (p = 0.283), and CT scores (p = 0.212) of the patients at baseline and after 8-week course of treatment between drug and placebo group. Similar to many studies, the use of topical antifungal treatment for patients with CRS was not shown to be significantly effective. However, further studies are needed to obtain high levels of consistent evidence in order to arrive at a decision whether antifungal therapy is effective in management of CRS or not.
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Affiliation(s)
- Farshad Hashemian
- Department of Clinical Pharmacy, Faculty of Pharmacy, Islamic Azad University, Pharmaceutical Sciences Branch, Tehran, Iran
| | - Farnaz Hashemian
- Department of Otolaryngology, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Najmeh Molaali
- Department of Clinical Pharmacy, Faculty of Pharmacy, Islamic Azad University, Pharmaceutical Sciences Branch, Tehran, Iran
| | - Mohammadreza Rouini
- Department of Pharmaceutics, Tehran University of Medical Sciences, Tehran, Iran
| | - Elnaz Roohi
- Department of Clinical Pharmacy, Faculty of Pharmacy, Islamic Azad University, Pharmaceutical Sciences Branch, Tehran, Iran
| | - Saadat Torabian
- Department of Community Medicine, School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran
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Boase S, Valentine R, Singhal D, Tan LW, Wormald PJ. A sheep model to investigate the role of fungal biofilms in sinusitis: fungal and bacterial synergy. Int Forum Allergy Rhinol 2011; 1:340-7. [PMID: 22287463 DOI: 10.1002/alr.20066] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2010] [Revised: 03/07/2011] [Accepted: 03/15/2011] [Indexed: 12/27/2022]
Abstract
BACKGROUND The role of fungi in the spectrum of chronic rhinosinusitis (CRS) is poorly understood. Fungal biofilms have recently been discovered in CRS patients. We have developed an animal model for the investigation of sinonasal fungal biofilms. The role of type I hypersensitivity and pathogenic bacteria is presented. METHODS Thirty sheep were sensitized with fungal antigens-Aspergillus fumigatus and Alternaria alternata, or control. Endoscopic surgery was performed to expose both frontal sinus ostia-1 was occluded. Fungi with or without Staphylococcus aureus were inoculated into the sinus. Skin-prick tests assessed for fungal allergy. Fungal and S. aureus biofilms, histology, and culture rates were assessed. RESULTS Forty-five percent of experimental sheep were sensitized to fungal antigen. Only 1 sinus inoculated with fungus developed minimal fungal biofilm. Eighty percent developed fungal biofilm when S. aureus was co-inoculated. The presence of hypersensitivity to fungus was not related to fungal biofilm development. CONCLUSION Significant fungal biofilm only occurred when S. aureus was the co-inoculum. Hypersensitivity was not requisite. The relationship of S. aureus to fungal biofilms is of great clinical interest. Fungi may be opportunistic pathogens that simply require inflamed mucosa with weakened innate defenses; alternatively, a cross-kingdom synergy could be contributing to fungal proliferation.
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Affiliation(s)
- Sam Boase
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Adelaide and Flinders University, Adelaide, Australia
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Hedayati M, Bahoosh M, Kasiri A, Ghasemi M, Motahhari S, Poormosa R. Prevalence of fungal rhinosinusitis among patients with chronic rhinosinusitis from Iran. J Mycol Med 2010. [DOI: 10.1016/j.mycmed.2010.09.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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8
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Curtis L, Lieberman A, Stark M, Rea W, Vetter M. Adverse Health Effects of Indoor Molds. ACTA ACUST UNITED AC 2009. [DOI: 10.1080/13590840400010318] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Shin SH, Ye MK, Lee YH. Fungus culture of the nasal secretion of chronic rhinosinusitis patients: seasonal variations in Daegu, Korea. ACTA ACUST UNITED AC 2008; 21:556-9. [PMID: 17999789 DOI: 10.2500/ajr.2007.21.3065] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND The role of fungi in the pathogenesis of chronic rhinosinusitis (CRS) is being increasingly recognized. The presences of fungal spores are a necessary condition for fungal sinusitis, and fungal spore counts vary widely, both geographically and seasonally. The aim of this study was to characterize fungal seasonal variation in the nasal cavity of CRS patients and to compare it with histologic types of nasal polyps. METHODS One hundred eight patients with a clinical diagnosis of CRS with polyps were enrolled in this study for 1 year. Nasal secretions were obtained by aspiration and cultured to identify fungi. Nasal polyps were divided into four histologic types: eosinophilic, fibroinflammatory, seromucinous, and atypical. RESULTS Positive cultures for fungi were obtained in 60 of 108 (63.0%) CRS patients, and 28 of 45 (62.2%) normal volunteers. Fungus culture rates were higher during summer and fall. Cladosporium, Aspergillus, Alternaria, and Penicilium were frequently isolated from CRS patients and normal volunteers. The most common histologic type was the fibroinflammatory type (60.2%), although in the summer and fall the proportion of the eosinophilic type increased. CONCLUSION Fungi were commonly cultured during a hot and humid environment, during summer and fall, and cultured organism types were found to be seasonal dependent. Histologic types of nasal polyps appear to be associated with fungal culture rate, organism type, and seasonal variations.
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Affiliation(s)
- Seung-Heon Shin
- Department of Otorhinolaryngology, School of Medicine, Catholic University of Daegu, Daegu, Korea.
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10
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Aydil U, Kalkanci A, Ceylan A, Berk E, Kuştimur S, Uslu S. Investigation of fungi in massive nasal polyps: microscopy, culture, polymerase-chain reaction, and serology. ACTA ACUST UNITED AC 2007; 21:417-22. [PMID: 17882909 DOI: 10.2500/ajr.2007.21.3054] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Although some clues exist about the causative relationship of fungi and chronic rhinosinusitis, the relationship of nasal polyps and fungi has not been enlightened. The purpose of this study was to determine whether a relationship exists between fungi and massive nasal polyps and to evaluate current available diagnostic techniques for detection of fungi. METHODS Thirty cases of massive nasal polyposis (NP) were evaluated prospectively for fungal evidence and were compared with 18 cases of concha bullosa based on direct microscopy, fungal culture, serology, polymerase chain reaction (PCR), and sequencing. RESULTS Fungal colonization was detected in 15 (50.0%) of the cases with massive NP, but only in 2 (11.1%) of the cases with concha bullosa. A significant difference was found between the study and the control groups in terms of fungal existence (p < 0.016). Direct microscopy was positive in 14 (46.7%) and 1 (5.6%) of the cases;fungal culture was positive in 8 (26.7%) and 4 (22.2%) of the cases; serology was positive in 9 (30.0%) and 2 (11.1%) of the cases; PCR was positive in 18 (60.0%) and 6 (33.3%) of the cases with massive NP and concha bullosa, respectively. CONCLUSION Fungal colonization was found to be more common in massive NP patients compared with the control group. According to our results, microscopy and PCR were most sensitive techniques for detection of fungi.
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Affiliation(s)
- Utku Aydil
- Department of Otorhinolaryngology, Gazi University School of Medicine, Ankara, Turkey.
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11
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Characterization of fungi in chronic rhinosinusitis using polymerase chain reaction and sequencing. Eur Arch Otorhinolaryngol 2007; 265:651-5. [DOI: 10.1007/s00405-007-0529-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2007] [Accepted: 10/30/2007] [Indexed: 11/25/2022]
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Impact of Perioperative Systemic Steroids on Surgical Outcomes in Patients With Chronic Rhinosinusitis With Polyposis: Evaluation With the Novel Perioperative Sinus Endoscopy (POSE) Scoring System. Laryngoscope 2007; 117:1-28. [DOI: 10.1097/mlg.0b013e31814842f8] [Citation(s) in RCA: 173] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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13
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Sok JC, Ferguson BJ. Differential diagnosis of eosinophilic chronic rhinosinusitis. Curr Allergy Asthma Rep 2006; 6:203-14. [PMID: 16579870 DOI: 10.1007/s11882-006-0036-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Eosinophilic chronic rhinosinusitis (ECRS) encompasses a wide variety of etiologies. To date, a unifying pathophysiologic mechanism remains elusive. Eosinophilia is frequently, but not exclusively, caused by immunoglobulin (Ig)E-mediated hypersensitivity and is dominated by the associated cytokine milieu of Th2 inflammation. The provisional subcategories of ECRS include superantigen-induced eosinophilic chronic rhinosinusitis, allergic fungal sinusitis, nonallergic fungal eosinophilic chronic rhinosinusitis, and aspirin-exacerbated eosinophilic chronic rhinosinusitis. Within each subcategory, recent findings supporting distinct mechanisms that promote eosinophilic infiltration are presented, and, therefore, targeted therapeutic interventions with specific antibacterial, antifungal, or immune modulation may be indicated.
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Murr AH, Goldberg AN, Vesper S. Fungal speciation using quantitative polymerase chain reaction (QPCR) in patients with and without chronic rhinosinusitis. Laryngoscope 2006; 116:1342-8. [PMID: 16885733 PMCID: PMC7165928 DOI: 10.1097/01.mlg.0000225896.91392.6a] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES/HYPOTHESIS The objectives of this study were to determine the mycology of the middle meatus using an endoscopically guided brush sampling technique and polymerase chain reaction laboratory processing of nasal mucous; to compare the mycology of the middle meatus in patients with sinus disease with subjects without sinus disease; to compare the responses on two standardized quality-of-life survey forms between patients with and without sinusitis; and to determine whether the presence of fungi in the middle meatus correlates with responses on these data sets. STUDY DESIGN The authors conducted a single-blind, prospective, cross-sectional study. METHODS Patients with sinus disease and a control group without sinus disease were enrolled in the study. A disease-specific, validated Sinonasal Outcomes Test survey (SNOT-20) was completed by the subjects and a generalized validated Medical Outcomes Short Form 36 Survey (SF-36) was also completed. An endoscopically guided brush sampling of nasal mucous was obtained from the middle meatus. Fungal specific quantitative polymerase chain reaction (QPCR) was performed on the obtained sample to identify one of 82 different species of fungus in the laboratory. Statistical analysis was used to categorize the recovered fungal DNA and to crossreference this information with the outcomes surveys. RESULTS The fungal recovery rate in the study was 45.9% in patients with sinus disease and 45.9% in control subjects. Patients with chronic rhinosinusitis had a mean SNOT-20 score of 1.80 versus the control group mean score of 0.77 (P < .0001). SF-36 data similarly showed a statistically significant difference between diseased and control populations with controls scoring a mean of 80.37 and patients with chronic rhinosinusitis scoring a mean of 69.35 for a P value of .02. However, no statistical significance could be ascribed to the presence or absence of fungi recovered, the type of fungi recovered, or the possible impact of fungi on the quality-of-life survey results. CONCLUSION The recovery rate of fungi from the middle meatus of patients with chronic rhinosinusitis and a control population without chronic rhinosinusitis is 45.9% using QPCR techniques. No direct causation with regard to fungal species or presence was proven; however, a species grouping for future studies is proposed based on trends in this data and other reports. Disease-specific outcomes surveys revealed a statistically significant difference between the two groups.
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Affiliation(s)
- Andrew H Murr
- Department of Otolaryngology/Head and Neck Surgery, School of Medicine, University of California-San Francisco, San Francisco, CA 94143, USA.
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Dall'Igna C, Palombini BC, Anselmi F, Araújo E, Dall'Igna DP. Rinossinusite fúngica em pacientes com infecção nasossinusal crônica. ACTA ACUST UNITED AC 2005. [DOI: 10.1590/s0034-72992005000600004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJETIVO: Estudar a rinossinusite fúngica em pacientes com infecção nasossinusal crônica. Nas últimas décadas houve aumento das infecções fúngicas, e a rinossinusite fúngica (RSF) tem sido mais freqüentemente diagnosticada. O conhecimento da flora fúngica, da sua prevalência e da apresentação sintomática em pacientes portadores de rinossinusite crônica (RSC) permitirá um melhor entendimento da doença, fato importante para a realização do diagnóstico, estabelecimento do tratamento e formulação do prognóstico. FORMA DE ESTUDO: clínico retrospectivo com coorte transversal. MATERIAL E MÉTODO: 62 pacientes com diagnóstico de RSF foram selecionados entre 890 portadores de RSC submetidos à cirurgia endoscópica. Avaliou-se anamnese, exame otorrinolaringológico com videoendoscopia nasal, TC dos seios da face e exames microbiológicos e histopatológico. RESULTADOS: A prevalência de RSF foi de 6,7% em portadores de RSC submetidos à cirurgia endoscópica dos seios paranasais, e o tipo de fungo mais encontrado foi do gênero Aspergillus. Bola fúngica foi encontrada em mais da metade dos casos, e RSFA, em mais de um terço dos pacientes. CONCLUSÕES: A evolução sintomática após a cirurgia endoscópica foi mais favorável nos portadores de bola fúngica, que necessitaram menor número de reintervenções.
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Dall'Igna C, Palombini BC, Anselmi F, Araújo E, Dall'Igna DP. Fungal rhinosinusitis in patients with chronic sinusal disease. Braz J Otorhinolaryngol 2005; 71:712-20. [PMID: 16878237 PMCID: PMC9443512 DOI: 10.1016/s1808-8694(15)31237-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2005] [Accepted: 08/05/2005] [Indexed: 11/10/2022] Open
Abstract
AIM Fungal rhinosinusitis in patients with chronic sinusal disease study. In the past decades, there has been an increase in fungal infections, and fungal rhinosinusitis (FRS) has been diagnosed more frequently. Knowing the fungal flora, its prevalence and symptomatic presentation in patients with chronic rhinosinusitis (CRS) will allow a better understanding of this disease, permitting a correct diagnosis, and treatment and formulating its prognosis. STUDY DESIGN clinical retrospective with transversal cohort. MATERIAL AND METHOD 62 patients diagnosed with FRS were selected among 890 cases of CRS undergoing endoscopic surgery. We assessed clinical history otolaryngologic examination with nasal videoendoscopy, CT scan, microbiologic and histopatologic tests. RESULTS The prevalence of FRS was 6.7% and the fungal type most frequently found was the gender Aspergillus. Fungal ball was found in more than half the cases, and allergic fungal rhinosinusitis (AFRS) in more than one third of the patients. Evolution after endoscopic sinus surgery was more favorable in patients with fungus ball, with a minor number of recurrences. CONCLUSIONS The symptomatic evolution following endoscopic surgery was more favorable in patients with fungal ball, who require a lower number of re-interventions.
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McClenny N. Laboratory detection and identification of Aspergillus species by microscopic observation and culture: the traditional approach. Med Mycol 2005; 43 Suppl 1:S125-8. [PMID: 16110804 DOI: 10.1080/13693780500052222] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
Molecular and immunologic tests promise better, faster laboratory diagnosis of aspergillosis, but microscopy and culture remain commonly used and essential tools. Procedural changes, as well as adequate training of laboratory professionals, can enhance the value of these traditional tools. Using Blankophor or Calcofluor for microscopic examinations; improving recognition of morphologic characteristics of opportunistic fungi in stained smears of specimens; maximizing the growth rate and production of conidia by Aspergillus spp. in culture; and recognizing atypical variants of common aspergilli can improve the laboratory's contribution to rapid diagnosis. Surveys indicate that the number of laboratory professionals is declining as the demand for healthcare is rising. Effective recruitment, retention, and training of personnel must be concurrent with advances in technology.
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Affiliation(s)
- N McClenny
- CLS Internship Program, San Francisco State University, San Francisco, CA, USA.
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Polzehl D, Weschta M, Podbielski A, Riechelmann H, Rimek D. Fungus culture and PCR in nasal lavage samples of patients with chronic rhinosinusitis. J Med Microbiol 2005; 54:31-37. [PMID: 15591252 DOI: 10.1099/jmm.0.45881-0] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Chronic rhinosinusitis (CRS) affects approximately 15 % of the adult population in industrialized countries. Fungi have been recognized as important pathogens in CRS in the immunocompromised host. Recently, fungi have been detected in more than 90 % of nasal lavages (NLs) in immunocompetent patients with CRS. Employing NLs of immunocompetent patients with CRS in the present study, the detection rates for fungi by culture techniques were compared with the results of different fungus-specific PCR assays. Standard fungal cultures were performed on NLs from 77 patients with CRS. NLs were also tested for the presence of fungal DNA by a panfungal assay with and without specific probes for Candida spp. and Aspergillus spp./Penicillium spp., and an Aspergillus-specific nested PCR assay. Nineteen of the 77 samples (25 %) grew fungi. Fungus-specific DNA was detected in 34 of 77 NLs (44 %). Twelve samples were positive for both culture and panfungal PCR, whereas seven specimens grew fungi in culture, but were negative in panfungal PCR, and an additional seven samples were positive in panfungal PCR, but negative in culture. The combination of culture and all employed PCR assays detected fungi in 39 patients (50 %). This study demonstrated that PCR and conventional culture techniques could be complementary diagnostic techniques to detect fungi in nasal specimens from CRS patients.
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Affiliation(s)
- Doreen Polzehl
- Department of Otorhinolaryngology, University of Ulm, Prittwitzstrasse 43, 89075 Ulm, Germany 2Department of Medical Microbiology and Hospital Hygiene, University Hospital, Rostock, Germany 3Department of Medical Microbiology and Hospital Hygiene, University of Rostock, Germany
| | - Michael Weschta
- Department of Otorhinolaryngology, University of Ulm, Prittwitzstrasse 43, 89075 Ulm, Germany 2Department of Medical Microbiology and Hospital Hygiene, University Hospital, Rostock, Germany 3Department of Medical Microbiology and Hospital Hygiene, University of Rostock, Germany
| | - Andreas Podbielski
- Department of Otorhinolaryngology, University of Ulm, Prittwitzstrasse 43, 89075 Ulm, Germany 2Department of Medical Microbiology and Hospital Hygiene, University Hospital, Rostock, Germany 3Department of Medical Microbiology and Hospital Hygiene, University of Rostock, Germany
| | - Herbert Riechelmann
- Department of Otorhinolaryngology, University of Ulm, Prittwitzstrasse 43, 89075 Ulm, Germany 2Department of Medical Microbiology and Hospital Hygiene, University Hospital, Rostock, Germany 3Department of Medical Microbiology and Hospital Hygiene, University of Rostock, Germany
| | - Dagmar Rimek
- Department of Otorhinolaryngology, University of Ulm, Prittwitzstrasse 43, 89075 Ulm, Germany 2Department of Medical Microbiology and Hospital Hygiene, University Hospital, Rostock, Germany 3Department of Medical Microbiology and Hospital Hygiene, University of Rostock, Germany
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Ravikumar A, Mohanty S, Vatsanath RP, Raghunandhan S. Allergic fungal sinusitis- A clinico-pathological study. Indian J Otolaryngol Head Neck Surg 2004; 56:317-20. [PMID: 23120110 DOI: 10.1007/bf02974401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
The co-existence of fungal elements in allergic nasal Polyposis, has given rise to a distinct clinical entity known as 'Allergic fungal sinusitis ' (AF'S). Many a time, these fungal elements may not be diagnosed pre-operatively by routine diagnostic nasal endoscopy or CT scan of paranasal sinuses, due to the florid presentation of nasal polyps, which usually obscure the underlying fungal pathology. The diagnosis is often made intra-operatively. The post-operative confirmation of AFS is by histopathology, fungal smear, fungal culture, allergic murin study and fungal specific IgE titres. We report a series often such cases done in our institution, which highlight that AFS should be considered as a differential diagnosis in Sinonasal Polyposis cases, for their effective management.
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Affiliation(s)
- A Ravikumar
- Department of ENT-Head & Neck Surgery, Sriramachandra Medical College & Research Institute, Deemed University, Ramachandra Nagar, Porur, Chennai-600116 Tamil Nadu, India
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Chakrabarti A, Das A, Panda NK. Overview of fungal rhinosinusitis. Indian J Otolaryngol Head Neck Surg 2004; 56:251-8. [PMID: 23120090 PMCID: PMC3451156 DOI: 10.1007/bf02974381] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
The incidence of fungal rhinosinusitis has increased to such extent in recent years that fungal infection should be considered in all patients with chronic rhino sinusitis. In India though the disease was reported earlier only from northern regions of this country, nowadays the disease is increasingly diagnosed from other parts as well. The disease has been categorized with possible five types: acute necrothing (fulminant), chronic invasive, chronic granulomatous invasive, fungal hall (sinus mycetoma), allergic. The first three types are tissue-invasive and the last two are non-invasive fungal rhinosinusitis. However, the categorization is still controversial and open to discussion. Chronic fungal rhinosinusitis can occur in otherwise healthy host and Aspergillus flavus is the common etiological agent in Indian scenario. The pathophys iologic mechanism of the disease remains unclear. It may represent an allergic IgE response, a cell-mediated reaction, or a combination of two. Early diagnosis may prevent multiple surgical procedures and lead to effective treatment. Histopathology and radio-imaging techniques help to distinguish different types and delineate extension of disease process. Culture helps to identify the responsible etiological agent. The presence or absence oj precipitating antibody correlates well with disease progression or recovery. The most immediate need regarding management is to establish the respective roles of surgery and antifungal therapy. Non-invasive disease requires surgical debridement and sinus ventilation only, though, additional oral or local corticosterold therapy may be beneficial in allergie type. For invasive disease, the adjuvant medical therapy is recommended to prevent recurrence and further extension. Itraconazole has been found as an effective drug in such situation. Patients with acute neerotizing type require radical surgery and amphotericin B therapy.
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Affiliation(s)
- Arunaloke Chakrabarti
- Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research, PGIMER, 160012 Chandigarh
| | - Ashim Das
- Department of Medical Histopathology, Postgraduate Institute of Medical Education and Research, Chandigarh
| | - Naresh K Panda
- Department of Medical Otolaryngology, Postgraduate Institute of Medical Education and Research, Chandigarh
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Abstract
PURPOSE OF REVIEW The presence of eosinophilia histopathologically in sinusitis is frequently associated with greater disease objectively and a decreased likelihood of surgical success. Eosinophilic chronic rhinosinusitis encompasses a wide variety of etiologies and associations that can be grouped under this umbrella term. In addition, this term can be further divided into those patients with no polyps and those with polyps. The purpose of this review is to detail the epidemiology of eosinophilic chronic rhinosinusitis, to define known and potential subcategories, and to discuss targeted therapeutic interventions. Eosinophilia is frequently, but not exclusively, caused by IgE-mediated hypersensitivity and is dominated by the associated cytokine milieu of Th2 inflammation. Thus, allergic rhinitis or allergy is a subcategory and not synonymous with eosinophilic chronic rhinosinusitis. RECENT FINDINGS Recent findings supporting mechanisms that promote eosinophilic infiltration are discussed and include the following subcategories: super antigen-induced eosinophilic chronic rhinosinusitis, allergic fungal sinusitis, nonallergic fungal eosinophilic chronic rhinosinusitis, and aspirin-exacerbated eosinophilic chronic rhinosinusitis. Undoubtedly there are other mechanisms and categorizations of eosinophilic chronic rhinosinusitis as yet unknown. It is possible, and in fact probable, that some patients may have overlapping mechanisms for eosinophilia. Corticosteroid therapy is an important treatment across all eosinophilic disorders and a profoundly potent but nonspecific antiinflammatory agent. Within each subcategory a specific antibacterial, antifungal, or immune modulation may be indicated. SUMMARY The subcategories of eosinophilic chronic rhinosinusitis are discussed in light of recent findings and treatment recommendations.
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Sha Q, Truong-Tran AQ, Plitt JR, Beck LA, Schleimer RP. Activation of airway epithelial cells by toll-like receptor agonists. Am J Respir Cell Mol Biol 2004; 31:358-64. [PMID: 15191912 DOI: 10.1165/rcmb.2003-0388oc] [Citation(s) in RCA: 369] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Toll-like receptors (TLR) play an important role in pathogen recognition and innate immunity. We investigated the presence and function of TLRs in the BEAS-2B airway epithelial cell line and primary bronchial epithelial cells. Standard real-time reverse transcriptase-polymerase chain reaction (RT-PCR) analysis and Taqman RT-PCR revealed that BEAS-2B cells express mRNA for TLR1-10. Several TLR ligands were tested for their ability to activate gene expression in BEAS-2B cells using limited microarray analyses focusing on genes of the chemokine and chemokine receptor family, cytokines, and signaling pathways. While the TLR3 ligand double-stranded RNA was the most effective epithelial activator, clear responses to flagellin, lipopolysaccharide, CpG, peptidoglycan, and zymosan were also observed. RT-PCR and/or enzyme-linked immunosorbent assay were used to confirm results obtained with microarrays for five of the induced genes: interleukin-8, serum amyloid A, TLR3, macrophage inflammatory protein-3alpha, and granulocyte-macrophage colony-stimulating factor. Stimulation of epithelial cells with double-stranded RNA induced levels of interleukin-8 exceeding 20 ng/ml and levels of serum amyloid A exceeding 80 ng/ml. Double-stranded RNA, lipopolysaccharide, zymosan A, and flagellin also induced expression of macrophage inflammatory protein-3alpha and granulocyte-macrophage colony-stimulating factor, which may facilitate immature dendritic cell migration and maturation. These results suggest that airway epithelial cells express several TLRs and that they are functionally active. Epithelial expression of TLRs may be of importance in inflammation and immunity in the airways in response to inhaled pathogens.
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Affiliation(s)
- Quan Sha
- Division of Clinical Immunology, Department of Medicine, Johns Hopkins University School of Medicine, Asthma and Allergy Center, Baltimore, Maryland 21224, USA
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