Allergic fungal rhinosinusitis (AFRS) ‐ more than a fungal disease?

Dutré, Tineke; Dousary, Surayie Al; Zhang, Nan; Bachert, Claus

doi:10.1186/2045-7022-3-s2-p15

Cited by 5 publications

(4 citation statements)

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“…Investigations show specific IgE antibodies present in serum against Aspergillus species, as well as elevated total serum IgE. As for Imaging; characteristic computed tomography findings include typical heterogeneity of the signal within involved sinuses, complete opacification of at least 1 paranasal sinus, and the expansion and attenuation/erosion of the bone with displacement of adjacent anatomic compartments [21,22]. The bony changes have been assumed to be caused due to expansion of the fungal rather than invasion [21,23] as well as damage from inflammatory mediators [21,24].…”

Section: Manifestation Of Fungal Rhinosinusitis Based On Immunologic mentioning

confidence: 99%

The Different Clinical Presentations of Allergic Fungal Rhinosinusitis

Mulhem¹

2018

OOAJ

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The aim of this study is to describe different clinical presentations of allergic fungal rhinosinusitis (AFRS) managed in King Fahad Specialist hospital, a tertiary care hospital in the Eastern Province, Saudi Arabia. A total number of 15 cases (8 males and 7 females) of AFRS were diagnosed and managed. The youngest age at presentation was 7 years and the eldest was 68 years. 7 of these cases were briefly presented in this article, each with a different clinical presentation and all diagnosed to have allergic fungal sinusitis based on Bent and Khun diagnostic criteria. Some of these cases even have been diagnosed with other types of fungal sinusitis that were occurring concurrently. To conclude, despite AFRS being categorized as a benign, non-invasive disease, its presentation can range from simple nasal obstruction to signs and symptoms of intraorbital and/or intracranial complications; with paediatric cases being more aggressive in nature than in adults. Other forms of fungal sinusitis may coexist with allergic fungal sinusitis as well. For that, each patient should undergo careful clinical evaluation, detailed histopathological examination to rule out mixed types and malignancies, and a lifelong follow up to manage the recurrence.

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Section: Manifestation Of Fungal Rhinosinusitis Based On Immunologic mentioning

confidence: 99%

The Different Clinical Presentations of Allergic Fungal Rhinosinusitis

Mulhem¹

2018

OOAJ

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“…12 CT scans often reveal characteristic serpiginous sinus opacification of more than one sinus, mucosal thickening, and erosion of bone, but this does not represent tissue invasion. 13 In addition, allergic fungal sinusitis may be suspected when a patient with nasal polyposis, having no other known disease, responds only to oral corticosteroids. 14 Different clinical presentations of AFRS were described in the literature as seen in our patients.…”

Section: Discussionmentioning

confidence: 99%

A case series on allergic fungal rhino sinusitis – variable presentations

Sengottuvelu¹,

J²,

Semmanaselvan³

et al. 2023

Asian J Med Sci

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Allergic fungal rhino sinusitis (AFRS) is a non-invasive fungal sinusitis resulting from an allergic and immunologic response to the presence of extramucosal fungal hyphae in the sinuses. Defined largely by the presence of allergic fungal mucin, which is a thick, tenacious, and eosinophilic secretion with characteristic histologic findings. To present a case series on the variable presentations in patients diagnosed with AFRS. A retrospective study of 10 cases that presented to Rajiv Gandhi Government General Hospital ENT outpatient department with allergic fungal rhinosinusitis confirmed by diagnostic nasal endoscopy and CT scan who were managed successfully by endoscopic sinus surgery. In our study, out of 10 cases, nine patients had unilateral symptoms, only one patient has bilateral symptoms. Most common presentation was headache, facial pain, nasal obstruction, and nasal discharge. Some patients had variable presentations such as proptosis, oroantral fistula, blurring of vision, watering of eye, and unilateral frontal headache. On diagnostic nasal endoscopy, two patients had nasal polyposis. Complete disease clearance was achieved in nine cases by functional endoscopic sinus surgery. Patients were started on topical and oral corticosteroids, pre/postoperatively. On follow-up, only one patient had recurrence. Preventing and treating the condition, as well as its spread and complications, are greatly aided by early detection and management of AFRS. The key to enhancing the result is surgical intervention (endoscopic sinus surgery) and medical therapy (corticosteroids). Antifungals have limited role in treatment of AFRS. Longstanding unilateral Sinusitis should always raise suspicious of AFRS.

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“…A cross kingdom synergy between fungi and bacteria has been proposed, where both organisms benefit from alternative macrophage activation and weakened innate defences [16]. Fungal and bacterial superantigens drive an exaggerated inflammatory response through the stimulation of T cells, causing elaboration of epithelial cell-derived cytokines (IL-33, IL-25, and TSLP) and activation of group 2 innate lymphoid cells (ILC2) [11].…”

Section: Epidemiologymentioning

confidence: 99%

“…Activated ILC2 release IL-13, promoting a type 2 eosinophilic response and increased tissue and serum immunoglobulin E (IgE) [11,17,18]. Staphylococcus aureus enterotoxin (SE) has been proposed as a culprit superantigen with SE-specific IgE identified in AFRS patients [16].…”

Section: Superantigen Theorymentioning

confidence: 99%

Pediatric allergic fungal rhinosinusitis: optimizing outcomes

Suzuki¹,

Connell

Psaltis

2021

Current Opinion in Otolaryngology &Amp; Head &Amp; Neck Surgery

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Purpose of review Allergic fungal rhinosinusitis (AFRS) is a debilitating condition for children. Despite there being several reviews on this topic in the adult population, there is a paucity of reviews of AFRS in the pediatric literature. This article reviews the recent evidence of pediatric AFRS with the aim to optimize outcomes of pediatric patients with this condition. Recent findings AFRS is clinically characterized by nasal polyposis, a type I hypersensitivity to fungal epitopes, very thick eosinophilic mucin, and peripheral eosinophilia. Pediatric AFRS has similar clinical characteristics to that in adults but is thought to have a more aggressive nature, with higher serum immunoglobulin E and more frequently bone erosion and malformation of facial bones. Diagnosis of pediatric AFRS is made by using the Bent and Kuhn's criteria developed for adult AFRS. The mainstay of treatment is surgery followed by postoperative corticosteroids. Adjunctive therapies, including topical/oral antifungal agents, allergen immunotherapy and biologics may improve outcomes in pediatric AFRS, but to date the current evidence is limited. Summary To optimize the outcome of pediatric AFRS, adequate and early diagnosis and treatment are essential. Appropriate and comprehensive endoscopic sinus surgery to open the sinuses, remove the fungal burden of disease and improve access of the sinuses to postoperative topical corticosteroid remains the standard of care.

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Allergic fungal rhinosinusitis (AFRS) ‐ more than a fungal disease?

Cited by 5 publications

References 0 publications

The Different Clinical Presentations of Allergic Fungal Rhinosinusitis

The Different Clinical Presentations of Allergic Fungal Rhinosinusitis

A case series on allergic fungal rhino sinusitis – variable presentations

Pediatric allergic fungal rhinosinusitis: optimizing outcomes

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