Fungal Rhinosinusitis

Abstract

Fungal rhinosinusitis (FRS) once considered a rare disease. This global rise in the burden of fungal disease is a consequence of an increment in the population with weakened immune systems. Increased life expectancy with rise in conditions like diabetes mellitus, medical advancements with invasive interventions, use of steroid, wider uses of broad-spectrum antibiotics, immunosuppressive treatments for transplantation and autoimmune diseases, increased incidence of immune deficiency disease. Fungal infections of the paranasal sinuses are in fact a spectrum of diseases rather than one distinct entity. As such, there has been much published on the classification of fungal rhinosinusitis (FRS).Early classifications of FRS used the causative organism as the descriptor, i.e., aspergillosis, mucormycosis, etc. Rapid diagnosis and prompt treatment may save at least some of these patients. When fever with neutropenia and sinonasal symptoms are seen in patients with impaired immune function maintaining a high index of suspicion is essential, and the appropriate diagnostic work up should involve imaging studies and nasal endoscopy with a possible biopsy so as to initiate treatment in a timely manner.Clinical and histopathologic features of fungal rhinosinusitis are specific to each form, and criteria for diagnosis have been developed. This review of fungal sinus diseases summarizes invasive and noninvasive fungal rhinosinusitis forms but concentrates on AFS because of its high prevalence and the fundamental role the allergist-immunologist plays in its diagnosis and treatment.

The multifaceted potential of fenugreek seeds: From health benefits to food and nanotechnology applications

“…Significant pharmacological and clinical evidence has highlighted the medicinal application of fenugreek seeds as antidiabetic activity (Singh, Chamoli, et al, 2022;Singh, Yadav, et al, 2022), hypolipidemic activity, anti-obesity activity, anticancer activity (Varadarajan et al, 2023), anti-inflammatory activity, antioxidant activity, and antibacterial activity (Salam et al, 2023) due to its rich composition of phytochemicals. Figure 2 presents reported health benefits that have been linked with the consumption of fenugreek seeds.…”

“…The nontoxic alkaloids and oil components present in the seeds contribute to the bitter taste. However, defatted seeds do not possess a bitter taste (Singh, Chamoli, et al, 2022;Singh, Yadav, et al, 2022). The United States Food and Drug Administration (FDA) has approved and generally acknowledged the safety of fenugreek seeds, extracts, oleoresins, and oils (Mandal & DebMandal, 2016).…”

“…In the beverage industry, fenugreek gum serves as an effective tool for viscosity control and thickening, owing to its inherent properties. Additionally, it exhibits resistance to degradation even in low pH conditions commonly found in beverages (Singh, Chamoli, et al, 2022;Singh, Yadav, et al, 2022).…”

Clinical Manifestations of Human Exposure to Fungi

“…Initially considered a rare disease, the burden of fungal rhinosinusitis is increasing because of the rising trend in life expectancy, medical advancements with invasive interventions, the misusage of prescription drugs (e.g., corticosteroids, antibiotics), and the number of patients with primary or secondary immunodeficiencies (e.g., underlying conditions such as diabetes mellitus, malignancies) [ 63 ].…”

“…In these patients, even in the absence of fungal colonization, type I (IgE-mediated reaction to an antigen) and type III (IgG-mediated antigen-antibody complex formation) hypersensitivity reactions to fungal antigens are observed, inducing the production of ‘eosinophilic’ mucin with the enrolment of several inflammatory mediators (e.g., Th2 cytokines, such as interleukin (IL)-4, and IL-5) [ 63 ]. ‘Eosinophilic’ or ‘allergic’ mucin is a trademark of AFRS, macroscopically defined as a thick, tenacious mucus, highly viscous in consistency and light tan to brown (peanut-butter-like appearance) or dark green.…”