Immunologic Response to Fungus is not Universally Associated with Rhinosinusitis

Orlandi, Richard R.; Marple, Bradley F.; Georgelas, Ann; Durtschi, Drew; Barr, Lucy

doi:10.1016/j.otohns.2009.09.016

Cited by 37 publications

(22 citation statements)

References 12 publications

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“…Part of the controversy relating to the fact that fungus is ubiquitous has been isolated in both healthy and diseased subjects . Although there has been previous evidence of disturbance in the innate and adaptive immunity associated with fungi, this has been contradicted by later studies by Orlandi et al The systematic review also has found no routine role for the use of antifungal medication in the management of CRS . A recent review article has disputed the hypothesis that fungi are the underlying causative factor for all CRS patients .…”

Section: Discussionmentioning

confidence: 99%

Role of fungi in chronic rhinosinusitis through ITS sequencing

et al. 2017

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Objective: Next-generation sequencing increases the sensitivity of fungal identification and may improve our understanding of the role that fungi play in sinus health and disease, which remains incompletely understood. We sequenced the internal transcribed spacer (ITS) amplicon to explore the role of the mycobiome in chronic rhinosinusitis (CRS).Methods: Swabs were collected intraoperatively from the middle meatus of 90 patients (63 with CRS; 27 controls). DNA was extracted, and ITS amplicon concentration was measured using fluorometry. Internal transcribed spacer amplicons were sequenced on the Illumina MiSeq (Illumina Inc San Diego CA). Sequencing data were analyzed using QIIME.Results: Using conventional detection techniques of culture and histology, fungi only were identified in nine of 63 (14.3%) CRS patients (fungus-identified group); the remaining 54 CRS patients and all controls did not have fungus identified using the traditional techniques. This fungus-identified group had a significantly higher average ITS concentration and a significantly lower Shannon's diversity index compared to the other two groups. The most abundant organism sequenced was Aspergillus (35.22% of all sequences). Multivariate analysis showed that positive fungal detection using traditional techniques and computed tomography (CT) double densities were the most important clinical predictors of a high fungal biomass, whereas Lund-Mackay score, polyps, eosinophilia, and eosinophilic mucus were not significant in comparison.Conclusion: Fungal biomass estimated through ITS amplicon concentration correlated with traditional fungal detection techniques and CT double densities. Our results suggest that fungal dysbiosis only occurs in the sinuses of a selected subset of patients, and therefore could not be a universal determinant of sinus disease pathogenesis in all CRS patients.

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Section: Discussionmentioning

confidence: 99%

Role of fungi in chronic rhinosinusitis through ITS sequencing

et al. 2017

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“…This response was independent of IgE sensitivity to fungi. Orlandi et al, 369 however, replicated the methods of Shin et al 368 and had opposing results. They found that IL-5 levels correlated strongly with fungal-specific IgE, but did not correlate with fungal-specific IgG as described by Shin et al 368 In a study performed by Pant et al, 370 IgG1 and IgG3 isotypes to fungi were identified in CRS patients with eosinophilic mucin.…”

Section: S55mentioning

confidence: 98%

International Consensus Statement on Allergy and Rhinology: Rhinosinusitis

Orlandi

Kingdom

Hwang

et al. 2016

Int Forum Allergy Rhinol

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558

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Background:The body of knowledge regarding rhinosinusitis (RS) continues to expand, with rapid growth in number of publications, yet substantial variability in the quality of those presentations. In an effort to both consolidate and critically appraise this information, rhinologic experts from around the world have produced the International Consensus Statement on Allergy and Rhinology: Rhinosinusitis (ICAR:RS). Methods:Evidence-based reviews with recommendations (EBRRs) were developed for scores of topics, using previously reported methodology. Where existing evidence was insufficient for an EBRR, an evidence-based review (EBR) was produced. The sections were then synthesized and the entire manuscript was then reviewed by all authors for consensus. Results:The resulting ICAR:RS document addresses multiple topics in RS, including acute RS (ARS), chronic RS (CRS) with and without nasal polyps (CRSwNP and CRSsNP), recurrent acute RS (RARS), acute exacerbation of CRS (AE-CRS), and pediatric RS. Conclusion:As a critical review of the RS literature, ICAR:RS provides a thorough review of pathophysiology and evidence-based recommendations for medical and surgical treatment. It also demonstrates the significant gaps in our understanding of the pathophysiology and optimal management of RS. Too o en the foundation upon which these recommendations are based is comprised of lowerlevel evidence. It is our hope that this summary of the evidence in RS will point out where additional research efforts may be directed. C 2016 ARS-AAOA, LLC. Key Words:rhinosinusitis; chronic rhinosinusitis; acute rhinosinusitis; recurrent acute rhinosinusitis; evidence-based medicine; systematic review; endoscopic sinus surgery List of Abbreviations Used

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“…2, 3). Eosinophilic mucin is now the preferred term instead of allergic mucin since there is debate regarding whether the etiology of this mucinous material, as well as allergic FRS, is allergic at all [1,2,17,18,[20][21][22][23][24][25][26][27][28][29]. Fungal hyphae are occasionally seen on H and E stain but are best highlighted by histochemical stains such as silver or periodic acid Schiff (PAS) (Fig.…”

Section: Allergic Fungal Rhinosinusitismentioning

confidence: 99%