Fungal rhinosinusitis – a categorization and definitional schema

Fungal rhinosinusitis – a categorization and definitional schema

David W. DenningDirector, National Aspergillosis Centre

University Hospital of South ManchesterThe University of Manchester

www.aspergillus.org.uk

Eosinophilic fungal rhinosinusitisEosinophilic fungal rhinosinusitis

‘Rhinosinusitis’ is preferred to ‘sinusitis’

www.aspergillus.org.uk

Myelodysplasia with clinical evidence of sinusitis after chemotherapy –

biopsy showed hyphal invasion of bone

Pre-treatment 6 months later after initial caspofungin then voriconazole

‘acute invasive fungal rhinosinusitis’ is preferred to ‘fulminant’ or

‘necrotizing’ and should refer to disease of <4 weeks duration in immunocompromised patients

ANITHA, NIZAMUDDIN,PUSHPA, REMADEVI. SIHAM 2006

Diabetic with swelling, nasal obstruction and epistaxis

A. terreus cultured

Hope et al, Med Mycol 2005:43 (Suppl 1):S207

Chronic invasive Aspergillus rhinosinusitis

‘chronic invasive rhinosinusitis’ and ‘granulomatous rhinosinusitis’ were useful terms encompassing locally

invasive disease over at least 3 months duration, with differing pathology and

clinical settings

Chronic Aspergillus granulomatous Chronic Aspergillus granulomatous sinusitis = A. flavus

Chakrabarti et al. Laryngoscope 2009 In press

Saprophytic fungal rhinosinusitisSaprophytic fungal rhinosinusitis

Hope et al, Med Mycol 2005:43 (Suppl 1):S207

Fungus ball of the (paranasal)sinus

‘fungal ball of the sinus’ is preferred to either ‘mycetoma’ or ‘aspergilloma’

of the sinuses

Chakrabarti et al. Laryngoscope 2009 In press

Localized fungal colonization of nasal or paranasal mucosa

‘localized fungal colonization of nasal or paranasalmucosa’ should be introduced to refer to localized

infection visualized endoscopically, which is not (yet) invasive or a fungus ball

Chakrabarti et al. Laryngoscope 2009 In press

Mucin

‘eosinophilic mucin’ is preferred to ‘allergic mucin’

Chakrabarti et al. Laryngoscope 2009 In press

Terminology for “allergic rhinosinusitis”

the terms ‘allergic fungal rhinosinusitis’ (AFRS), ‘eosinophilic fungal rhinosinusitis’ and ‘eosinophilic

mucin rhinosinusitis’ (EMRS) are imprecise and require better definition

www.aspergillus.man.ac.uk

Eosinophilic fungal rhinosinusitisEosinophilic fungal rhinosinusitis

Clinical features = nasal obstruction, recurrent sinus infections, loss of smell and nasal polyps

Aspergillus precipitins +ve in 85% of original series

From Ponikau - Chakrabarti et al. Laryngoscope 2009 In press

Eosinophilic fungal rhinosinusitis Eosinophilic fungal rhinosinusitis ––hunting for fungihunting for fungi

H&E

GMS

Anti-MBP

Anti-Alternaria

Chakrabarti et al. Laryngoscope 2009 In press

Chakrabarti et al. Laryngoscope 2009 In press