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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
