TY - JOUR
T1 - Fungal rhinosinusitis
T2 - A categorization and definitional schema addressing current controversies
AU - Chakrabarti, Arunaloke
AU - Denning, David W.
AU - Ferguson, Berrylin J.
AU - Ponikau, Jens
AU - Buzina, Walter
AU - Kita, Hirohito
AU - Marple, Bradley
AU - Panda, Naresh
AU - Vlaminck, Stephan
AU - Kauffmann-Lacroix, Catherine
AU - Das, Ashim
AU - Singh, Paramjeet
AU - Taj-Aldeen, Saad J.
AU - Kantarcioglu, A. Serda
AU - Handa, Kumud K.
AU - Gupta, Ashok
AU - Thungabathra, M.
AU - Shivaprakash, Mandya R.
AU - Bal, Amanjit
AU - Fothergill, Annette
AU - Radotra, Bishan D.
PY - 2009/9
Y1 - 2009/9
N2 - Background: Fungal (rhino-) sinusitis encompasses a wide spectrum of immune and pathological responses, including invasive, chronic, granulomatous, and allergic disease. However, consensus on terminology, pathogenesis, and optimal management is lacking. The International Society for Human and Animal Mycology convened a working group to attempt consensus on terminology and disease classification.Discussion: Key conclusions reached were: rhinosinusitis is preferred to sinusitis; acute invasive fungal rhinosinusitis is preferred to fulminant, or necrotizing and should refer to disease of <4 weeks duration in immunocompromised patients; both 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; fungal ball of the sinus is preferred to either mycetoma or aspergilloma of the sinuses; localized fungal colonization of nasal or paranasal mucosa should be introduced to refer to localized infection visualized endoscopically; eosinophilic mucin is preferred to allergic mucin; and allergic fungal rhinosinusitis (AFRS), eosinophilic fungal rhinosinusitis, and eosinophilic mucin rhinosinusitis (EMRS) are imprecise and require better definition. In particular, to implicate fungi (as in AFRS and EMRS), hyphae must be visualized in eosinophilic mucin, but this is often not processed or examined carefully enough by histologists, reducing the universality of the disease classification.A schema for subclassifying these entities, including aspirin-exacerbated rhinosinusitis, is proposed allowing an overlap in histopathological features, and with granulomatous, chronic invasive, and other forms of rhinosinusitis. Recommendations for future research avenues were also identified.
AB - Background: Fungal (rhino-) sinusitis encompasses a wide spectrum of immune and pathological responses, including invasive, chronic, granulomatous, and allergic disease. However, consensus on terminology, pathogenesis, and optimal management is lacking. The International Society for Human and Animal Mycology convened a working group to attempt consensus on terminology and disease classification.Discussion: Key conclusions reached were: rhinosinusitis is preferred to sinusitis; acute invasive fungal rhinosinusitis is preferred to fulminant, or necrotizing and should refer to disease of <4 weeks duration in immunocompromised patients; both 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; fungal ball of the sinus is preferred to either mycetoma or aspergilloma of the sinuses; localized fungal colonization of nasal or paranasal mucosa should be introduced to refer to localized infection visualized endoscopically; eosinophilic mucin is preferred to allergic mucin; and allergic fungal rhinosinusitis (AFRS), eosinophilic fungal rhinosinusitis, and eosinophilic mucin rhinosinusitis (EMRS) are imprecise and require better definition. In particular, to implicate fungi (as in AFRS and EMRS), hyphae must be visualized in eosinophilic mucin, but this is often not processed or examined carefully enough by histologists, reducing the universality of the disease classification.A schema for subclassifying these entities, including aspirin-exacerbated rhinosinusitis, is proposed allowing an overlap in histopathological features, and with granulomatous, chronic invasive, and other forms of rhinosinusitis. Recommendations for future research avenues were also identified.
KW - Allergy
KW - Aspergillus
KW - Dematiaceous fungi
KW - Fungal sinusitis
KW - Zygomycetes
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U2 - 10.1002/lary.20520
DO - 10.1002/lary.20520
M3 - Review article
C2 - 19544383
AN - SCOPUS:70349584616
SN - 0023-852X
VL - 119
SP - 1809
EP - 1818
JO - Laryngoscope
JF - Laryngoscope
IS - 9
ER -