The diagnosis and incidence of allergic fungal sinusitis
The diagnosis and incidence of allergic fungal sinusitis
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DOI：
10.4065/74.9.877
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发表时间：
1999-09-01
影响因子：
8.9
通讯作者：
Roberts, GD
中科院分区：
文献类型：
--
作者：
Ponikau, JU;Sherris, DA;Roberts, GD
目的：重新评估当前诊断过敏性真菌性鼻窦炎（AFS）的标准并确定慢性鼻窦炎（CRS）患者中 AFS 的发生率。方法：这项前瞻性研究评估了 210 名连续患有或不患有息肉病的 CRS 患者的 AFS 发生率，其中 101 名接受了手术治疗。从鼻粘液中收集和培养真菌需要特殊处理，并且描述了新方法。手术标本处理强调组织学检查，以观察粘蛋白中的真菌和嗜酸性粒细胞，检查过敏测试在 AFS 诊断中的价值。结果：210 名连续 CRS 患者中，202 名 (96%) 的鼻分泌物真菌培养呈阳性。在连续 101 例 CRS 手术病例中，有 97 例 (96%) 发现过敏性粘蛋白，根据组织病理学结果和培养结果，在 101 例连续 CRS 手术病例中，有 94 例 (93%) 被诊断为过敏性真菌性鼻窦炎。在大多数 AFS 患者中，免疫球蛋白 E 介导的对真菌过敏原的超敏反应并不明显。结论：所提供的数据表明，AFS 的诊断标准存在于大多数伴有或不伴有息肉病的 CRS 患者中。由于过敏性粘蛋白中存在嗜酸性粒细胞，而不是 I 型超敏反应，可能是 AFS 病理生理学的共同点，因此我们建议将术语从 AFS 更改为嗜酸性真菌性鼻窦炎。
Objective: To reevaluate the current criteria for diagnosing allergic fungal sinusitis (AFS) and determine the incidence of AFS in patients with chronic rhinosinusitis (CRS),Methods: This prospective study evaluated the incidence of AFS in 210 consecutive patients with CRS with or without polyposis, of whom 101 were treated surgically. Collecting and culturing fungi from nasal mucus require special handling, and novel methods are described. Surgical specimen handling emphasizes histologic examination to visualize fungi and eosinophils in the mucin, The value of allergy testing in the diagnosis of AFS is examined.Results: Fungal cultures of nasal secretions were positive in 202 (96%) of 210 consecutive CRS patients. Allergic mucin was found in 97 (96%) of 101 consecutive surgical cases of CRS, Allergic fungal sinusitis was diagnosed in 94 (93%) of 101 consecutive surgical cases with CRS, based on histopathologic findings and culture results. Immunoglobulin E-mediated hypersensitivity to fungal allergens was not evident in the majority of AFS patients.Conclusion: The data presented indicate that the diagnostic criteria for AFS are present in the majority of patients with CRS with or without polyposis. Since the presence of eosinophils in the allergic mucin, and not a type I hypersensitivity, is likely the common denominator in the pathophysiology of AFS, we propose a change in terminology from AFS to eosinophilic fungal rhinosinusitis.