Kaschke O, Rumor D, Jautzke G, Wölke K, Seefeld B
Abteilung HNO, plastische Gesichts- und Halschirurgie, Germany.
Laryngorhinootologie. 2002 Sep;81(9):629-34. doi: 10.1055/s-2002-34446.
The incidence of allergic fungal sinusitis (AFS) is estimated differently. The importance of hyphal findings in nasal mucus for initiation of chronic hyperplastic sinusitis is not proven.
124 patients with clinical signs and CT-scan findings of a chronic-hyperplastic rhinosinusitis were treated by functional endoscopic sinus surgery. During the operation a thick mucus was found in each patient. The mucus was isolated and investigated by histopathological analysis with special Grocott-stain and a culture for fungal growth was initiated. Furthermore the diagnostic for allergic reactions against fungus was done by prick- and RAST-tests.
21 patients had positive histopathological findings of fungus. In 10 cases fungal hyphae were found embedded in typical eosinophilic mucus. A positive allergic reaction against fungus was seen in 7 of these 10 patients. The culture results showed different pictures according to the isolated species, in 3 cases of the 10 AFS cases the culture was negative. The other 11 cases of 21 positive histological findings of fungus were cases of a fungus ball. The other 103 patients were without any sign for fungus in the HE- or Grocott-stain.
A high incidence of AFS is not evident in group of chronic hyperplastic rhinosinusitis. The presence of eosinophilic "allergic" mucus is not the evidence for AFS. The inflammatory cascade leading to the clinical picture is a multifactorial event. The role of detectable fungus hyphae have to be estimated by further investigations.
变应性真菌性鼻窦炎（AFS）的发病率估计存在差异。鼻黏液中菌丝发现对于慢性增生性鼻窦炎起始的重要性尚未得到证实。
124例有慢性增生性鼻-鼻窦炎临床体征及CT扫描表现的患者接受了功能性鼻内镜鼻窦手术治疗。手术过程中，在每位患者中均发现了浓稠的黏液。分离出黏液并通过特殊的格罗科特染色进行组织病理学分析，同时启动真菌生长培养。此外，通过点刺试验和放射变应原吸附试验（RAST）对真菌过敏反应进行诊断。
21例患者真菌组织病理学检查结果为阳性。10例患者中发现真菌菌丝包埋于典型的嗜酸性黏液中。这10例患者中有7例对真菌呈阳性过敏反应。培养结果根据分离出的菌种呈现不同情况，10例AFS病例中有3例培养结果为阴性。21例真菌组织学检查阳性结果中的另外11例为真菌球病例。其他103例患者在苏木精-伊红（HE）染色或格罗科特染色中未发现任何真菌迹象。
在慢性增生性鼻-鼻窦炎患者群体中，AFS的高发病率并不明显。嗜酸性“变应性”黏液的存在并非AFS的证据。导致临床表现的炎症级联反应是一个多因素事件。可检测到的真菌菌丝的作用必须通过进一步研究来评估。
