Manning S C, Schaefer S D, Close L G, Vuitch F
Department of Otorhinolaryngology, University of Texas Southwestern Medical Center, Dallas 75235-9035.
Arch Otolaryngol Head Neck Surg. 1991 Feb;117(2):174-8. doi: 10.1001/archotol.1991.01870140062007.
Allergic Aspergillus sinusitis is a well-defined clinical and histologic entity, although surprisingly few reported cases have yielded any fungal growth on culture. Taking advantage of recent changes in the identification and classification of certain groups of fungi, we were able to identify a specific fungal organism in 19 of 22 consecutive patients with a histologic diagnosis of allergic fungal sinusitis over the past 2 1/2 years. Aspergillus was found in only one patient, while an organism in the family of dematiaceous fungi was found in 18 patients. Of these patients, the genus Bipolaris was the most commonly represented, while Exserohilum, Curvularia, and Alternaria species were seen with less frequency. Thus, it appears that Aspergillus may not be the most common etiologic agent in allergic "Aspergillus" sinusitis. Allergic fungal sinusitis is not unusual and its incidence may be increasing. On initial clinical evaluation it may be easily mistaken for malignancy or invasive fungal disease with the potential for overly aggressive treatment. Preoperative suspicion of allergic fungal sinusitis based on clinical and roentgenographic findings along with careful communication with the mycology laboratory about the possibility of dematiaceous fungal growth are necessary for proper diagnosis.
变应性曲霉菌性鼻窦炎是一种定义明确的临床和组织学实体，尽管令人惊讶的是，报道的病例中很少有培养出真菌生长的。利用某些真菌类群鉴定和分类方面的最新变化，在过去两年半的时间里，我们在连续22例经组织学诊断为变应性真菌性鼻窦炎的患者中，有19例鉴定出了特定的真菌病原体。仅在1例患者中发现曲霉菌，而在18例患者中发现了暗色孢科真菌家族中的一种病原体。在这些患者中，离蠕孢属最为常见，而凸脐蠕孢属、弯孢属和链格孢属的出现频率较低。因此，曲霉菌似乎不是变应性“曲霉菌性”鼻窦炎最常见的病原体。变应性真菌性鼻窦炎并不罕见，其发病率可能正在上升。在最初的临床评估中，它可能很容易被误诊为恶性肿瘤或侵袭性真菌病，从而有可能进行过度积极的治疗。基于临床和影像学检查结果术前怀疑变应性真菌性鼻窦炎，并与真菌学实验室仔细沟通暗色孢科真菌生长的可能性，对于正确诊断是必要的。
