Nawaz Ghareeb, Sattar Syed Fazle
Department of Otorhinolaryngology, Head & Neck Surgery, Khyber Medical College, Peshawar, Pakistan.
J Ayub Med Coll Abbottabad. 2010 Jan-Mar;22(1):53-7.
Allergic fungal sinusitis (AFS) is a form of fungal disease that has recently been considered a distinct clinicopathologic entity. Other forms of fungal sinusitis include acute-fulminant (invasive), chronic indolent (invasive) and mycetoma (non-invasive). Objectives were to assess the presentation and to describe the diagnostic techniques for allergic fungal sinusitis in our setup.
Descriptive study was conducted in the Department of ENT and Head & Neck Surgery, Khyber Medical College and Khyber Teaching Hospital, Peshawar from January 2002 to April 2008. Twenty-three cases of allergic fungal sinusitis (ASF) were selected for the study. Data like, name, age, sex, address, clinical features, labs (Eosinophil count) and imaging studies (CT and/or MRI) were recorded, including the pre- and postoperative treatment, operative findings and postoperative results, recurrence of disease were also recorded. Surgical procedures were performed on all cases followed by medical treatment.
Study revealed that AFS is a disease of younger age, mainly occurring in 2nd & 3rd decade of life, with male to female ratio 1:1.3. Allergic rhinitis (91%) and nasal polyposis (91%) were important associated factors. Nasal obstruction (96%), nasal discharge (91%), post-nasal discharge (87%) and unilateral multi sinus extension were important clinical features. Increased eosinophil count and increased IgE level was found in 78% cases. Histopathological analysis showed fungal hyphae in all cases and aspergillus was predominant organism on culture. Orbital erosion was seen in 78% and skull base erosion was observed in 9%. Recurrence of disease was seen in nine cases.
Allergic fungal sinusitis (AFS) is a disease of young immunocompetent adults. Nasal obstruction, nasal discharge, nasal allergy and proptosis were the most common presentations. Initial diagnosis of allergic fungal sinusitis requires high index of suspicion in patients presenting with chronic rhinosinusitis, such cases should be properly evaluated. Differentiation from invasive forms of fungal sinus disease is crucial.
变应性真菌性鼻窦炎（AFS）是一种真菌性疾病，近来被视为一种独特的临床病理实体。其他类型的真菌性鼻窦炎包括急性暴发性（侵袭性）、慢性无痛性（侵袭性）和真菌瘤（非侵袭性）。目的是评估变应性真菌性鼻窦炎的临床表现，并描述在我们的机构中其诊断技术。
2002年1月至2008年4月在白沙瓦开伯尔医学院和开伯尔教学医院的耳鼻喉科及头颈外科进行了描述性研究。选择23例变应性真菌性鼻窦炎（ASF）患者进行研究。记录患者的姓名、年龄、性别、地址、临床特征、实验室检查（嗜酸性粒细胞计数）和影像学检查（CT和/或MRI）数据，包括术前和术后治疗、手术所见和术后结果，以及疾病复发情况。所有病例均先进行手术，随后进行药物治疗。
研究表明，AFS是一种好发于年轻人的疾病，主要发生在20至30岁，男女比例为1:1.3。变应性鼻炎（91%）和鼻息肉（91%）是重要的相关因素。鼻塞（96%）、流涕（91%）、后鼻滴漏（87%）和单侧多鼻窦受累是重要的临床特征。78%的病例嗜酸性粒细胞计数增加和IgE水平升高。组织病理学分析显示所有病例均有真菌菌丝，培养结果显示曲霉菌是主要病原体。78%的病例可见眶骨侵蚀，9%的病例可见颅底侵蚀。9例出现疾病复发。
变应性真菌性鼻窦炎（AFS）是年轻免疫功能正常成年人的疾病。鼻塞、流涕、鼻过敏和眼球突出是最常见的表现。对于慢性鼻窦炎患者，变应性真菌性鼻窦炎的初步诊断需要高度怀疑，此类病例应进行适当评估。与侵袭性真菌性鼻窦炎的鉴别至关重要。
