Barac Aleksandra, Stevanovic Goran, Pekmezovic Marina, Rakocevic Zoran, Stosovic Rajica, Erovic Boban, Tomic Spiric Vesna
Clinic for Infectious and Tropical Diseases, Clinical Centre of Serbia, Belgrade, Serbia.
School of Medicine, University of Belgrade, Belgrade, Serbia.
Med Mycol. 2018 Feb 1;56(2):162-171. doi: 10.1093/mmy/myx032.
Dysbiosis of the microbiome on the airway mucosa leads to the development of chronic inflammatory and allergic disorders. The aim of this study was to consider the potential diagnostic criteria for allergic fungal rhinosinusitis (AFRS) and nonallergic fungal rhinosinusitis (FRS), and the role of fungal presence in an environment for the development of AFRS. In this study, 136 patients were divided into two groups: patients with positive specific immunoglobulin E (sIgE) and fungal finding (AFRS group), and patients with negative sIgE and positive fungal finding (FRS group). The study design included: anamnesis data, sIgE, eosinophil count and skin-prick test, rhinology and computerized tomography (CT) observation and mycological finding. Our results showed: (i) the prevalence in Serbia is: AFRS 1.3%, FRS 2.8%; (ii) 30.4% patients with sIgE+ had more often severe and recurrent chronic rhinosinusitis (CRS) (P = .005) and the presence of polyps (P = .025); (iii) 46.4% patients with sIgE+ had positive fungi on the sinonasal mucosa and were considered as AFRS; (iv) patients with AFRS had more frequent asthma (P = .024) and chronicity of CRS >10 years (P = .000). The persistent fungal presence and prolonged duration of CRS could be a silent threat for the progression of inflammation and development of FRS. Lavage with hypertonic-NaCl should be included in the everyday hygiene routine in an effort to decrease fungal load and antigenic exposure. The presence of allergological parameters and better response to corticosteroid therapy in AFRS patients should be considered as crucial diagnostic criteria for AFRS.
气道黏膜微生物群失调会导致慢性炎症和过敏性疾病的发生。本研究的目的是探讨变应性真菌性鼻-鼻窦炎（AFRS）和非变应性真菌性鼻-鼻窦炎（FRS）的潜在诊断标准，以及真菌在AFRS发病环境中的作用。本研究将136例患者分为两组：特异性免疫球蛋白E（sIgE）阳性且真菌检测阳性的患者（AFRS组），以及sIgE阴性且真菌检测阳性的患者（FRS组）。研究设计包括：病史数据、sIgE、嗜酸性粒细胞计数和皮肤点刺试验、鼻科学和计算机断层扫描（CT）观察以及真菌学检查。我们的结果显示：（i）在塞尔维亚的患病率为：AFRS 1.3%，FRS 2.8%；（ii）sIgE阳性的患者中有30.4%更常出现严重且复发性慢性鼻-鼻窦炎（CRS）（P = 0.005）和息肉（P = 0.025）；（iii）sIgE阳性的患者中有46.4%鼻窦黏膜真菌检测呈阳性，被视为AFRS；（iv）AFRS患者哮喘更常见（P = 0.024）且CRS病程>10年（P = 0.000）。真菌持续存在和CRS病程延长可能是炎症进展和FRS发生的潜在威胁。应将高渗氯化钠冲洗纳入日常卫生习惯，以降低真菌负荷和抗原暴露。AFRS患者存在变应性参数以及对皮质类固醇治疗反应更好应被视为AFRS的关键诊断标准。
