Chakrabarti Arunaloke, Kaur Harsimran
Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh 160012, India.
J Fungi (Basel). 2016 Dec 8;2(4):32. doi: 10.3390/jof2040032.
Allergic fungal rhinosinusitis (AFRS) is a unique variety of chronic polypoid rhinosinusitis usually in atopic individuals, characterized by presence of eosinophilic mucin and fungal hyphae in paranasal sinuses without invasion into surrounding mucosa. It has emerged as an important disease involving a large population across the world with geographic variation in incidence and epidemiology. The disease is surrounded by controversies regarding its definition and etiopathogenesis. A working group on "Fungal Sinusitis" under the International Society for Human and Animal Mycology (ISHAM) addressed some of those issues, but many questions remain unanswered. The descriptions of "eosinophilic fungal rhinosinusitis" (EFRS), "eosinophilic mucin rhinosinusitis" (EMRS) and mucosal invasion by hyphae in few patients have increased the problem to delineate the disease. Various hypotheses exist for etiopathogenesis of AFRS with considerable overlap, though recent extensive studies have made certain in depth understanding. The diagnosis of AFRS is a multi-disciplinary approach including the imaging, histopathology, mycology and immunological investigations. Though there is no uniform management protocol for AFRS, surgical clearing of the sinuses with steroid therapy are commonly practiced. The role of antifungal agents, leukotriene antagonists and immunomodulators is still questionable. The present review covers the controversies, recent advances in pathogenesis, diagnosis, and management of AFRS.
变应性真菌性鼻-鼻窦炎（AFRS）是一种独特的慢性息肉样鼻-鼻窦炎，通常见于特应性个体，其特征为鼻窦内存在嗜酸性黏液和真菌菌丝，但不侵犯周围黏膜。它已成为一种涉及全球大量人群的重要疾病，发病率和流行病学存在地域差异。关于该疾病的定义和病因发病机制存在诸多争议。国际人类和动物真菌学会（ISHAM）下属的“真菌性鼻窦炎”工作组解决了其中一些问题，但仍有许多问题未得到解答。“嗜酸性真菌性鼻-鼻窦炎”（EFRS）、“嗜酸性黏液性鼻-鼻窦炎”（EMRS）的描述以及少数患者中菌丝的黏膜侵犯增加了界定该疾病的难度。尽管最近的广泛研究有了一定的深入理解，但关于AFRS病因发病机制存在各种假说，且有相当多的重叠。AFRS的诊断是一种多学科方法，包括影像学、组织病理学、真菌学和免疫学检查。尽管对于AFRS没有统一的治疗方案，但鼻窦手术清理联合类固醇治疗是常用的方法。抗真菌药物、白三烯拮抗剂和免疫调节剂的作用仍存在疑问。本综述涵盖了AFRS的争议、发病机制、诊断和治疗方面的最新进展。
