Deniz DEMİR, Yusufhan SÜOĞLU, Mehmet GÜVEN, Mahmut Sinan YILMAZ

Türkiye’nin Kuzeybatısında endoskopik sinüs cerrahisi uygulanan nazal polipli ya da polipsiz kronik rinosinüzit hastalarında alerjik fungal sinüzit yaygınlığı

Amaç: Bu çalışmada Türkiye’nin kuzeybatısındaki kronik rinosinüzit hastalarında alerjik fungal rinosinüzit yaygınlığı araştırıldı.Hastalar ve Yöntemler: Bu prospektif çalışmaya kronik rinosinüzit tanısı konulup endonazal sinüs cerrahisi planlanan 87 hasta dahil edildi. Hastalar ayrıntılı klinik muayene, bilgisayarlı tomografi, alerjenlere ve total serum immünoglobulin E IgE ve mantar spesifik IgE antikora karşı deri testi ve histopatolojik ve mikolojik izlem ile değerlendirildi.Bulgular: Doku invazyonu gösteren fungal elementler yalnız dört hastada tespit edildi. Bu hastalarda Aspergillus fumigatusa karşı spesifik IgE vardı %4.6 . On altı hastada deri testleri en az bir alerjen için pozitifti %18.3 . Sonuç: Hastaların hiçbiri alerjik fungal rinosinüzit tanı kriterlerini karşılamadı. Bu sonuç, hastalığın yaygınlığının coğrafi konuma göre farklılaşmasından ya da tanı yöntemlerinden kaynaklanabilir

Anahtar Kelimeler:

Alerji, mantar, nazal polip, yaygınlık, sinüzit

Prevalence of allergic fungal rhinosinusitis among patients with chronic rhinosinusitis with or without nasal polyposis who underwent endonasal sinus surgery in Northwestern Turkey

Objectives: This study aims to evaluate the prevalence of allergic fungal rhinosinusitis in chronic rhinosinusitis patients in the northwest of Turkey. Patients and Methods: Eighty-seven patients diagnosed with chronic rhinosinusitis and who were planned endonasal sinus surgery were enrolled in this prospective study. Patients were evaluated by detailed clinical examination, computed tomography, skin test against allergens, total serum immunoglobulin E IgE antibody, fungal-specific IgE antibody, and histopathologic and mycologic monitoring. Results: Fungal elements showing tissue invasiveness were detected in only four patients. These patients had specific IgE against Aspergillus fumigatus 4.6% . Skin tests were positive for at least one allergen in 16 patients 18.3% . Conclusion: None of the patients met diagnostic criteria for allergic fungal rhinosinusitis. This result may be due to the diversity in disease prevalence based on geographical location or diagnostic methods.

Keywords:

Allergy, fungus, nasal polyp, prevalence, sinusitis,

PDF

___

de Shazo RD, Chapin K, Swain RE. Fungal sinusitis. N Engl J Med 1997;337:254-9.
Schubert MS, Goetz DW. Evaluation and treatment of allergic fungal sinusitis. I. Demographics and diagnosis. J Allergy Clin Immunol 1998;102:387-94.
Manning SC, Holman M. Further evidence for allergic pathophysiology in allergic fungal sinusitis. Laryngoscope 1998;108:1485-96.
Stewart AE, Hunsaker DH. Fungus-specific IgG and IgE in allergic fungal rhinosinusitis. Otolaryngol Head Neck Surg 2002;127:324-32.
Bakhshaee M, Fereidouni M, Mohajer MN, Majidi MR, Azad FJ, Moghiman T. The prevalence of allergic fungal rhinosinusitis in sinonasal polyposis. Eur Arch Otorhinolaryngol 2013;270:3095-8.
Collins MM, Nair SB, Wormald PJ. Prevalence of noninvasive fungal sinusitis in South Australia. Am J Rhinol 2003;17:127-32.
Jain S, Das S, Gupta N, Malik JN. Frequency of fungal isolation and antifungal susceptibility pattern of the fungal isolates from nasal polyps of chronic rhinosinusitis patients at a tertiary care centre in north India. Med Mycol 2013;51:164-9.
Ferguson BJ, Barnes L, Bernstein JM, Brown D, Clark CE 3rd, Cook PR, et al. Geographic variation in allergic fungal rhinosinusitis. Otolaryngol Clin North Am 2000;33:441-9.
deShazo RD, Swain RE. Diagnostic criteria for allergic fungal sinusitis. J Allergy Clin Immunol 1995;96:24-35.
Ferguson BJ. Eosinophilic mucin rhinosinusitis: a distinct clinicopathological entity. Laryngoscope 2000;110:799-813.
Cody DT 2nd, Neel HB 3rd, Ferreiro JA, Roberts GD. Allergic fungal sinusitis: the Mayo Clinic experience. Laryngoscope 1994;104:1074-9.
Ramadan HH, Quraishi HA. Allergic mucin sinusitis without fungus. Am J Rhinol 1997;11:145-7.
Millar JW, Johnson A, Lamb D. Allergic aspergillosis of the maxillary sinuses. Thorax 1981;36:710. [Abstract]
Katzenstein AL, Sale SR, Greenberger PA. Allergic Aspergillus sinusitis: a newly recognized form of sinusitis. J Allergy Clin Immunol 1983;72:89-93.
Gourley DS, Whisman BA, Jorgensen NL, Martin ME, Reid MJ. Allergic Bipolaris sinusitis: clinical and immunopathologic characteristics. J Allergy Clin Immunol 1990;85:583-91.
Bent JP 3rd, Kuhn FA. Diagnosis of allergic fungal sinusitis. Otolaryngol Head Neck Surg 1994;111:580-8.
Ponikau JU, Sherris DA, Kern EB, Homburger HA, Frigas E, Gaffey TA, et al. The diagnosis and incidence of allergic fungal sinusitis. Mayo Clin Proc 1999;74:877-84.
Guo C, Ghadersohi S, Kephart GM, Laine RA, Sherris DA, Kita H, et al. Improving the detection of fungi in eosinophilic mucin: seeing what we could not see before. Otolaryngol Head Neck Surg 2012;147:943-9.
El-Morsy SM, Khafagy YW, El-Naggar MM. Allergic fungal rhinosinusitis: detection of fungal DNA in sinus aspirate using polymerase chain reaction. J Laryngol Otol 2010;124:152-60.
Collins M, Nair S, Smith W, Kette F, Gillis D, Wormald PJ. Role of local immunoglobulin E production in the pathophysiology of noninvasivefungal sinusitis. Laryngoscope 2004;114:1242-6.
deShazo RD. The fungal conundrum. Ann Allergy Asthma Immunol 2006;96:256-7.
Hutcheson PS, Schubert MS, Slavin RG. Distinctions between allergic fungal rhinosinusitis and chronic rhinosinusitis. Am J Rhinol Allergy 2010;24:405-8.
Mukherji SK, Figueroa RE, Ginsberg LE, Zeifer BA, Marple BF, Alley JG, et al. Allergic fungal sinusitis: CT findings. Radiology 1998;207:417-22.
Thakar A, Sarkar C, Dhiwakar M, Bahadur S, Dahiya S. Allergic fungal sinusitis: expanding the clinicopathologic spectrum. Otolaryngol Head Neck Surg 2004;130:209-16.
Hidir Y, Tosun F, Saracli MA, Gunal A, Gulec M, Yetiser S. Rate of allergic fungal etiology of chronic rhinosinusitis in Turkish population. Eur Arch Otorhinolaryngol 2008;265:415-9.