Rinosinusitis alérgica por Curvularia inaequalis (Shear) Boedijn

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Abstract

Curvularia inaequalis (Shear) Boedijn es un hongo dematiáceo, saprófito y fitopatógeno, presente principalmente en áreas tropicales y subtropicales, asociado a distintos sustratos orgánicos. Se ha identificado escasamente en infecciones sistémicas, cutáneas y sólo existe una comunicación de un caso de rinosinusitis alérgica descrito anteriormente. Presentamos el caso clínico de un paciente con una rinosinusitis alérgica fúngica por Curvularia inaequalis (Shear) Boedijn en cuyo diagnóstico se consideró los síntomas y signos clínicos, la TAC de senos paranasales y el cultivo de la mucina. El paciente fue tratado con un aseo quirúrgico por vía endoscópica, además del uso de corticoesteroides inhalatorios e itra-conazol sistémico. Presentó una buena respuesta clínica, encontrándose asintomático a un año del tratamiento.

Translated abstract

Curvularia inaequalis (Shear) Boedijn is a fungus dematiaceo, saprophyte and plant pathogen found mainly in tropical and subtropical areas, associated with various organic substrates. Rarely been identified in systemic infections, skin and there is only one report of allergic rhinosinusitis described above. A case of allergic fungal rhinosinusitis by Curvularia inaequalis (Shear) Boedijn in which diagnosis was considered the signs and symptoms, sinus CT and cultivation of mucin.The patient was treated with endoscopic surgical toilet, plus use of inhaled steroids and itraconazole systemic. With good clinical response, is asymptomatic at one year.

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Most cited references 47

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The diagnosis and incidence of allergic fungal sinusitis.

T A Gaffey, E Frigas, H. Homburger … (1999)

To reevaluate the current criteria for diagnosing allergic fungal sinusitis (AFS) and determine the incidence of AFS in patients with chronic rhinosinusitis (CRS). This prospective study evaluated the incidence of AFS in 210 consecutive patients with CRS with or without polyposis, of whom 101 were treated surgically. Collecting and culturing fungi from nasal mucus require special handling, and novel methods are described. Surgical specimen handling emphasizes histologic examination to visualize fungi and eosinophils in the mucin. The value of allergy testing in the diagnosis of AFS is examined. Fungal cultures of nasal secretions were positive in 202 (96%) of 210 consecutive CRS patients. Allergic mucin was found in 97 (96%) of 101 consecutive surgical cases of CRS. Allergic fungal sinusitis was diagnosed in 94 (93%) of 101 consecutive surgical cases with CRS, based on histopathologic findings and culture results. Immunoglobulin E-mediated hypersensitivity to fungal allergens was not evident in the majority of AFS patients. The data presented indicate that the diagnostic criteria for AFS are present in the majority of patients with CRS with or without polyposis. Since the presence of eosinophils in the allergic mucin, and not a type I hypersensitivity, is likely the common denominator in the pathophysiology of AFS, we propose a change in terminology from AFS to eosinophilic fungal rhinosinusitis.

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Allergic fungal sinusitis: pathophysiology, diagnosis and management.

S Schubert (2008)

Allergic fungal sinusitis (AFS) is a noninvasive form of fungal rhinosinusitis with an incidence of between 6 and 9% of all rhinosinusitis requiring surgery. Regional variation in incidence has been reported, with the southern and southwestern US particularly endemic. Patients with AFS commonly present with chronic rhinosinusitis with nasal polyps, inhalant atopy, elevated total serum immunoglobulin E (IgE), and sinus-obstructing inspissates of a characteristic extramucosal 'peanut buttery' visco-elastic eosinophil-rich material called 'allergic mucin' that contains sparse numbers of fungal hyphae. Sinus CT is always abnormal, showing findings of chronic rhinosinusitis that often include central areas of increased contrast ('hyperattenuation') within abnormal paranasal sinuses that represent the presence of fungal-containing allergic mucin. AFS has been found to be analogous in several ways to allergic bronchopulmonary aspergillosis (ABPA). Both are chronic inflammatory respiratory tract disorders that are driven by hypersensitivity responses to the presence of small numbers of extramucosal fungi found growing within airway-impacting allergic mucin. AFS allergic mucin typically cultures positive for either dematiaceous fungi such as Bipolaris spicifera or Curvularia lunata, or Aspergillus species such as A. fumigatus, A. flavus or A. niger. As with ABPA, patients have type I immediate hypersensitivity to the etiologic mold in AFS. Further, both AFS and ABPA have been found to have association with specific class II major histocompatibility alleles. Proper diagnosis of AFS and differentiation from the other forms of both noninvasive and invasive fungal rhinosinusitis requires strict adherence to published diagnostic criteria. Medical treatment of AFS has been modeled to an extent after treatment approaches for ABPA that includes the use of postoperative oral corticosteroids and aggressive antiallergic inflammation therapy. The use of follow-up measurements of total serum IgE during treatment of both AFS and ABPA patients can help to monitor disease activity. Future AFS research will lead to further insights into pathogenesis, improved treatments, and ultimately decreases in surgical recurrence rates for this highly recurrent hypertrophic rhinosinusitis disorder.

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Computed tomography and magnetic resonance diagnosis of allergic fungal sinusitis.

F. Vuitch, S Manning, B Marple … (1997)

The objective of this study was to describe CT and MR findings in patients with allergic fungal sinusitis (AFS). CT and MR images were examined from 10 patients with histologically proven AFS. All patients demonstrated CT evidence of central sinus high attenuation and T2-weighted MR signal void corresponding to surgically proven areas of thick inspissated allergic mucin. AFS is a distinct clinical entity with a highly specific radiographic appearance based on CT and MRI.

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Journal

Journal ID (publisher-id): rci

Title: Revista chilena de infectología

Abbreviated Title: Rev. chil. infectol.

Publisher: Sociedad Chilena de Infectología (Santiago, , Chile )

ISSN (Print): 0716-1018

Publication date (Print and electronic): June 2013

Volume: 30

Issue: 3

Pages: 319-322

Affiliations

[03] orgnameHospital Naval de Viña del Mar orgdiv1Servicio de Otorrinolaringología Chile

[01] orgnameUniversidad de Valparaíso orgdiv1Cátedra de Micología Chile

[02] orgnameHospital Naval de Viña del Mar orgdiv1Unidad de Infectología Chile

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Publisher ID: S0716-10182013000300008 Publisher ID: S0716-1018(13)03000300008

DOI: 10.4067/S0716-10182013000300008

SO-VID: 32060be7-8b32-403b-8dd5-a19ad01c1fa5

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This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

History

Date accepted : 28 March 2013

Date received : 20 December 2012

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Figures: 0, Tables: 0, Equations: 0, References: 30, Pages: 4

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Rinosinusitis alérgica por Curvularia inaequalis (Shear) Boedijn Translated title: Allergic rhinosinusitis by Curvularia inaequalis (Shear) Boedijn

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Abstract

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SciELO Chile

Most cited references 47

The diagnosis and incidence of allergic fungal sinusitis.

Allergic fungal sinusitis: pathophysiology, diagnosis and management.

Computed tomography and magnetic resonance diagnosis of allergic fungal sinusitis.

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