Jubilee Hospital, Trivandrum, Kerala, India.
Allergic fungal sinusitis (AFS) now is believed to be an allergic reaction to fungi and most patients with allergic fungal sinusitis have a history of allergic rhinitis.
The common causative fungi in allergic fungal sinusitis are by Aspergillus.
Diagnosis:
Symptoms of nasal airway obstruction, allergic rhinitis, or chronic sinusitis that includes nasal congestion, purulent rhinorrhea, postnasal drainage, or headaches are common. Pain is uncommon among patients with allergic fungal sinusitis and suggests the concomitant presence of a bacterial rhinosinusitis.
Patients with allergic fungal sinusitis are atopic, but generally their symptoms have been unresponsive to antihistamines, corticosteroids, antibiotics and prior immunotherapy. Use of systemic corticosteroids may produce some relief of symptoms, but relapse is typical following completion of therapy. In contrast to patients who have invasive fungal sinusitis, patients with allergic fungal sinusitis always are immunocompetent.
The range of physical findings on examination is typically of nasal airway obstruction resulting from intranasal inflammation and polyposis, facial dysmorphism, consisting of proptosis. Proptosis usually occurs over long period of time hence no diplopia or visual loss is seen. Visual loss from allergic fungal sinusitis caused by compression of the ophthalmic nerve,
CT Scan
Accumulation of allergic fungal mucin eventually leads to the increasingly well-recognized radiographic findings characteristic of allergic fungal sinusitis. Heterogeneous areas of signal intensity within Para nasal sinuses filled with allergic fungal mucin are frequently seen.
Treatment
Medical treatment of the disease has made use of various combinations of antifungal medications, corticosteroids, antihistamines and immunotherapy.
Surgical Treatment: A combined approach- Caldwel Luc and FESS procedures are done under General anesthesia to eradicate the disease.
This comprehensive approach to management depends on complete removal of all fungal mucin usually requiring radical surgery and long-term prevention of recurrence through both corticosteroids and antifungal therapy
Systemic antifungal therapy often was used in an attempt to provide some degree of control over recurrence of allergic fungal sinusitis e.g. ketoconazole, itraconazole, and fluconazole. Topical application of antifungal agents may hold some benefit in the control of postoperative recurrence.
Itraconazole and fluconazole offer a slightly safer form of antifungal therapy but still may give rise to drug-induced cardiac dysrhythmias, hepatic dysfunction, urticaria, and agranulocytosis.
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