title: Fungal rhinosinusitis: a categorization and definitional schema addressing current controversies.
abstract: BACKGROUND
  Fungal (rhino-) sinusitis encompasses a wide spectrum of immune and pathological responses, including invasive, chronic, granulomatous, and allergic disease. However, consensus on terminology, pathogenesis, and optimal management is lacking. The International Society for Human and Animal Mycology convened a working group to attempt consensus on terminology and disease classification.
  
  
  CONCLUSIONS
  Key conclusions reached were: rhinosinusitis is preferred to sinusitis; acute invasive fungal rhinosinusitis is preferred to fulminant, or necrotizing and should refer to disease of <4 weeks duration in immunocompromised patients; both chronic invasive rhinosinusitis and granulomatous rhinosinusitis were useful terms encompassing locally invasive disease over at least 3 months duration, with differing pathology and clinical settings; fungal ball of the sinus is preferred to either mycetoma or aspergilloma of the sinuses; localized fungal colonization of nasal or paranasal mucosa should be introduced to refer to localized infection visualized endoscopically; eosinophilic mucin is preferred to allergic mucin; and allergic fungal rhinosinusitis (AFRS), eosinophilic fungal rhinosinusitis, and eosinophilic mucin rhinosinusitis (EMRS) are imprecise and require better definition. In particular, to implicate fungi (as in AFRS and EMRS), hyphae must be visualized in eosinophilic mucin, but this is often not processed or examined carefully enough by histologists, reducing the universality of the disease classification. A schema for subclassifying these entities, including aspirin-exacerbated rhinosinusitis, is proposed allowing an overlap in histopathological features, and with granulomatous, chronic invasive, and other forms of rhinosinusitis. Recommendations for future research avenues were also identified.
authors: Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India. arunaloke@hotmail.com
authors: Arunaloke
authors: A
authors: Chakrabarti
authors: David W
authors: DW
authors: Denning
authors: Berrylin J
authors: BJ
authors: Ferguson
authors: Jens
authors: J
authors: Ponikau
authors: Walter
authors: W
authors: Buzina
authors: Hirohito
authors: H
authors: Kita
authors: Bradley
authors: B
authors: Marple
authors: Naresh
authors: N
authors: Panda
authors: Stephan
authors: S
authors: Vlaminck
authors: Catherine
authors: C
authors: Kauffmann-Lacroix
authors: Ashim
authors: A
authors: Das
authors: Paramjeet
authors: P
authors: Singh
authors: Saad J
authors: SJ
authors: Taj-Aldeen
authors: A Serda
authors: AS
authors: Kantarcioglu
authors: Kumud K
authors: KK
authors: Handa
authors: Ashok
authors: A
authors: Gupta
authors: M
authors: M
authors: Thungabathra
authors: Mandya R
authors: MR
authors: Shivaprakash
authors: Amanjit
authors: A
authors: Bal
authors: Annette
authors: A
authors: Fothergill
authors: Bishan D
authors: BD
authors: Radotra
mesh_terms: D004804:Eosinophils / Q000737:chemistry; D006801:Humans; D007238:Infarction / Q000473:pathology; D009077:Mucins / Q000378:metabolism; D009181:Mycoses / Q000145:classification* / Q000473:pathology; D010256:Paranasal Sinuses / Q000098:blood supply / Q000473:pathology; D012220:Rhinitis / Q000145:classification / Q000382:microbiology* / Q000473:pathology; D012852:Sinusitis / Q000145:classification / Q000382:microbiology* / Q000473:pathology
chemical_list: D009077:Mucins