Fungal rhinosinusitis: a categorization and definitional schema addressing current controversies.
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.
Chakrabarti
Arunaloke
A
Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India. arunaloke@hotmail.com
Denning
David W
DW
Ferguson
Berrylin J
BJ
Ponikau
Jens
J
Buzina
Walter
W
Kita
Hirohito
H
Marple
Bradley
B
Panda
Naresh
N
Vlaminck
Stephan
S
Kauffmann-Lacroix
Catherine
C
Das
Ashim
A
Singh
Paramjeet
P
Taj-Aldeen
Saad J
SJ
Kantarcioglu
A Serda
AS
Handa
Kumud K
KK
Gupta
Ashok
A
Thungabathra
M
M
Shivaprakash
Mandya R
MR
Bal
Amanjit
A
Fothergill
Annette
A
Radotra
Bishan D
BD
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
D009077:Mucins