Kronik sinüzitte allerjik fungal etiyolojinin rolü
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Abstract
ÖZET Allerjik Fungal Sinüzit farklı bir klinik aintitedir, fakat patofizyolojisi hakkında hala tartışmalar bulunmaktadır. Bazı yazarlar hastalığın sebebi olarak immünolojik hipersensiviteyi, bazıları ise infeksiyonu suçlamaktadırlar. 1983 'de Katzenstein ve arkadaşları Aspergillus sinizitini tarif etmişlerdir. Hastalığın tanısı olarakda aşağıdaki histolojik kriterleri sıralamıştır. 1) Nekrotik eozinofil kümeleri, 2) Charcot-Leyden crystalleri, 3) Noninvasiv mantar hifleri içeren mukus. 1989'da Robson ve arkadaşları Allerjik Fungal sinüzit deyimini kullanmaya başlamışlardır. Bent ve Kuhn AFSde 5 tam kriterini tanımlamışlar. 1) Nazal polip, 2) Allerjik musin, 3)BT, 4) Mantar tespiti Kronik Sinüzitti olgularda AFS insidansı değişmekle birlikte yaklaşık %6-%7dir. Bu hastaların %75inde polip %65 sinde Astım tespit edilmiştir. Çalışmamızda kronik sinüzitti polipli yada polipsiz 87 hasta araştırıldı. 87 hastanın 4 tanesinde mantara rastlandı. Alınan cerrahi materyallerde ve mukuslarda Charcot leyden kristallerine rastlanamadı. 13 hastada prick test pozitif tespit edildi. 87 hastannın 1 tanesinde de spesifik IgE rastlandı. Sonuç olarak 87 kronik sinüzitti hastaların hiçbirinde AFS tam kriterlerine rastlayamadık. 44 YABANCI DİLDE ÖZET Allerjic ftmgal sinusitis (AFS) is increasingly recognized as a distinct entity, but controversy persists about its true pathophysilohy. Some authors believe that the dissease represents a pure immunologic hypersensitivity; others are concerned about a possible infectious compenentln 1983, Katzenstein et al. described allergic Aspergillus sinusitis as a newly recognized form of sinusitis. The diagnosis was made based on the histologictriad of (1) clumps or sheets of necrotic eosinophils(2) Charcot-Leyden crystals( from degraded eosinophils) and (3) noninvasive fungal hypae with morphology consistent with aspergillus species within the nasal musuc.In 1989, Robson et al introduced the term allergic fungal sinusitis because they identified a number of fungi thught to case the same disorder.Bent and Kuhn proposed 5 criteria for the diagnosis of AFS; (1) nasal polposis; (2) allergic musin;(3) computed tomographic (CT) scan findings consistent with CRS; (4) positive fungal The incidence of AFS in cases of chronic rhinosinusitis treted surgically has been approximately %6 to %7. Nasal polyps were found in %75, and asthma was found in %65 of the AFS cases described. 87 consecutive patients with the clinical diagnosis of CRS with or without nasal polyposis had surgical specimens collected for culture. Of the 87 surgical cases, fungal elements were found in 4 histologic specimens. The allergic musin, containing charcot-leyden crsytals of degenerating eosinofils and their by- products was not found in 87 surgical cases. With the skin prick method 13 of 87 patients had a positive reaction. The specific IgE levels in the blood were elevated for at least 1 fungal species in 1 of 87 patient. Overall, the diagnostic criteria for AFS were not in 87 patiets with CRS. 45
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