Dykewicz and Hamilos listed criteria for the diagnosis of Allergic Fungal Rhinosinusitis (AFRS). The authors are from Wake Forest University and Massachusetts General Hospital.


Criteria for AFRS:

(1) features of chronic rhinosinusitis

(2) evidence of fungal infection


Features of chronic rhinosinusitis - all of the following:

(1) Symptoms are present for more than 12 weeks.

(2) 3 or 4 of the following clinical findings:

(2a) mucopurulent drainage, anterior and/or posterior

(2b) nasal congestion

(2c) facial pressure and/or facial pain

(2d) decreased sense of smell

(3) evidence of inflammation on one or both of the following

(3a) rhinoscopic examination

(3b) CT sinus scan or other imaging study


Evidence of fungal infection with ALL of the following:

(1) evidence of IgE-mediated fungal allergy

(2) allergic mucus (thick inspissated mucus that ranges in color from light tan to brown to dark green and that contains degranulated eosinophils)

(3) the mucus shows one or both of the following:

(3a) smear positive for fungus

(3b) positive fungal culture


Additional features of AFRS:

(1) Tissue invasion is absent.

(2) Obtaining the mucus required for diagnosis usually requires surgery.

(3) The patient will usually have nasal polyps.

(4) The typical patient is immunocompetent.

(5) Rarely the patient may present with complete nasal obstruction, a change in vision and gross facial dysmorphia.


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