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Gavito-Higuera J, Mullins CB, Ramos-Duran L, Sandoval H, Akle N, Figueroa R. Sinonasal Fungal Infections and Complications: A Pictorial Review. J Clin Imaging Sci 2016; 6:23. [PMID: 27403401 PMCID: PMC4926542 DOI: 10.4103/2156-7514.184010] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Accepted: 05/20/2016] [Indexed: 11/04/2022] Open
Abstract
Fungal infections of the nose and paranasal sinuses can be categorized into invasive and non-invasive forms. The clinical presentation and course of the disease is primarily determined by the immune status of the host and can range from harmless or subtle presentations to life threatening complications. Invasive fungal infections are categorized into acute, chronic or chronic granulomatous entities. Immunocompromised patients with poorly controlled diabetes mellitus, HIV and patients receiving chemotherapy or chronic oral corticosteroids are mostly affected. Mycetoma and Allergic Fungal Rhinosinusitis are considered non-invasive forms. Computer tomography is the gold-standard in sinonasal imaging and is complimented by Magnetic resonance imaging (MRI) as it is superior in the evaluation of intraorbital and intracranial extensions. The knowledge and identification of the characteristic imaging patterns in invasive - and non- invasive fungal rhinosinusitis is crucial and the radiologist plays an important role in refining the diagnosis to prevent a possible fatal outcome.
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Affiliation(s)
- Jose Gavito-Higuera
- Department of Radiology, Texas Tech University Health Sciences Center, El Paso, TX 79905, USA
| | - Carola Birgit Mullins
- Department of Radiology, Texas Tech University Health Sciences Center, El Paso, TX 79905, USA
| | - Luis Ramos-Duran
- Department of Radiology, Texas Tech University Health Sciences Center, El Paso, TX 79905, USA
| | - Hugo Sandoval
- Department of Radiology, Texas Tech University Health Sciences Center, El Paso, TX 79905, USA
| | - Nassim Akle
- Department of Radiology, Texas Tech University Health Sciences Center, El Paso, TX 79905, USA
| | - Ramon Figueroa
- Department of Radiology and Imaging, Medical College of Georgia, Augusta University, Augusta, GA 30912, USA
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Tamborini A, Robertson E, Talbot JJ, Barrs VR. Sinonasal aspergillosis in a British Shorthair cat in the UK. JFMS Open Rep 2016; 2:2055116916653775. [PMID: 28491427 PMCID: PMC5362982 DOI: 10.1177/2055116916653775] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/16/2016] [Indexed: 12/02/2022] Open
Abstract
Case summary A 13-year-old, castrated male, British Shorthair cat presented for investigation of chronic, intermittent, bilateral epistaxis and stertor. CT revealed severe asymmetric bilateral intranasal involvement with extensive turbinate lysis, increased soft tissue attenuation and lysis of the sphenopalatine bone and cribriform plate. On retroflexed pharyngoscopy, a plaque-like mass occluded the choanae. Rostral rhinoscopic examination revealed extensive loss of nasal turbinates, necrotic tissue and mucosal fungal plaques in the left nasal cavity. The right nasal cavity was less severely affected. The nasal cavities were debrided extensively of plaques and necrotic tissue. Aspergillus fumigatus was isolated on fungal culture, and species identity was confirmed using comparative sequence analysis of the partial β-tubulin gene. On histopathology of nasal biopsies, there was ulcerative lymphoplasmacytic and neutrophilic rhinitis, and fungal hyphae were identified on nasal mucosa, consistent with a non-invasive mycosis. The cat was treated with oral itraconazole after endoscopic debridement, but signs relapsed 4.5 months from diagnosis. Residual left nasal fungal plaques were again debrided endoscopically and oral posaconazole was administered for 6 months. Fourteen months from diagnosis, the cat remains clinically well with mild intermittent left nasal discharge secondary to atrophic rhinitis. Relevance and novel information This is the first case of rhinoscopically confirmed sinonasal aspergillosis to be diagnosed in a cat in the UK. Endoscopic confirmation of resolution of infection is useful in cases where mild nasal discharge persists after treatment.
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Affiliation(s)
| | | | - Jessica J Talbot
- Faculty of Veterinary Science, School of Life and Environmental Sciences, University of Sydney, Sydney, NSW 2006 Australia
| | - Vanessa R Barrs
- Faculty of Veterinary Science, School of Life and Environmental Sciences, University of Sydney, Sydney, NSW 2006 Australia
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Baxi SN, Portnoy JM, Larenas-Linnemann D, Phipatanakul W. Exposure and Health Effects of Fungi on Humans. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2016; 4:396-404. [PMID: 26947460 DOI: 10.1016/j.jaip.2016.01.008] [Citation(s) in RCA: 111] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Revised: 01/04/2016] [Accepted: 01/13/2016] [Indexed: 01/28/2023]
Abstract
Fungi are ubiquitous microorganisms that are present in outdoor and indoor environments. Previous research has found relationships between environmental fungal exposures and human health effects. We reviewed recent articles focused on fungal exposure and dampness as risk factors for respiratory disease development, symptoms, and hypersensitivity. In particular, we reviewed the evidence suggesting that early exposure to dampness or fungi is associated with the development of asthma and increased asthma morbidity. Although outdoor exposure to high concentrations of spores can cause health effects such as asthma attacks in association with thunderstorms, most people appear to be relatively unaffected unless they are sensitized to specific genera. Indoor exposure and dampness, however, appears to be associated with an increased risk of developing asthma in young children and asthma morbidity in individuals who have asthma. These are important issues because they provide a rationale for interventions that might be considered for homes and buildings in which there is increased fungal exposure. In addition to rhinitis and asthma, fungus exposure is associated with a number of other illnesses including allergic bronchopulmonary mycoses, allergic fungal sinusitis, and hypersensitivity pneumonitis. Additional research is necessary to establish causality and evaluate interventions for fungal- and dampness-related health effects.
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54
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Fukutomi Y, Taniguchi M. Sensitization to fungal allergens: Resolved and unresolved issues. Allergol Int 2015; 64:321-31. [PMID: 26433528 DOI: 10.1016/j.alit.2015.05.007] [Citation(s) in RCA: 125] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Revised: 05/01/2015] [Accepted: 05/07/2015] [Indexed: 01/06/2023] Open
Abstract
Exposure and sensitization to fungal allergens can promote the development and worsening of allergic diseases. Although numerous species of fungi have been associated with allergic diseases in the literature, the significance of fungi from the genera Alternaria, Cladosporium, Penicillium, Aspergillus, and Malassezia has been well documented. However, it should be emphasized that the contribution of different fungal allergens to allergic diseases is not identical, but species-specific. Alternaria and Cladosporium species are considered to be important outdoor allergens, and sensitization and exposure to species of these genera is related to the development of asthma and rhinitis, as well as epidemics of asthma exacerbation, including life-threatening asthma exacerbation. In contrast, xerophilic species of Penicillium and Aspergillus, excluding Aspergillus fumigatus, are implicated in allergic diseases as indoor allergens. A. fumigatus has a high capacity to colonize the bronchial tract of asthmatic patients, causing severe persistent asthma and low lung function, and sometimes leading to allergic bronchopulmonary aspergillosis. Malassezia are common commensals of healthy skin, although they are also associated with atopic dermatitis, especially on the head and neck, but not with respiratory allergies. Despite its importance in the management of allergic diseases, precise recognition of species-specific IgE sensitization to fungal allergens is often challenging because the majority of fungal extracts exhibit broad cross-reactivity with taxonomically unrelated fungi. Recent progress in gene technology has contributed to the identification of specific and cross-reactive allergen components from different fungal sources. However, data demonstrating the clinical relevance of IgE reactivity to these allergen components are still insufficient.
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Affiliation(s)
- Yuma Fukutomi
- Clinical Research Center for Allergy and Rheumatology, Sagamihara National Hospital, Kanagawa, Japan.
| | - Masami Taniguchi
- Clinical Research Center for Allergy and Rheumatology, Sagamihara National Hospital, Kanagawa, Japan
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55
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Davoudi S, Kumar VA, Jiang Y, Kupferman M, Kontoyiannis DP. Invasive mould sinusitis in patients with haematological malignancies: a 10 year single-centre study. J Antimicrob Chemother 2015; 70:2899-905. [PMID: 26188039 DOI: 10.1093/jac/dkv198] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2015] [Accepted: 06/15/2015] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVES Invasive mould sinusitis (IMS) is a severe infection in patients with haematological malignancies. Because of a paucity of contemporaneous data about IMS, we sought to evaluate clinical aspects and outcome of IMS in these patients. METHODS The records of adult haematological malignancy patients with proven or probable IMS over a 10 year period were reviewed retrospectively. RESULTS We identified 44 patients with IMS. Mucorales were isolated in 13 (35.1%) patients and Fusarium and Aspergillus were isolated in 9 (24.3%) patients each. Patients with IMS owing to Mucorales were more likely to have a history of diabetes mellitus (P = 0.003) and high-dose corticosteroid use (P = 0.03). Thirty-five (80%) patients received antifungal combinations and 36 (82%) underwent surgical debridement. The 12 week IMS-attributable mortality was 36.4% (16 patients). A relapsed and/or refractory haematological malignancy was an independent risk factor for 6 week IMS-attributable (P = 0.038), 12 week all-cause (P = 0.005) and 12 week IMS-attributable (P = 0.0015) mortality. Neutrophil count <100/µL and lymphocyte count <200/µL were associated with increased 12 week IMS-attributable and 6 week all-cause mortality, respectively (P = 0.044 and 0.013). IMS due to Aspergillus was an independent risk factor for both 12 week all-cause (P = 0.011) and IMS-attributable (P = 0.026) mortality. Initial antifungal therapy with a triazole-containing regimen was associated with decreased 6 week all-cause (P = 0.032) and IMS-attributable (P = 0.038) mortality. Surgery was not an independent factor for improved outcome. CONCLUSIONS Despite combined medical and surgical therapy, IMS had high mortality. Mortality risk factors were relapsed and/or refractory malignancy, cytopenia and Aspergillus infection in this study.
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Affiliation(s)
- S Davoudi
- Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, TX, USA Department of Infectious Diseases, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - V A Kumar
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Y Jiang
- Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - M Kupferman
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - D P Kontoyiannis
- Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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56
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Pekala KR, Clavenna MJ, Shockley R, Weiss VL, Turner JH. Chronic invasive fungal sinusitis associated with intranasal drug use. Laryngoscope 2015; 125:2656-9. [PMID: 26153255 DOI: 10.1002/lary.25429] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/18/2015] [Indexed: 11/09/2022]
Abstract
Chronic invasive fungal sinusitis (CIFS) is a rare but potentially aggressive form of invasive fungal disease that occurs in immunocompetent patients. We report a case of CIFS in an otherwise healthy young adult associated with intranasal illicit drug abuse. The patient presented with nonhealing nasal septal and palatal perforations. Biopsy demonstrated invasive Aspergillus flavus requiring surgical debridement and extended intravenous antifungal therapy. Tissue necrosis and ulceration related to intranasal drug use should be recognized as a potential risk factor for invasive fungal sinusitis.
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Affiliation(s)
- Kelly R Pekala
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University School of Medicine, Nashville, Tennessee, U.S.A
| | - Matthew J Clavenna
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University School of Medicine, Nashville, Tennessee, U.S.A
| | - Ross Shockley
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University School of Medicine, Nashville, Tennessee, U.S.A
| | - Vivian L Weiss
- Department of Pathology, Microbiology, and Immunology, Vanderbilt University School of Medicine, Nashville, Tennessee, U.S.A
| | - Justin H Turner
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University School of Medicine, Nashville, Tennessee, U.S.A
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57
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Enomoto Y, Oba M, Ishii N, Nakanaga K, Yagi Y, Hasegawa H, Ozawa Y, Matsui T, Yokomura K, Suda T. Rhinosinusitis and disseminated cutaneous infection caused by Mycobacterium chelonae in an immunocompromised patient. J Infect Chemother 2015; 21:691-4. [PMID: 26025682 DOI: 10.1016/j.jiac.2015.04.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2015] [Revised: 03/20/2015] [Accepted: 04/24/2015] [Indexed: 11/28/2022]
Abstract
Mycobacterium chelonae frequently involves the skin, and the disseminated form can be observed in immunocompromised patients. In contrast, rhinosinusitis caused by the bacterium is a rare manifestation, which occurs independently of immune status. We report here a rare case of M. chelonae infection presenting as both disseminated cutaneous infection and rhinosinusitis in an immunocompromised patient. He had received systemic corticosteroids for 11 months due to cryptogenic organizing pneumonia. Before admission, he sustained injuries to his left arm and hand; those injuries succumbed to an infection that would subsequently spread to his other limbs, face, and even nasal cavities. This valuable case suggests that disseminated cutaneous infection by M. chelonae could spread to other organs.
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Affiliation(s)
- Yasunori Enomoto
- Department of Respiratory Medicine, Respiratory Disease Center, Seirei Mikatahara General Hospital, Japan; Second Department of Internal Medicine, Hamamatsu University School of Medicine, Japan.
| | - Misao Oba
- Department of Dermatology, Seirei Mikatahara General Hospital, Japan
| | - Norihisa Ishii
- Leprosy Research Center, National Institute of Infectious Diseases, Japan
| | - Kazue Nakanaga
- Leprosy Research Center, National Institute of Infectious Diseases, Japan
| | - Yuki Yagi
- Department of Otorhinolaryngology, Seirei Mikatahara General Hospital, Japan
| | - Hirotsugu Hasegawa
- Department of Respiratory Medicine, Respiratory Disease Center, Seirei Mikatahara General Hospital, Japan
| | - Yuichi Ozawa
- Department of Respiratory Medicine, Respiratory Disease Center, Seirei Mikatahara General Hospital, Japan
| | - Takashi Matsui
- Department of Respiratory Medicine, Respiratory Disease Center, Seirei Mikatahara General Hospital, Japan
| | - Koshi Yokomura
- Department of Respiratory Medicine, Respiratory Disease Center, Seirei Mikatahara General Hospital, Japan
| | - Takafumi Suda
- Second Department of Internal Medicine, Hamamatsu University School of Medicine, Japan
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58
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Zhang J, Li Y, Lu X, Wang X, Zang H, Wang T, Zhou B, Zhang L. Distinguishing the dominant species of pathogen in maxillary sinusitis by sequencing DNA dataset analysis. Gene 2015; 561:256-60. [PMID: 25724392 DOI: 10.1016/j.gene.2015.02.037] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2014] [Revised: 01/24/2015] [Accepted: 02/13/2015] [Indexed: 12/16/2022]
Abstract
This study determined the microbial composition in maxillary sinusitis and determined the predominant fungal and bacterial species. Samples were obtained from 11 patients with fungal sinusitis and 2 healthy patients. The 13 samples were sequenced using an Illumina Hi-Seq 2000, and mapping to the human, bacterial, and the fungal genomes were based on several steps. Bioinformatics and statistical analyses were then performed for bacterial and fungal expressions in the samples. All samples were cultures for fungal growth. The sequencing data revealed that Aspergillus flavus and Aspergillus oryzae were the dominant fungal strains in the rhinosinusitis samples, and Bacillus cereus and Bacillus thuringiensis were the dominant bacterial strains. Indeed, the fungi and bacteria were associated with the development of fungal rhinosinusitis. Furthermore, B. cereus and B. thuringiensis may cooperate with Pseudomonas aeruginosa to inhibit the growth of fungal mycelia. Knowledge of the microbial composition can provide a diagnostic reference for patients with maxillary sinusitis.
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Affiliation(s)
- Junyi Zhang
- Department of Otolaryngology Head and Neck Surgery, State Key Laboratory Otolaryngology Head and Neck Surgery of Ministry of Education, Beijing Tongren hospital, Capital Medical University, Beijing 100730, China; Department of Otolaryngology, Daqing Oilfield General Hospital, Daqing, Heilongjiang Province 163001, China
| | - Yunchuan Li
- Department of Otolaryngology Head and Neck Surgery, State Key Laboratory Otolaryngology Head and Neck Surgery of Ministry of Education, Beijing Tongren hospital, Capital Medical University, Beijing 100730, China.
| | - Xinxin Lu
- Department of Clinical Laboratory, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China
| | - Xiangdong Wang
- Department of Otolaryngology Head and Neck Surgery, State Key Laboratory Otolaryngology Head and Neck Surgery of Ministry of Education, Beijing Tongren hospital, Capital Medical University, Beijing 100730, China
| | - Hongrui Zang
- Department of Otolaryngology Head and Neck Surgery, State Key Laboratory Otolaryngology Head and Neck Surgery of Ministry of Education, Beijing Tongren hospital, Capital Medical University, Beijing 100730, China
| | - Tong Wang
- Department of Otolaryngology Head and Neck Surgery, State Key Laboratory Otolaryngology Head and Neck Surgery of Ministry of Education, Beijing Tongren hospital, Capital Medical University, Beijing 100730, China
| | - Bing Zhou
- Department of Otolaryngology Head and Neck Surgery, State Key Laboratory Otolaryngology Head and Neck Surgery of Ministry of Education, Beijing Tongren hospital, Capital Medical University, Beijing 100730, China
| | - Luo Zhang
- Department of Otolaryngology Head and Neck Surgery, State Key Laboratory Otolaryngology Head and Neck Surgery of Ministry of Education, Beijing Tongren hospital, Capital Medical University, Beijing 100730, China
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Peters AT, Spector S, Hsu J, Hamilos DL, Baroody FM, Chandra RK, Grammer LC, Kennedy DW, Cohen NA, Kaliner MA, Wald ER, Karagianis A, Slavin RG. Diagnosis and management of rhinosinusitis: a practice parameter update. Ann Allergy Asthma Immunol 2015; 113:347-85. [PMID: 25256029 DOI: 10.1016/j.anai.2014.07.025] [Citation(s) in RCA: 111] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2014] [Accepted: 07/22/2014] [Indexed: 02/06/2023]
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60
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Tsukatani T, Ogawa H, Anzawa K, Kobayashi E, Hasegawa H, Makimura K, Yoshizaki T, Ueda N. Schizophyllum commune-induced allergic fungal rhinosinusitis and sinobronchial mycosis. Med Mycol Case Rep 2015; 8:10-3. [PMID: 25756007 PMCID: PMC4348453 DOI: 10.1016/j.mmcr.2015.02.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2014] [Revised: 02/09/2015] [Accepted: 02/23/2015] [Indexed: 12/28/2022] Open
Abstract
We present 32- and 38-year-old males with Schizophyllum commune-induced allergic fungal rhinosinusitis (AFRS). S. commune-induced AFRS was diagnosed by clinical and radiographic findings, positive specific IgE antibodies against S. commune as measured by the ImmunoCAP system, and sequencing analysis of the fungus. Our two cases with S. commune-induced AFRS for the first time showed evidence for type 1 hypersensitivity to S. commune as determined by using specific IgE antibodies against S. commune, and the fungus was identified by sequence analysis.
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Affiliation(s)
- Toshiaki Tsukatani
- Department of Otorhinolaryngology, Public Central Hospital of Matto Ishikawa, Hakusan, Ishikawa 924-8588, Japan
| | - Haruhiko Ogawa
- Division of Pulmonary Medicine, Ishikawa-ken Saiseikai Kanazawa Hospital, Kanazawa, Ishikawa, Japan
| | - Kazushi Anzawa
- Division of Dermatomycology (Novartis Pharma), Medical Research Institute, Kanazawa Medical University, Uchinada, Ishikawa, Japan
| | - Eiji Kobayashi
- Department of Otorhinolaryngology, Public Central Hospital of Matto Ishikawa, Hakusan, Ishikawa 924-8588, Japan
| | - Hiroki Hasegawa
- Department of Otorhinolaryngology, Public Central Hospital of Matto Ishikawa, Hakusan, Ishikawa 924-8588, Japan
| | - Koichi Makimura
- Laboratory of Space and Environmental Medicine, Teikyo University, Hachioji, Tokyo, Japan
| | - Tomokazu Yoshizaki
- Department of Otorhinolaryngology, Head and Neck Surgery, Kanazawa University, Kanazawa, Ishikawa, Japan
| | - Norishi Ueda
- Department of Pediatrics, Public Central Hospital of Matto Ishikawa, Hakusan, Ishikawa, Japan
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Endonasal endoscopic surgery with combined middle and inferior meatal antrostomies for fungal maxillary sinusitis. The Journal of Laryngology & Otology 2015; 129 Suppl 2:S52-5. [DOI: 10.1017/s0022215114002394] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AbstractObjective:The purpose of this study was to evaluate the effectiveness of the combination of inferior and middle meatal antrostomies for treatment of a maxillary sinus fungus ball by functional endoscopic sinus surgery.Methods:A retrospective analysis including 28 patients with non-invasive fungal maxillary sinusitis was performed. Fourteen patients underwent FESS with both middle and inferior meatal antrostomies (combined group). The remaining 14 patients were treated with FESS through only the middle meatal antrostomy (control group).Results:Post-operative computed tomography showed normal maxillary sinuses in all patients in the combined group. In contrast, in the control group, five patients (36 per cent) exhibited a normal maxillary sinus, seven (50 per cent) showed maxillary mucosal thickening and two (14 per cent) had persistent fungus balls in the maxillary sinus.Conclusion:FESS with a combination of middle and inferior meatal antrostomies proved more effective for treating fungal maxillary sinusitis.
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62
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The prognostic value of gadolinium-enhanced magnetic resonance imaging in acute invasive fungal rhinosinusitis. J Infect 2015; 70:88-95. [DOI: 10.1016/j.jinf.2014.07.027] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2014] [Revised: 06/30/2014] [Accepted: 07/03/2014] [Indexed: 12/20/2022]
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63
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Guivarc'h M, Ordioni U, Catherine JH, Campana F, Camps J, Bukiet F. Implications of Endodontic-related Sinus Aspergillosis in a Patient Treated by Infliximab: A Case Report. J Endod 2015; 41:125-9. [DOI: 10.1016/j.joen.2014.09.022] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2014] [Revised: 09/22/2014] [Accepted: 09/23/2014] [Indexed: 11/28/2022]
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64
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Barrs VR, Ujvari B, Dhand NK, Peters IR, Talbot J, Johnson LR, Billen F, Martin P, Beatty JA, Belov K. Detection of Aspergillus-specific antibodies by agar gel double immunodiffusion and IgG ELISA in feline upper respiratory tract aspergillosis. Vet J 2014; 203:285-9. [PMID: 25634077 DOI: 10.1016/j.tvjl.2014.12.020] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2014] [Revised: 11/30/2014] [Accepted: 12/21/2014] [Indexed: 12/14/2022]
Abstract
Feline upper respiratory tract aspergillosis (URTA) is an emerging infectious disease. The aims of this study were: (1) to assess the diagnostic value of detection of Aspergillus-specific antibodies using an agar gel double immunodiffusion (AGID) assay and an indirect immunoglobulin G (IgG) ELISA; and (2) to determine if an aspergillin derived from mycelia of Aspergillus fumigatus, Aspergillus niger and Aspergillus flavus can be used to detect serum antibodies against cryptic Aspergillus spp. in Aspergillus section Fumigati. Sera from cats with URTA (group 1: n = 21) and two control groups (group 2: cats with other upper respiratory tract diseases, n = 25; group 3: healthy cats and cats with non-respiratory, non-fungal illness, n = 84) were tested. Isolates from cats with URTA comprised A. fumigatus (n = 5), A. flavus (n = 1) and four cryptic species: Aspergillus felis (n = 12), Aspergillus thermomutatus (Neosartorya pseudofischeri, n = 1), Aspergillus lentulus (n = 1) and Aspergillus udagawae (n = 1). Brachycephalic purebred cats were significantly more likely to develop URTA than other breeds (P = 0.013). The sensitivity (Se) of the AGID was 43% and the specificity (Sp) was 100%. At a cut-off value of 6 ELISA units/mL, the Se of the IgG ELISA was 95.2% and the Sp was 92% and 92.9% for groups 2 and 3 cats, respectively. Aspergillus-specific antibodies against all four cryptic species were detected in one or both assays. Assay Se was not associated with species identity. Detection of Aspergillus-specific antibodies by IgG ELISA has high Se and Sp for diagnosis of feline URTA.
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Affiliation(s)
- V R Barrs
- Faculty of Veterinary Science, University of Sydney, NSW 2006, Australia.
| | - B Ujvari
- Faculty of Veterinary Science, University of Sydney, NSW 2006, Australia
| | - N K Dhand
- Faculty of Veterinary Science, University of Sydney, NSW 2006, Australia
| | - I R Peters
- TDDS, Innovation Centre, University of Exeter, Devon, UK
| | - J Talbot
- Faculty of Veterinary Science, University of Sydney, NSW 2006, Australia
| | - L R Johnson
- School of Veterinary Medicine, University of California, Davis, CA 95616, USA
| | - F Billen
- Faculty of Veterinary Medicine, University of Liege, Belgium
| | - P Martin
- Faculty of Veterinary Science, University of Sydney, NSW 2006, Australia
| | - J A Beatty
- Faculty of Veterinary Science, University of Sydney, NSW 2006, Australia
| | - K Belov
- Faculty of Veterinary Science, University of Sydney, NSW 2006, Australia
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65
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The occurrence of molds in patients with chronic sinusitis. Eur Arch Otorhinolaryngol 2014; 271:1143-8. [PMID: 24121778 DOI: 10.1007/s00405-013-2737-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2013] [Accepted: 09/24/2013] [Indexed: 10/26/2022]
Abstract
Chronic rhinosinusitis (CRS) is a common inflammatory condition of nasal and paranasal sinus mucosa. Although pathogenic bacteria were postulated as main etiological factor responsible for most cases of CRS, the involvement of molds was recently proved in some cases. The aim of the study was to conduct mycological analysis of material obtained from patients operated on due to chronic sinusitis. The study included 107 patients, 45 women and 62 men. During the surgery, a fragment of mucosa from the region of the ethmoid bulla was obtained as microbiological characteristics of this material closely resemble those of sinus mucosa. In addition, maxillary sinus lavage was obtained. The control group comprised patients without chronic sinusitis. The dithiothreitol solution method was used for the lavage examination. The tissue material (mucosal fragment from the region of the ethmoid bulla) was incubated in 2% liquid Sabouraud medium for 24 h. The material was inoculated onto culture media. The presence of molds was detected in 67% of examined samples. Overall, 41 species belonging to 12 genera were isolated. The most frequently detected genera included Penicillium spp. (46%) and Aspergillus spp. (16%). In addition, Cladosporium spp. (11%), Fusarium spp. (7%), Acremonium spp. (4%), Eurotium spp. (4%), Alternaria spp. (2%), Chaetomium spp. (1%), Geotrichum spp. (1%), Verticillium spp. (1%), Rhizopus spp. (1%), and some unidentified colonies (5%) were isolated. Penicillium crustosum, Penicillium citrinum, Aspergillus niger, Cladosporium cladosporioides, and Fusarium verticillioides were the most prevalent species.
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Eldridge ML, Chambers CJ, Sharon VR, Thompson GR. Fungal infections of the skin and nail: new treatment options. Expert Rev Anti Infect Ther 2014; 12:1389-405. [DOI: 10.1586/14787210.2014.960849] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Feng L, Li H, E LL, Li CJ, Ding Y. Pathological changes in the maxillary sinus mucosae of patients with recurrent odontogenic maxillary sinusitis. Pak J Med Sci 2014; 30:972-5. [PMID: 25225509 PMCID: PMC4163215 DOI: 10.12669/pjms.305.5312] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Objective: To study the structural and functional changes of maxillary sinus mucosae of patients with odontogenic maxillary sinusitis, and to improve the therapeutic effects. Methods: Ten mucosal biopsy samples collected during the surgeries of patients with recurrent odontogenic maxillary sinusitis were selected as Group A. Another ten mucosal biopsy sample were collected during retention cyst-removing surgeries and referred to as Group B. The mucosae were put in 10% neutral formalin solution for 1 day and prepared into 5-7 µm thick paraffin sections which were subjected to hematoxylin-eosin staining. The reactions included: (1) Reaction with T-lymphocyte (CD-3); (2) reaction with T-helper cell (CD-4); (3) reaction with T-suppressing cell (CD-8); (4) reaction with B-lymphocyte (CD-20). Polymeric horseradish peroxidase visualized detection system was used. The contents of CD3, CD4, CD8 and CD20 in the stained cells of the maxillary sinus mucosal layer were calculated. The responses of receptors to muramidase were classified as mild, moderate and strong. All data were analyzed by Statistica 6.0 package for Windows based on Mann-Whitney non-parametric standards. Results: The epithelial tissues in the maxillary sinus mucosa of Group B were covered with multiple rows of cilia. The epithelial cells of Group A suffered from degeneration, shrinkage and desquamation. Different cells were distributed in the autologous mucosal layer, of which macrophages, fibroblasts, lymphocytes and neutrophils were dominant. The average contents of macrophages and lymphocytes accounted for 42.8%. Lymphocyte subset analysis showed that the number of CD3 cells exceeded that of CD20 ones and there were more CD4+ cells than CD8+ ones. T-helper and T-suppressing cells were distributed remarkably differently. CD8+ cells were mainly located inside and under the epithelium, while CD4+ cells were scattered in the autologous matrix. Conclusion: For patients with recurrent odontogenic maxillary sinusitis, the maxillary sinus mucosa mainly suffered from regeneration of epithelial tissues and inhibition of cell proliferation, which were accompanied by damages to the protective and shielding effects of the mucociliary transport system. Macrophages and lymphocytes dominated in the infiltration of autologous mucosal layer, and the coexisting copious fibroblasts indicated the onset of inflammation.
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Affiliation(s)
- Lin Feng
- Lin Feng, Department of Stomatology, Chinese PLA General Hospital, Beijing 100853, P. R. China
| | - Hua Li
- Hua Li, Department of Stomatology, Chinese PLA General Hospital, Beijing 100853, P. R. China
| | - Ling-Ling E
- Ling-Ling E, Department of Stomatology, Chinese PLA General Hospital, Beijing 100853, P. R. China
| | - Chuan-Jie Li
- Chuan-Jie Li, Department of Stomatology, Chinese PLA General Hospital, Beijing 100853, P. R. China
| | - Yan Ding
- Yan Ding, Mitchell Medical Institute, University of South Alabama, Mobile, AL 36604, USA
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68
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Dimaka K, Mallis A, Naxakis SS, Marangos M, Papadas TA, Stathas T, Mastronikolis NS. Chronic rhinocerebral mucormycosis: a rare case report and review of the literature. Mycoses 2014; 57:699-702. [PMID: 25039925 DOI: 10.1111/myc.12219] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2014] [Revised: 06/07/2014] [Accepted: 06/12/2014] [Indexed: 12/17/2022]
Abstract
Rhinocerebral mucormycosis is an invasive infection caused by filamentous fungi of the Mucoraceae family. The rhinocerebral form of the disease represents the most common form and has two distinct clinical entities. The common presentation consists of a rapidly progressive infection with high mortality rate, while the other presentation is that of a chronic infection with lower mortality. In the present paper we report a rare case of chronic rhinocerebral mucormycosis. An 85-year-old male with a 6-month history of purulent and odorous nasal discharge, and sporadic episodes of epistaxis and anosmia, presented to the outpatient department of our clinic. Initial cultures were positive only for Pseudomonas aeruginosa. The patient was unresponsive to ciprofloxacin treatment, developing necrotic areas of the nasal septum suspicious for rhinocerebral mucormycosis. Admission to the ENT clinic followed, with histopathologic evaluation of the vomer bone confirming the diagnosis. The patient was treated with amphotericin B and was discharged 3 weeks later on oral posaconazole therapy. Chronic rhinocerebral mucormycosis may present with atypical symptoms or coinfection with another agent. A high degree of clinical suspicion is required for correct diagnosis and prompt initiation of appropriate treatment.
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69
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Kim IA, Thompson CF, Kedeshian PA, Palma-Diaz F, Suh JD. Invasive fungal sinusitis in a healthy athlete due to long-term anabolic steroid use. Laryngoscope 2014; 124:1756-9. [DOI: 10.1002/lary.24608] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2013] [Revised: 12/26/2013] [Accepted: 01/21/2014] [Indexed: 01/25/2023]
Affiliation(s)
- Irene A. Kim
- Department of Head & Neck Surgery; University of California, Los Angeles, David Geffen School of Medicine; Los Angeles California U.S.A
| | - Christopher F. Thompson
- Department of Head & Neck Surgery; University of California, Los Angeles, David Geffen School of Medicine; Los Angeles California U.S.A
| | - Paul A. Kedeshian
- Department of Head & Neck Surgery; University of California, Los Angeles, David Geffen School of Medicine; Los Angeles California U.S.A
| | - Fernando Palma-Diaz
- Department of Pathology; University of California, Los Angeles, David Geffen School of Medicine; Los Angeles California U.S.A
| | - Jeffrey D. Suh
- Department of Head & Neck Surgery; University of California, Los Angeles, David Geffen School of Medicine; Los Angeles California U.S.A
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Barrs VR, Beatty JA, Dhand NK, Talbot JJ, Bell E, Abraham LA, Chapman P, Bennett S, van Doorn T, Makara M. Computed tomographic features of feline sino-nasal and sino-orbital aspergillosis. Vet J 2014; 201:215-22. [PMID: 24685469 DOI: 10.1016/j.tvjl.2014.02.020] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2013] [Revised: 01/27/2014] [Accepted: 02/10/2014] [Indexed: 12/16/2022]
Abstract
Feline upper respiratory tract aspergillosis (URTA) occurs as two distinct anatomical forms, namely, sino-nasal aspergillosis (SNA) and sino-orbital aspergillosis (SOA). An emerging pathogen, Aspergillus felis, is frequently involved. The pathogenesis of URTA, in particular the relationship between the infecting isolate and outcome, is poorly understood. In this study, computed tomography was used to investigate the route of fungal infection and extension in 16 cases (SNA n = 7, SOA n = 9) where the infecting isolate had been identified by molecular testing. All cases had nasal cavity involvement except for one cat with SNA that had unilateral frontal sinus changes. There was a strong association between the infecting species and anatomic form (P = 0.005). A. fumigatus infections remained within the sino-nasal cavity, while cryptic species infections were associated with orbital and paranasal soft-tissue involvement and with orbital lysis. Cryptic species were further associated with a mass in the nasal cavity, paranasal sinuses or nasopharynx. Orbital masses showed heterogeneous contrast enhancement, with central coalescing hypoattenuating foci and peripheral rim enhancement. Severe, cavitated turbinate lysis, typical of canine SNA, was present only in cats with SNA. These findings support the hypothesis that the nasal cavity is the portal of entry for fungal spores in feline URTA and that the route of extension to involve the orbit is via direct naso-orbital communication from bone lysis. Additionally, a pathogenic role for A. wyomingensis and a sinolith in a cat with A. udagawae infection are reported for the first time.
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Affiliation(s)
- V R Barrs
- Valentine Charlton Cat Centre, Faculty of Veterinary Science, The University of Sydney, Sydney, NSW 2006, Australia.
| | - J A Beatty
- Valentine Charlton Cat Centre, Faculty of Veterinary Science, The University of Sydney, Sydney, NSW 2006, Australia
| | - N K Dhand
- Farm Animal and Veterinary Public Health, Faculty of Veterinary Science, University of Sydney, Sydney, NSW 2570, Australia
| | - J J Talbot
- Valentine Charlton Cat Centre, Faculty of Veterinary Science, The University of Sydney, Sydney, NSW 2006, Australia
| | - E Bell
- University of Melbourne Veterinary Clinic and Hospital, Werribee, Vic. 3030, Australia
| | - L A Abraham
- University of Melbourne Veterinary Clinic and Hospital, Werribee, Vic. 3030, Australia
| | - P Chapman
- Veterinary Speciality and Emergency Centre, Levittown, 301 Veterans Highway, Philadelphia, PA, 19056, USA
| | - S Bennett
- Department of Veterinary Clinical Sciences, Murdoch University, Murdoch, WA 6150, Australia
| | - T van Doorn
- Department of Applied and Industrial Mycology, CBS-KNAW Fungal Biodiversity Centre, Utrecht, The Netherlands
| | - M Makara
- Valentine Charlton Cat Centre, Faculty of Veterinary Science, The University of Sydney, Sydney, NSW 2006, Australia
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71
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Halderman A, Shrestha R, Sindwani R. Chronic granulomatous invasive fungal sinusitis: an evolving approach to management. Int Forum Allergy Rhinol 2014; 4:280-3. [DOI: 10.1002/alr.21299] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2013] [Revised: 01/02/2014] [Accepted: 01/07/2014] [Indexed: 11/07/2022]
Affiliation(s)
- Ashleigh Halderman
- Section of Rhinology; Sinus and Skull Base Surgery, Head & Neck Institute, Cleveland Clinic Foundation; Cleveland OH
| | - Rabin Shrestha
- Section of Infectious Disease; Medicine Institute, Cleveland Clinic Foundation; Cleveland OH
| | - Raj Sindwani
- Section of Rhinology; Sinus and Skull Base Surgery, Head & Neck Institute, Cleveland Clinic Foundation; Cleveland OH
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Abstract
Invasive fungal rhinosinusitis (IFRS) is a disease of the paranasal sinuses and nasal cavity that typically affects immunocompromised patients in the acute fulminant form. Early symptoms can often mimic rhinosinusitis, while late symptoms can cause significant morbidity and mortality. Swelling and mucosal thickening can quickly progress to pale or necrotic tissue in the nasal cavity and sinuses, and the disease can rapidly spread and invade the palate, orbit, cavernous sinus, cranial nerves, skull base, carotid artery, and brain. IFRS can be life threatening if left undiagnosed or untreated. While the acute fulminant form of IFRS is the most rapidly progressive and destructive, granulomatous and chronic forms also exist. Diagnosis of IFRS often mandates imaging studies in conjunction with clinical, endoscopic, and histopathological examination. Treatment of IFRS consists of reversing the underlying immunosuppression, antifungal therapy, and aggressive surgical debridement. With early diagnosis and treatment, IFRS can be treated and increase patient survival.
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Affiliation(s)
- Praveen Duggal
- Emory University, Sinus, Nasal, and Allergy Center, Atlanta, Georgia 30308, USA
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Medical Management of Acute Rhinosinusitis in Children and Adults. DISEASES OF THE SINUSES 2014. [PMCID: PMC7122618 DOI: 10.1007/978-1-4939-0265-1_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Zhang F, An Y, Li Z, Zhao C. A Novel Model of Invasive Fungal Rhinosinusitis in Rats. Am J Rhinol Allergy 2013; 27:361-6. [PMID: 23816783 DOI: 10.2500/ajra.2013.27.3953] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Background Invasive fungal rhinosinusitis (IFRS) is a life-threatening inflammatory disease that affects immunocompromised patients, but animal models of the disease are scarce. This study aimed to develop an IFRS model in neutropenic rats. Methods The model was established in three consecutive steps: unilateral nasal obstruction with Merocel sponges, followed by administration of cyclophosphamide (CPA), and, finally, nasal inoculation with Aspergillus fumigatus. Fifty healthy Wistar rats were randomly divided into five groups, with group I as the controls, group II undergoing unilateral nasal obstruction alone, group III undergoing nasal obstruction with fungal inoculation, group IV undergoing nasal obstruction with administration of CPA, and group V undergoing nasal obstruction with administration of CPA and fungal inoculation. Hematology, histology, and mycology investigations were performed. Results The changes in the rat absolute neutrophil counts (ANCs) were statistically different across the groups. The administration of CPA decreased the ANCs, whereas nasal obstruction with fungal inoculation increased the ANCs, and nasal obstruction did not change them. Histological examination of the rats in group V revealed the hyphal invasion of sinus mucosa and bone, thrombosis, and tissue infarction. No pathology indicative of IFRS was observed in the remaining groups. Positive rates of fungal culture in tissue homogenates from the maxillary sinus (62.5%) and lung (25%) were found in group V, whereas groups I, II, III, and IV showed no fungal culture in the homogenates. Conclusion A rat IFRS model was successfully developed through nasal obstruction, CPA-induced neutropenia, and fungal inoculation. The disease model closely mimics the pathophysiology of anthropic IFRS.
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Affiliation(s)
- Fang Zhang
- Department of Otorhinolaryngology–Head and Neck Surgery, Second Hospital of Shanxi Medical University, Taiyuan, China
| | - Yunfang An
- Department of Otorhinolaryngology–Head and Neck Surgery, Second Hospital of Shanxi Medical University, Taiyuan, China
| | - Zeqing Li
- Department of Otolaryngology, Affiliated Hospital of Nanjing University of Traditional Chinese Medicine, Nanjing, China
| | - Changqing Zhao
- Department of Otorhinolaryngology–Head and Neck Surgery, Second Hospital of Shanxi Medical University, Taiyuan, China
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Abstract
BACKGROUND Human exposure to fungal elements is inevitable, with normal respiration routinely depositing fungal hyphae within the nose and paranasal sinuses. Fungal species can cause sinonasal disease, with clinical outcomes ranging from mild symptoms to intracranial invasion and death. There has been much debate regarding the precise role fungal species play in sinonasal disease and optimal treatment strategies. METHODS A literature review of fungal diseases of the nose and sinuses was conducted. RESULTS Presentation, diagnosis, and current management strategies of each recognized form of fungal rhinosinusitis was reviewed. CONCLUSION Each form of fungal rhinosinusitis has a characteristic presentation and clinical course, with the immune status of the host playing a critical pathophysiological role. Accurate diagnosis and targeted treatment strategies are necessary to achieve optimal outcomes.
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Affiliation(s)
- Zachary M Soler
- Division of Rhinology and Sinus Surgery, Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina 29425, USA.
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Chang C, Gershwin ME, Thompson GR. Fungal disease of the nose and sinuses: an updated overview. Curr Allergy Asthma Rep 2013; 13:152-61. [PMID: 23135919 DOI: 10.1007/s11882-012-0320-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Fungal diseases of the nose and sinuses encompasses a diverse spectrum of disease. Clinical manifestations are largely dependent upon the immune status of the host, as, given the ubiquitous nature of these organisms, exposure is unavoidable. Asymptomatic colonization of the nasal passages by fungi warrants no treatment and is common, while allergic fungal rhinosinusitis is challenging and often requires a combined approach of surgical intervention, immunotherapy, and corticosteroid administration. A diagnosis requires a combination of IgE immune reactivity, eosinophilic infiltration, and fungi recovery. Similarly, invasive disease may present only after several months of slowly progressive disease, or in rapid and fulminant fashion in the appropriate host. A differentiation of these overlapping syndromes and the pathophysiologic processes at play, and recommended treatment algorithms, are the focus of this review.
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Affiliation(s)
- Christopher Chang
- Department of Pediatrics, Division of Allergy, Asthma, and Immunology, Nemours/A.I. Dupont Hospital for Children, Thomas Jefferson University, 1600 Rockland Road, Wilmington, DE, 19803, USA.
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Shields RC, Mokhtar N, Ford M, Hall MJ, Burgess JG, ElBadawey MR, Jakubovics NS. Efficacy of a marine bacterial nuclease against biofilm forming microorganisms isolated from chronic rhinosinusitis. PLoS One 2013; 8:e55339. [PMID: 23441151 PMCID: PMC3575374 DOI: 10.1371/journal.pone.0055339] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2012] [Accepted: 12/21/2012] [Indexed: 11/18/2022] Open
Abstract
Background The persistent colonization of paranasal sinus mucosa by microbial biofilms is a major factor in the pathogenesis of chronic rhinosinusitis (CRS). Control of microorganisms within biofilms is hampered by the presence of viscous extracellular polymers of host or microbial origin, including nucleic acids. The aim of this study was to investigate the role of extracellular DNA in biofilm formation by bacteria associated with CRS. Methods/Principal Findings Obstructive mucin was collected from patients during functional endoscopic sinus surgery. Examination of the mucous by transmission electron microscopy revealed an acellular matrix punctuated occasionally with host cells in varying states of degradation. Bacteria were observed in biofilms on mucosal biopsies, and between two and six different species were isolated from each of 20 different patient samples. In total, 16 different bacterial genera were isolated, of which the most commonly identified organisms were coagulase-negative staphylococci, Staphylococcus aureus and α-haemolytic streptococci. Twenty-four fresh clinical isolates were selected for investigation of biofilm formation in vitro using a microplate model system. Biofilms formed by 14 strains, including all 9 extracellular nuclease-producing bacteria, were significantly disrupted by treatment with a novel bacterial deoxyribonuclease, NucB, isolated from a marine strain of Bacillus licheniformis. Extracellular biofilm matrix was observed in untreated samples but not in those treated with NucB and extracellular DNA was purified from in vitro biofilms. Conclusion/Significance Our data demonstrate that bacteria associated with CRS form robust biofilms which can be reduced by treatment with matrix-degrading enzymes such as NucB. The dispersal of bacterial biofilms with NucB may offer an additional therapeutic target for CRS sufferers.
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Affiliation(s)
- Robert C. Shields
- School of Dental Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Norehan Mokhtar
- School of Dental Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom
- Advanced Medical and Dental Institute, Universiti Sains Malaysia, Penang, Malaysia
| | - Michael Ford
- Microbiology Department, Freeman Hospital, Newcastle upon Tyne, United Kingdom
| | - Michael J. Hall
- School of Chemistry, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - J. Grant Burgess
- School of Marine Science and Technology, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Mohamed Reda ElBadawey
- Department of Otolaryngology and Head & Neck Surgery, Freeman Hospital, Newcastle upon Tyne, United Kingdom
- Otolaryngology Department, Tanta University, Tanta, Egypt
| | - Nicholas S. Jakubovics
- School of Dental Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom
- * E-mail:
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