In vivo and in vitro suppression of lymphocyte function in Aspergillus sinusitis

Fungus ball of the paranasal sinuses: Analysis of our serie of patients

INTRODUCTION AND OBJECTIVES

The fungus ball is the most frequent type of fungal rhino-sinusitis. The objective of this study is to analyze the clinical and surgical features of our patients.

METHODS

Retrospective analysis of 35 patients with fungus ball treated in our centre between 2006 and 2014.

RESULTS

Mean age was 55 years old. 49% were men and 51% women. 75% involved the maxillary sinus, whereas 25% involved the sphenoid. 69% of our patients showed microcalcifications in the CT study. All the patients were surgically treated, with no cases of recurrence.

CONCLUSIONS

Clinical manifestations of fungus ball are non-specific, therefore endoscopy and image study are mandatory. The definitive diagnosis is made by histopathological study of the lesion. Endoscopic sinus surgery is the treatment of choice, with opening of the diseased sinus and complete removal of the fungus ball. The frequency of complications is very low. No oral or topical antimycotic treatments are necessary.

Surgical complications after implant placement

Placement of dental implants in the maxillofacial region is routine and considered safe. However, as with any surgical procedure, complications occur. Many issues that arise at surgery can be traced to the preoperative evaluation of the patient and assessment of the underlying anatomy. In this article, the authors review some common and uncommon complications that can occur during and shortly after implant placement. The emphasis of each section is on the management and prevention of complications that may occur during implant placement.

Fungal infection as a complication of sinus bone grafting and implants: a case report

Sinus bone grafts have been used successfully to augment atrophic posterior maxilla for dental implant placement. Even though sinus bone grafting is generally considered to be a safe surgical procedure, postoperative maxillary sinus infections can occur and therefore need to be considered. Bacteria, as well as viruses and fungi, have been identified as causative agents. Because fungal infection of the maxillary sinus after sinus bone grafting is not well known, we report a case of a middle-aged male patient along with the clinical, radiographic, and histologic findings. The patient was referred from his private dentist because of failed sinus bone grafting and osseointegration of implants. The surgical approach to the sinus yielded a friable mass of brownish-red material from the sinus. Review of pathology slides revealed a noninvasive hyphal mass caused by Aspergillus and polypous mucosa. After surgical removal of the mycotic masses, sinus bone grafting, using allograft, was performed. Bone formation after the healing period was favorable and dental implants were placed. There was no recurrence of fungal sinusitis.

Serum immunoglobulins and IgG subclass levels in sinus mycetoma

OBJECTIVE

To study the immunity of patients with sinus mycetoma by measuring serum immunoglobulins and IgG subclass levels.

STUDY DESIGN AND SETTING

Thirty patients with sinus mycetoma, 71 ordinary chronic rhinosinusitis patients without nasal polyps, and 77 ordinary chronic rhinosinusitis patients with nasal polyps were collected. In all subjects, the levels of total serum immunoglobulins and IgG subclasses were measured during surgical treatment.

RESULTS

Among 30 patients with sinus mycetoma, decreased IgA level was found in 1 patient, and decreased IgM level was found in another 2 patients. There were no significant differences in the levels of total serum immunoglobulins or IgG subclasses between patients with sinus mycetoma and ordinary chronic rhinosinusitis patients with or without nasal polyps.

CONCLUSION

Immunologic defects cannot be detected in patients with sinus mycetoma by measuring levels of total serum immunoglobulins or IgG subclasses.

SIGNIFICANCE

Immunoglobulin deficiency may not play an important role in the pathogenesis of sinus mycetoma.

Case Report. Maxillary sinus infection due to Emericella nidulans

Fungal infections of the maxillary sinus are frequently caused by Aspergillus species, particularly A. fumigatus. In otherwise healthy persons there is an association with overfilling of dental root canals, when zinc-containing filling materials were used. Below, a maxillary sinus aspergilloma is reported in a young immunocompetent female patient caused by Aspergillus (Emericella) nidulans.

Erythrocyte transfusion causes immunosuppression after total hip replacement

A prospective study of 34 patients undergoing total hip replacement was done to determine whether homologous erythrocyte transfusion causes postoperative immunosuppression. In the transfused patient group (14 patients), there was a reduction in CD3+ and CD3+4+ cell numbers at Day 2, returning to preoperative levels by Day 7. In contrast, in the untransfused patient group (20 patients), there was no significant depression in these lymphocyte subgroups at Day 2 and an increase in total lymphocyte, CD3+, CD3+4+, and CD3+4-8- cell numbers at Day 7. In both patient groups there was postoperative leukocytosis, granulocytosis, and monocytosis at Days 2 and 7, with no significant change in postoperative B (CD19+) cell numbers, natural killer cells, or the minor T cell populations of CD3+4+8+ and CD3+25+. The lymphocyte functional test of Candida recall was significantly impaired at Day 7 in the transfused patient group, where Candida recall is a memory T cell response to an antigen extracted from the yeast Candida Albicans. These findings suggest that homologous erythrocyte transfusion after hip replacement surgery causes cell mediated immune suppression. The main clinical implication of the current study is that perioperative homologous erythrocyte transfusion may place patients at greater risk of infectious complications, including infection of the prosthesis.

The spectrum of orbital aspergillosis: a clinicopathological review

Orbital aspergillosis is an uncommon but serious infection that may first present to the ophthalmologist. Usually arising from the paranasal sinuses, it may present in manifold ways within the orbit. Some presentations, such as optic nerve involvement, can respond to systemic corticosteroids, leading to delays in diagnosis and possibly iatrogenic potentiation of the infectious process. In this review, pertinent clinical and radiographic findings are discussed, and the literature is summarized. Classic approaches to therapy include local treatment, debridement, and systemic amphotericin B. We review novel approaches to treating orbital aspergillosis and detail a flow-chart for its management. Four patients from the spectrum of orbital aspergillosis are also described: initially presenting as an infection of an exenteration socket, a complex dacryocystitis, and optic nerve tumor, and post-operative periorbital swelling. Physicians should be familiar with the clinical spectrum of disease and the variable presentation of this infection, as early diagnosis and rapid institution of appropriate therapy are crucial elements in the management of invasive aspergillosis. In the neutropenic or otherwise immunocompromised patient, a high index of suspicion must be maintained as delays in diagnosis of fulminant aspergillosis may lead to overwhelming and rapidly progressive infection. Obtaining adequate diagnostic material for pathological and microbiological examination is critical. Newer methods of therapy, particularly itraconazole and liposomal amphotericin B, may be beneficial in selected patients.

Aspergillosis of the paranasal sinuses. A case report and radiographic review

Aspergillosis of the paranasal sinuses is uncommon; however, its incidence in recent years has shown a marked increase, and it is believed that it may account for a number of cases of nonspecific sinusitis. It may present in one of four forms, one of which is the noninvasive Aspergillus mycetoma. One such case affecting the maxillary sinus is reported, and reference is made to its possible sequelae and management. The significance of its presentation as a radiodense focus within the antrum on plain radiographs and computed tomography is discussed, as is the use of magnetic resonance imaging for excluding aspergillosis from the differential diagnosis.