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Ambika S, Lakshmi P. Infectious optic neuropathy (ION), how to recognise it and manage it. Eye (Lond) 2024; 38:2302-2311. [PMID: 38831116 PMCID: PMC11306351 DOI: 10.1038/s41433-024-03152-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Revised: 05/10/2024] [Accepted: 05/22/2024] [Indexed: 06/05/2024] Open
Abstract
Optic neuropathy can be of infectious or non-infectious/idiopathic aetiology. Many infectious organisms can cause optic neuropathy that can be of varied presentation including papillitis, retrobulbar optic neuritis, neuroretinitis, and optic perineuritis. Detailed history, ocular, systemic/neurologic examination along with appropriate laboratory evaluation can help clinicians to identify the infectious agent causing optic neuropathy. In spite of recent advanced techniques in serological testing and molecular diagnostics like polymerase chain reaction (PCR), the identification of these pathogens is still a diagnostic challenge. It is ideal to have an infectious disease (ID) consultant in the management team, as most of these infections are multisystem involving diseases. Most infectious agents can be effectively treated with specific antibiotics, with or without corticosteroid therapy, but visual recovery is highly variable and depends entirely on early diagnosis of the causative agent. This review article will provide an overview of common pathogens involved in ION and will describe their management paradigms.
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Affiliation(s)
- Selvakumar Ambika
- Department of Neuro-Ophthalmology, Sankara Nethralaya - A Unit of Medical Research Foundation, 18 College Road, Nungambakkam, Chennai, 600 006, India.
| | - Padma Lakshmi
- Department of Neuro-Ophthalmology, Sankara Nethralaya - A Unit of Medical Research Foundation, 18 College Road, Nungambakkam, Chennai, 600 006, India
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2
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Jeican II, Horhat DI, Dumitru M, Florea A, Barbu-Tudoran L, Gheban BA, Anton V, Toader C, Aluaș M, Siserman CV, Balica N, Vrînceanu D, Albu S. COVID-19-Associated Rhino-Orbital Mucormycosis: Histological and Electron Microscopy Characteristics. Diagnostics (Basel) 2024; 14:429. [PMID: 38396469 PMCID: PMC10887990 DOI: 10.3390/diagnostics14040429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Revised: 02/06/2024] [Accepted: 02/13/2024] [Indexed: 02/25/2024] Open
Abstract
COVID-19-associated rhino-orbital mucormycosis has become a new clinical entity. This study's aim was to evaluate the histopathological and ultramicroscopic morphological aspects of this fungal infection. This was an observational retrospective study on eight patients from three tertiary centers in Romania. The tissue samples collected during functional endoscopic sinus surgery were studied through histopathological examination, scanning electron microscopy, and transmission electron microscopy. In the histopathological examination, the morphological aspects characteristic of mucormycosis in all cases were identified: wide aseptate hyphae with right-angle ramifications, which invade blood vessels. One case presented perineural invasion into the perineural lymphatics. And in another case, mucormycosis-aspergillosis fungal coinfection was identified. Through scanning electron microscopy, long hyphae on the surface of the mucosa surrounded by cells belonging to the local immune system were identified in all samples, and bacterial biofilms were identified in half of the samples. Through transmission electron microscopy, aseptate hyphae and bacterial elements were identified in the majority of the samples. Rhino-orbital-cerebral mucormycosis associated with COVID-19 produces nasal sinus dysbiosis, which favors the appearance of bacterial biofilms. The way in which the infection develops depends on the interaction of the fungi with cells of the immune system.
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Affiliation(s)
- Ionuț Isaia Jeican
- Department of Anatomy and Embryology, Iuliu Hatieganu University of Medicine and Pharmacy, 400006 Cluj-Napoca, Romania;
| | - Delia Ioana Horhat
- Department of Ear-Nose-Throat, Victor Babes University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania; (D.I.H.); (N.B.)
| | - Mihai Dumitru
- Department of Ear-Nose-Throat, Carol Davila University of Medicine and Pharmacy, 050472 Bucharest, Romania; (M.D.); (D.V.)
| | - Adrian Florea
- Department of Cell and Molecular Biology, Iuliu Hatieganu University of Medicine and Pharmacy, 400349 Cluj-Napoca, Romania;
| | - Lucian Barbu-Tudoran
- Electron Microscopy Laboratory Prof. C. Crăciun, Faculty of Biology and Geology, Babes-Bolyai University, 400006 Cluj-Napoca, Romania;
- Electron Microscopy Integrated Laboratory, National Institute for R&D of Isotopic and Molecular Technologies, 400293 Cluj-Napoca, Romania
| | - Bogdan-Alexandru Gheban
- Department of Histology, Iuliu Hatieganu University of Medicine and Pharmacy, 400349 Cluj-Napoca, Romania;
- Department of Pathology, Emergency Clinical County Hospital, 400347 Cluj-Napoca, Romania
| | - Vlad Anton
- Department of Medical Biochemistry, Iuliu Hatieganu University of Medicine and Pharmacy, 400349 Cluj-Napoca, Romania;
| | - Corneliu Toader
- Clinic of Neurosurgery, National Institute of Neurology and Neurovascular Diseases, 041914 Bucharest, Romania;
| | - Maria Aluaș
- Department of Oral Health, Iuliu Hatieganu University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania
| | - Costel Vasile Siserman
- Institute of Legal Medicine, 400006 Cluj-Napoca, Romania;
- Department of Legal Medicine, Iuliu Hatieganu University of Medicine and Pharmacy, 400006 Cluj-Napoca, Romania
| | - Nicolae Balica
- Department of Ear-Nose-Throat, Victor Babes University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania; (D.I.H.); (N.B.)
| | - Daniela Vrînceanu
- Department of Ear-Nose-Throat, Carol Davila University of Medicine and Pharmacy, 050472 Bucharest, Romania; (M.D.); (D.V.)
| | - Silviu Albu
- Department of Head and Neck Surgery and Otorhinolaryngology, University Clinical Hospital of Railway Company, Iuliu Hatieganu University of Medicine and Pharmacy, 400015 Cluj-Napoca, Romania;
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3
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Thornton CR, Davies GE, Dougherty L. Development of a monoclonal antibody and a lateral-flow device for the rapid detection of a Mucorales-specific biomarker. Front Cell Infect Microbiol 2023; 13:1305662. [PMID: 38145040 PMCID: PMC10739493 DOI: 10.3389/fcimb.2023.1305662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 11/20/2023] [Indexed: 12/26/2023] Open
Abstract
Mucoromycosis is a highly aggressive angio-invasive disease of humans caused by fungi in the zygomycete order, Mucorales. While Rhizopus arrhizus is the principal agent of mucoromycosis, other Mucorales fungi including Apophysomyces, Cunninghamella, Lichtheimia, Mucor, Rhizomucor and Syncephalastrum are able to cause life-threatening rhino-orbital-cerebral, pulmonary, gastro-intestinal and necrotising cutaneous infections in humans. Diagnosis of the disease currently relies on non-specific CT, lengthy and insensitive culture from invasive biopsy, and time-consuming histopathology of tissue samples. At present, there are no rapid antigen tests that detect Mucorales-specific biomarkers of infection, and which allow point-of-care diagnosis of mucoromycosis. Here, we report the development of an IgG2b monoclonal antibody (mAb), TG11, which binds to extracellular polysaccharide (EPS) antigens of between 20 kDa and 250 kDa secreted during hyphal growth of Mucorales fungi. The mAb is Mucorales-specific and does not cross-react with other yeasts and molds of clinical importance including Aspergillus, Candida, Cryptococcus, Fusarium, Lomentospora and Scedosporium species. Using the mAb, we have developed a Competitive lateral-flow device that allows rapid (30 min) detection of the EPS biomarker in human serum and bronchoalveolar lavage (BAL), with a limit of detection (LOD) in human serum of ~100 ng/mL serum (~224.7 pmol/L serum). The LFD therefore provides a potential novel opportunity for detection of mucoromycosis caused by different Mucorales species.
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Affiliation(s)
- Christopher R. Thornton
- Biosciences, Faculty of Health and Life Sciences, University of Exeter, Exeter, United Kingdom
- ISCA Diagnostics Ltd., Hatherly Laboratories, Exeter, United Kingdom
| | - Genna E. Davies
- ISCA Diagnostics Ltd., Hatherly Laboratories, Exeter, United Kingdom
| | - Laura Dougherty
- Biosciences, Faculty of Health and Life Sciences, University of Exeter, Exeter, United Kingdom
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4
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Liu S, Yagan A. Invasive Fungal Rhinosinusitis Associated With Schizophyllum commune in an Immunocompetent Patient. J Neuroophthalmol 2023; 43:e227-e229. [PMID: 35234677 DOI: 10.1097/wno.0000000000001518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Siyin Liu
- Manchester Royal Eye Hospital (SL, AY), Manchester University NHS Foundation Trust, Manchester, United Kingdom; and School of Biological Sciences (SL), Faculty of Biology, Medicine and Health, University of Manchester, United Kingdom
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Alramadhan SA, Sam SS, Young S, Cohen DM, Islam MN, Bhattacharyya I. COVID-related mucormycosis mimicking dental infection. ORAL AND MAXILLOFACIAL SURGERY CASES 2023; 9:100310. [PMID: 37193535 PMCID: PMC10163790 DOI: 10.1016/j.omsc.2023.100310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 04/10/2023] [Accepted: 05/01/2023] [Indexed: 05/18/2023] Open
Abstract
A recent increase in the prevalence of mucormycosis of the head and neck in patients who have recovered from COVID-19 following hospitalization has been reported. A Majority of the cases have been reported from India. Conditions such as diabetes mellitus, use of corticosteroids for other autoimmune conditions, organ transplant, immunosuppression, immunodeficiency, and malignancies especially hematologic ones, are all known risk factors for mucormycosis. Recently, hospitalization for COVID-19 has been added to the list of risk factors for opportunistic mucormycosis infection. This is likely attributable to the high doses and prolonged use of corticosteroids in the treatment of hospitalized COVID-19 patients. Case Description: Two patients with post-COVID-19 associated rhinocerebral mucormycosis presented with profound unexplained dental disease including tooth mobility and dental abscess mimicking periodontal disease. The patients were previously hospitalized for COVID-19 and received prolonged treatment with high doses of corticosteroids. The patients responded well to the surgical debridement with or without antifungal therapy. Conclusion: Oral healthcare providers including oral and maxillofacial surgeons, dentists, dental hygienists, and other dental practitioners can play a vital role in the recognition and early diagnosis of rhinocerebral mucormycosis given the large number of patients with severe COVID-19 infection who have recovered following hospitalization and/or received long-term high doses of immunosuppressive treatment.
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Affiliation(s)
- Saja A Alramadhan
- Department of Oral and Maxillofacial Diagnostic Sciences, University of Florida College of Dentistry, Gainesville, FL, USA
| | - Sumita S Sam
- Department of Oral and Maxillofacial Diagnostic Sciences, University of Florida College of Dentistry, Gainesville, FL, USA
| | - Shaun Young
- Private Practice Limited to Oral and Maxillofacial Surgery at MOSAIC Maxillofacial Surgical Arts and Implants Center, Tampa, FL, USA
| | - Donald M Cohen
- Department of Oral and Maxillofacial Diagnostic Sciences, University of Florida College of Dentistry, Gainesville, FL, USA
| | - Mohammed N Islam
- Department of Oral and Maxillofacial Diagnostic Sciences, University of Florida College of Dentistry, Gainesville, FL, USA
| | - Indraneel Bhattacharyya
- Department of Oral and Maxillofacial Diagnostic Sciences, University of Florida College of Dentistry, Gainesville, FL, USA
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6
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Wang T, Cao D, Han J. Acute invasive mucormycosis rhinosinusitis causing multigroup cranial nerve injury and meningitis-A case report. Front Neurol 2022; 13:873694. [PMID: 36267886 PMCID: PMC9578558 DOI: 10.3389/fneur.2022.873694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 08/09/2022] [Indexed: 11/13/2022] Open
Abstract
This study reported a case of a Rhino-Orbital-Cerebral Mycosis (ROCM) patient with multiple groups of cranial nerve damage as the primary clinical manifestation, confirmed by histopathology and cerebrospinal fluid metagenomic next-generation sequencing (mNGS) technology. Relying on the MRI3D-SPACE technology, we observed the location and extent of the cranial nerve damage in the patient. The results suggested that fungal meningoencephalitis caused by mucor may enter the skull retrograde along the cranial nerve perineurium. The patient was admitted to the hospital with a preliminary diagnosis of mucormycosis infection after 1.5 days of mouth deviation. We treated the patient immediately with intravenous amphotericin B liposomes. After 21 days of hospitalization, the clinical symptoms of the patient did not improve significantly. The patient was discharged due to financial difficulties and antifungal treatment at home, and his disease had stabilized at the 6-month follow-up.
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Affiliation(s)
| | | | - Jingzhe Han
- Department of Neurology, Harrison International Peace Hospital, Hengshui, China
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7
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Davies GE, Thornton CR. Development of a Monoclonal Antibody and a Serodiagnostic Lateral-Flow Device Specific to Rhizopus arrhizus (Syn. R. oryzae), the Principal Global Agent of Mucormycosis in Humans. J Fungi (Basel) 2022; 8:jof8070756. [PMID: 35887511 PMCID: PMC9325280 DOI: 10.3390/jof8070756] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 07/01/2022] [Accepted: 07/20/2022] [Indexed: 12/04/2022] Open
Abstract
Mucormycosis is a highly aggressive angio-invasive disease of humans caused by fungi in the zygomycete order, Mucorales. Though a number of different species can cause mucormycosis, the principal agent of the disease worldwide is Rhizopus arrhizus, which accounts for the majority of rhino-orbital-cerebral, pulmonary, and disseminated infections in immunocompromised individuals. It is also the main cause of life-threatening infections in patients with poorly controlled diabetes mellitus, and in corticosteroid-treated patients with SARS-CoV-2 infection, where it causes the newly described disease, COVID-19-associated mucormycosis (CAM). Diagnosis currently relies on non-specific CT, a lengthy and insensitive culture from invasive biopsy, and a time-consuming histopathology of tissue samples. At present, there are no rapid antigen tests for the disease that detect biomarkers of infection, and which allow point-of-care diagnosis. Here, we report the development of an IgG1 monoclonal antibody (mAb), KC9, which is specific to Rhizopus arrhizus var. arrhizus (syn. Rhizopus oryzae) and Rhizopus arrhizus var. delemar (Rhizopus delemar), and which binds to a 15 kDa extracellular polysaccharide (EPS) antigen secreted during hyphal growth of the pathogen. Using the mAb, we have developed a competitive lateral-flow device (LFD) that allows rapid (30 min) and sensitive (~50 ng/mL running buffer) detection of the EPS biomarker, and which is compatible with human serum (limit of detection of ~500 ng/mL) and bronchoalveolar lavage fluid (limit of detection of ~100 ng/mL). The LFD, therefore, provides a potential novel opportunity for the non-invasive detection of mucormycosis caused by Rhizopus arrhizus.
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Affiliation(s)
- Genna E. Davies
- ISCA Diagnostics Ltd., B12A, Hatherly Laboratories, Prince of Wales Road, Exeter EX4 4PS, UK;
| | - Christopher R. Thornton
- MRC Centre for Medical Mycology, Geoffrey Pope Building, University of Exeter, Stocker Road, Exeter EX4 4QD, UK
- Correspondence:
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Jain V, Senetar AJ, Maciel CB, Remley W, Islam S, Fredenburg KM, Babi MA, Robinson CP. A 40-Year-Old Woman With COVID-19 and Bilateral Vision Loss. Neurohospitalist 2022; 12:664-668. [PMID: 36147755 PMCID: PMC9280117 DOI: 10.1177/19418744221114209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Mucormycosis is a fast-spreading angioinvasive fungal infection with a very high mortality rate. It is associated with immunodeficiency, diabetes mellitus, iron overload, stem cell transplantation and the use of steroids. As cultures and histopathological biopsy may have low yield in invasive fungal infections, new generation sequencing of cfDNA (cell free deoxyribonucleic acid) has become a cornerstone for diagnosis. Over the past 18 months, increasing reports of COVID-19 associated Mucormycosis have emerged, most specifically in India and other nearby developing countries. Awareness and knowledge of this newly discovered association is of high importance and clinical relevance as the global COVID-19 pandemic continues. Herein, we present a case of a patient who was treated with steroids for COVID-19 in the outpatient setting and presented with unilateral periorbital pain and blurry vision. She progressively developed bilateral vision loss, fixed bilateral mydriasis, ophthalmoplegia and coma. Imaging findings included leptomeningeal, vascular, and subcortical enhancement accompanied with multifocal infarction. Subsequent biopsy of the paranasal sinuses revealed broad type fungal elements and cfDNA sequencing identified the pathogen as Rhizopus species. She was treated with intravenous amphotericin B, but succumbed to the infection.
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Affiliation(s)
- Varun Jain
- Department of Neurology, University of Florida College of Medicine, Gainesville, FL, USA
| | - Alexander J. Senetar
- Department of Neurology, University of Florida College of Medicine, Gainesville, FL, USA
| | - Carolina B Maciel
- Department of Neurology and Neurosurgery, University of Florida College of Medicine, Gainesville, FL, USA
| | - William Remley
- Medical Student, Lake Erie College of Osteopathic Medicine, Gainesville, FL, USA
| | - Shehla Islam
- Department of Infectious Diseases, University of Florida College of Medicine, Gainesville, FL, USA
| | - Kristianna M. Fredenburg
- Department of Pathology, Immunology, and Laboratory Medicine, University of Florida College of Medicine, Gainesville, FL, USA
| | - Marc A Babi
- Department of Neurology and Neurosurgery, University of Florida College of Medicine, Gainesville, FL, USA
| | - Christopher P. Robinson
- Department of Neurology and Neurosurgery, University of Florida College of Medicine, Gainesville, FL, USA
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Beeraka NM, Liu J, Sukocheva O, Sinelnikov MY, Fan R. Antibody responses and CNS pathophysiology of Mucormycosis in Chronic SARS CoV-2 infection: Current Therapies against Mucormycosis. Curr Med Chem 2022; 29:5348-5357. [PMID: 35538800 DOI: 10.2174/0929867329666220430125326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 02/01/2022] [Accepted: 02/22/2022] [Indexed: 01/08/2023]
Abstract
The incidence rate of opportunistic secondary infections through invasive fungi has been observed to be 14.5% to 27% in the SARS CoV pandemic during the year 2003. But, the incidence of SARS CoV-2 is accompanied by the substantial rise in secondary opportunistic infections like mucormycosis (black fungus) mainly in the immunocompromised individuals, and diabetic patients taking steroids. Substantial rates of COVID-19 cases with mucormycosis were reported in India and other parts of the world. Previous research reports delineated the ability of Mucorales in invading the various tissues like lungs, brain, sinus through the GRP78 and subsequently this infection could invoke crusting, edema, and necrosis of brain parenchyma, ptosis, proptosis, and vision loss due to intraorbital & intracranial complications. Similarities of these pathophysiological complications with already existing diseases are causing clinicians to face several challenges in order to diagnose and treat this disease effectively at the early stage. This minireview depicts the mucormycosis-induced immune, and pathophysiological alterations in COVID-19 patients comorbid with diabetes, immunosuppression, and also reported the various clinical manifestations, and the therapeutic modalities and the failures of anti-fungal vaccines. Therefore, the emerging mucormycosis in COVID-19 patients need a rapid investigation and selective optimization of the effective therapeutic modalities including antifungal vaccines to minimize mortality rate.
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Affiliation(s)
- Narasimha M Beeraka
- Department of Radiation Oncology, Cancer Center, The First Affiliated Hospital of Zhengzhou University,1 Jianshedong Str., Zhengzhou, 450052, China
| | - Junqi Liu
- Department of Radiation Oncology, Cancer Center, The First Affiliated Hospital of Zhengzhou University,1 Jianshedong Str., Zhengzhou, 450052, China
| | - Olga Sukocheva
- Discipline of Health Sciences, College of Nursing and Health Sciences, Flinders University, Bedford Park, South Australia, 5042, Australia
| | - Mikhail Y Sinelnikov
- I.M. Sechenov First Moscow State Medical University (Sechenov University), 8/2 Trubetskaya Street, Moscow, 119991, Russian Federation
| | - Ruitai Fan
- Department of Radiation Oncology, Cancer Center, The First Affiliated Hospital of Zhengzhou University,1 Jianshedong Str., Zhengzhou, 450052, China
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Sekaran A, Patil N, Sabhapandit S, Sistla SK, Reddy DN. Rhino-orbito-cerebral mucormycosis: an epidemic in a pandemic. IJID REGIONS 2022; 2:99-106. [PMID: 35721429 PMCID: PMC8702630 DOI: 10.1016/j.ijregi.2021.12.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 12/20/2021] [Accepted: 12/20/2021] [Indexed: 01/06/2023]
Affiliation(s)
- Anuradha Sekaran
- Department of Pathology, AIG Hospitals, Hyderabad, Telangana, India
- Corresponding author. Address: Department of Pathology, AIG Hospitals, Mindspace Road, Gachibowli, Hyderabad, Telangana 500032, India.
| | - Nayana Patil
- Department of Pathology, AIG Hospitals, Hyderabad, Telangana, India
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Dental and Oral Manifestations of COVID-19 Related Mucormycosis: Diagnoses, Management Strategies and Outcomes. J Fungi (Basel) 2021; 8:jof8010044. [PMID: 35049983 PMCID: PMC8781413 DOI: 10.3390/jof8010044] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 12/28/2021] [Accepted: 12/29/2021] [Indexed: 12/14/2022] Open
Abstract
It has been nearly two years since the pandemic caused by the novel coronavirus disease (COVID-19) has affected the world. Several innovations and discoveries related to COVID-19 are surfacing every day and new problems associated with the COVID-19 virus are also coming to light. A similar situation is with the emergence of deep invasive fungal infections associated with severe acute respiratory syndrome 2 (SARS-CoV-2). Recent literature reported the cases of pulmonary and rhino-cerebral fungal infections appearing in patients previously infected by COVID-19. Histopathological analysis of these cases has shown that most of such infections are diagnosed as mucormycosis or aspergillosis. Rhino-orbital-cerebral mucormycosis usually affects the maxillary sinus with involvement of maxillary teeth, orbits, and ethmoidal sinuses. Diabetes mellitus is an independent risk factor for both COVID-19 as well as mucormycosis. At this point, there is scanty data on the subject and most of the published literature comprises of either case reports or case series with no long-term data available. The aim of this review paper is to present the characteristics of COVID-19 related mucormycosis and associated clinical features, outcome, diagnostic and management strategies. A prompt diagnosis and aggressive treatment planning can surely benefit these patients.
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Fungal Invasive Co-Infection Due to Aspergillus fumigatus and Rhizopus arrhizus: A Rhino-Orbital Presentation. J Fungi (Basel) 2021; 7:jof7121096. [PMID: 34947078 PMCID: PMC8704653 DOI: 10.3390/jof7121096] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Revised: 12/10/2021] [Accepted: 12/11/2021] [Indexed: 12/30/2022] Open
Abstract
Aspergillosis and mucormycosis are filamentous fungal infections occurring predominantly in immunocompromised patients. Fulminant process with rapid infiltration of the contiguous tissue is distinctive for both type of fungi. The rhinocerebral co-infection by Aspergillus and Mucorales is very rare and is usually associated in immunocompromised patients with a high mortality rate. This rare co-infection leads to difficulties in diagnosis, and therapeutic delays can result in a poor prognosis. Overall, the treatment of choice is surgical debridement and liposomal amphotericin B. This paper describes a combined aspergillosis and mucormycosis case in a diabetes mellitus type 2 patient with chronic ulcerations of the palatal and cheek. To our knowledge, this is the first report of an uncommon co-infection of Aspergillus fumigatus and Rhizopus arrhizus in a rhino-orbital presentation.
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13
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Vrinceanu D, Dumitru M, Patrascu OM, Costache A, Papacocea T, Cergan R. Current diagnosis and treatment of rhinosinusal aspergilloma (Review). Exp Ther Med 2021; 22:1264. [PMID: 34603532 PMCID: PMC8453335 DOI: 10.3892/etm.2021.10699] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 07/02/2021] [Indexed: 11/05/2022] Open
Abstract
There are numerous types of sinusitis caused by fungal strains, some of which already colonize the nasal cavity. Mild forms present fungus balls growing inside a preexisting sinus cavity. The invasive type ranges from chronic manifestations to acute aggravated episodes. The latter scenario is encountered in cases with reduced immune responses, such as patients with diabetes, individuals receiving any form of transplant, AIDS cases and chemotherapy patients. Without the control of immunosuppression, the infection is aggravated and extends to the orbit and inside the skull base, regardless of the prompt surgical and medical treatment. This is the most common pathogenic fungus on the nasal sinuses level. It can occasionally enter the sinus cavity during dental procedures. The pathogenesis is enhanced by anaerobic conditions in poorly ventilated sinus cavities. Rhinosinusal aspergilloma has a slow, insidious evolution over months and even years. Our experience revealed the presence of both a dental problem and previous self-administered antibiotic regimens in almost every case. The initial symptoms are common with sinusitis of dental origin, but aspergilloma should be considered when a patient with a competent immune system does not respond to standard antibiotic treatment. The final diagnosis of rhinosinusal aspergilloma is conducted on a pathology sample with silver staining. The bacteriology exam of the sinus secretion rarely reveals a fungus infection; however, as revealed in our clinical experience, there may be coinfection with other multidrug-resistant bacteria. Surgical treatment must establish a wide exposure of the sinus cavity and correct drainage regardless of the external, combined or endoscopic approach. Early diagnosis and emergency surgical debridement along with administering systemic antifungal compounds in some cases represent the key to the successful treatment of invasive aspergilloma.
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Affiliation(s)
- Daniela Vrinceanu
- ENT Department, Bucharest Emergency University Hospital, 010271 Bucharest, Romania
| | - Mihai Dumitru
- ENT Department, Bucharest Emergency University Hospital, 010271 Bucharest, Romania
| | - Oana Maria Patrascu
- Department of Pathology, 'Carol Davila' University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Adrian Costache
- Department of Pathology, 'Carol Davila' University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Toma Papacocea
- Department of Neurosurgery, 'Sf. Pantelimon' Hospital, 021661 Bucharest, Romania
| | - Romica Cergan
- Department of Anatomy, 'Carol Davila' University of Medicine and Pharmacy, 050474 Bucharest, Romania
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14
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Gupta A, Sharma A, Chakrabarti A. The emergence of post-COVID-19 mucormycosis in India: Can we prevent it? Indian J Ophthalmol 2021; 69:1645-1647. [PMID: 34146000 PMCID: PMC8374792 DOI: 10.4103/ijo.ijo_1392_21] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Affiliation(s)
- Amod Gupta
- Advanced Eye Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Aman Sharma
- Division of Clinical Immunology and Rheumatology, Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Arunaloke Chakrabarti
- Department of Microbiology and Division of Mycology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Can imaging suggest the aetiology in skull base osteomyelitis? A systematic literature review. Pol J Radiol 2021; 86:e309-e321. [PMID: 34136049 PMCID: PMC8186306 DOI: 10.5114/pjr.2021.106470] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Accepted: 09/15/2020] [Indexed: 12/27/2022] Open
Abstract
Purpose To assess differentiating features between bacterial, Aspergillus, and Mucor skull base osteomyelitis (SBO) with regard to clinical presentation and imaging appearances. Material and methods A literature search was performed in April 2020 for studies on SBO with a minimum sample size of 10 patients. Studies that reported presenting symptoms, cross-sectional imaging findings, complications, and mortality were included in the analysis. The quality of included articles was tested using the Quality Assessment of Diagnostic Accuracy Studies 2 tool. A data extraction form was used to retrieve relevant parameters from each of the articles. Results Thirteen articles were included in the final analysis. Diabetes mellitus was the most common predisposing factor (12.5-91.0%). Presenting complaints in all bacterial SBO studies were otogenic, while fungal SBO patients had nasal/ocular complaints. Rates of mortality and surgical intervention in the fungal group were 50-100% and 50%, respectively, as compared to the bacterial group – 7-87% and 10%, respectively. On imaging, the site of initial infection in bacterial SBO was the external auditory canal, while in fungal SBO it was the paranasal sinus. The incidence of orbital extension was < 5% in bacterial and 44-70% in fungal SBO, among which Mucor had rates of 65-70%. Bone erosion was less extensive in bacterial SBO, and the patterns differed. The highest incidence of vascular involvement and non-enhancing lesions (23-36%) was seen in Mucor. Aspergillus showed highest sino-cranial extension (52-55%) and homogenous bright enhancement. Conclusions Systematic analysis of the clinico-radiological parameters in each of the studies revealed differences in presentation, clinical course, extension, bone erosion, and enhancement.
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Razem B, Dennai Y, Slimani F. Chronical rhino-orbital mucormycosis in an immunocompetent host: A case report. Int J Surg Case Rep 2021; 82:105882. [PMID: 33865198 PMCID: PMC8079271 DOI: 10.1016/j.ijscr.2021.105882] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 04/06/2021] [Accepted: 04/07/2021] [Indexed: 11/26/2022] Open
Abstract
Mucormycosis is an opportunistic fungal infection caused by molds within the order Mucorales. The rhino-orbital-cerebral localization is the most frequent. It is a destructive, necrotizing and potentially fatal disease. The treatment involves aggressive surgical debridement combined with antifungal drugs. The course is quickly fatal in the event of delayed diagnosis and / or treatment. This infection usually affects immunocompromised and diabetic patients, but cases of mucormycosis in immunocompetents are increasingly reported. Chronic mucormycosis is extremely rare and affects both immunocompromised and immunocompetent patients, its clinical evolution is nonspecific and its treatment is not standardized. We report the case of a destructive rhino-orbital and pulmonary involvement in a 59 years old immunocompetent patient who presented a right periorbital edema associated and a vision loss and a notion of nasal obstruction and progressive onset headache four months before admission. Her condition progressed with rapidly extensive necrosis. She underwent extensive surgical resection but soon succumbed to multiple organ failure. The diagnosis of mucormycosis was confirmed post mortem on the excisional piece. The purpose of this article is to draw attention to chronic mucormycosis in the immunocompetent and to emphasize the importance of early diagnosis and adequate management of this fatal infection.
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Affiliation(s)
- Bahaa Razem
- Service de Stomatologie et chirurgie Maxillo-faciale, Hôpital 20 Août, CHU Ibn Rochd, B.P 2698, Casablanca, Morocco.
| | - Yassine Dennai
- Service de Stomatologie et chirurgie Maxillo-faciale, Hôpital 20 Août, CHU Ibn Rochd, B.P 2698, Casablanca, Morocco
| | - Faiçal Slimani
- Faculté de Médecine et Pharmacie, Hassan II University of Casablanca, B.P 5696, Casablanca, Morocco; Service de Stomatologie et chirurgie Maxillo-faciale, Hôpital 20 Août, CHU Ibn Rochd, B.P 2698, Casablanca, Morocco
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17
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Zayet S, Zaghdoudi A, Ammari L, Kilani B, Tiouiri Benaissa H. Cerebro-rhino-orbital mucormycosis and aspergillosis coinfection in a patient with diabetes mellitus: A case report. IDCases 2020; 23:e01022. [PMID: 33364168 PMCID: PMC7750555 DOI: 10.1016/j.idcr.2020.e01022] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 12/06/2020] [Accepted: 12/06/2020] [Indexed: 01/19/2023] Open
Abstract
Opportunistic fungal infections are life-threatening conditions with a high rate of morality, mostly occurring in immunocompromised hosts. We reported the case of mixed mold infection in a 69 year-old patient with latent diabetes mellitus. She was initially admitted for right orbital cellulitis. Cerebro-rhino-orbital mucormycosis and aspergillosis coinfection was diagnosed from mycological testing and histology after nasal biopsy sample. The patient received amphotericin B deoxycholate then voriconazole combined to surgical debridement with a favorable outcome.
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Affiliation(s)
- Souheil Zayet
- Department of Infectious Diseases, La Rabta Hospital, Tunisia
| | - Aida Zaghdoudi
- Department of Infectious Diseases, La Rabta Hospital, Tunisia
| | - Lamia Ammari
- Department of Infectious Diseases, La Rabta Hospital, Tunisia
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A case of primary pulmonary Schizophyllum commune empyema treated with video-assisted thoracoscopic decortication. Gen Thorac Cardiovasc Surg 2020; 69:584-587. [PMID: 33118109 DOI: 10.1007/s11748-020-01522-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Accepted: 09/27/2020] [Indexed: 10/23/2022]
Abstract
Schizophyllum commune (S. commune) is an environmental basidiomycete bracket fungus that can rarely cause invasive fungal disease. Its diagnosis is challenging and often missed. We present a rare case of a 56-year-old diabetic gentleman with a 6-months history of progressive productive cough, small volume hemoptysis and non-resolving fungal empyema treated with video-assisted thoracoscopic decortication. Pulmonary infection of S. Commune is extremely rare and can manifest as complex fungal empyema. Close cooperation between respirologists, thoracic surgeons and microbiologists is critical in the diagnosis and treatment of such cases.
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Leroy J, Vuotto F, Le V, Cornu M, François N, Marceau L, Fichet C, Loridant S, Sendid B. Invasive rhino-orbital-cerebral aspergillosis in an immunocompetent patient. J Mycol Med 2020; 30:101002. [PMID: 32507472 DOI: 10.1016/j.mycmed.2020.101002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 04/30/2020] [Accepted: 05/05/2020] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Rhino-orbital-aspergillosis (ROA) is a rare but serious disease in immunocompetent patients. Diagnosis is often delayed due to the absence of specific clinical symptoms. We describe the case of a patient who presented initially with ROA which spread progressively to the right ethmoid-sphenoid sinuses and then to the brain. OBSERVATION A 61-year-old patient with a history of well-controlled diabetes presented with a sudden severe decrease in right visual acuity. Cerebral MRI showed the presence of an infiltrate in the right orbital apex extending to the homolateral cavernous sinus without any cerebral involvement. A diagnosis of right orbital myositis was made and corticosteroid therapy was started. His symptoms worsened progressively leading to quasi-blindness. A new MRI showed the development of right sphenoid-ethmoid osteolytic lesions. A fungal aetiology was suspected and tests for fungal biomarkers found a β-(1-3)-D-glucan level of 99pg/ml but negative galactomannan. An ethmoid biopsy was performed for histological and mycological investigations, including the detection of Aspergillus DNA by qPCR. qPCR was positive and culture resulted in the isolation of multi-sensitive Aspergillus fumigatus. Treatment was initiated with voriconazole. Due to persistence of blindness and the appearance of a lesion extending to the right frontal lobe, surgical excision was performed followed by antifungal treatment for a total duration of 1year. The patient is currently stable, but has persistence of blindness in the right eye. CONCLUSION Invasive ROA is a rare but serious disease in immunocompetent patients which should be evoked in the differential diagnosis of a tumour or vasculitis. Early diagnosis is essential for optimal management.
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Affiliation(s)
- J Leroy
- Laboratoire de Parasitologie Mycologie, CHU Lille, University Lille, inserm U1285-CNRS UMR 8576, 59000 Lille, France
| | - F Vuotto
- Unité d'Infectiologie, CHU Lille, Lille, France
| | - V Le
- Laboratoire de Parasitologie Mycologie, CHU Lille, University Lille, inserm U1285-CNRS UMR 8576, 59000 Lille, France
| | - M Cornu
- Laboratoire de Parasitologie Mycologie, CHU Lille, University Lille, inserm U1285-CNRS UMR 8576, 59000 Lille, France
| | - N François
- Laboratoire de Parasitologie Mycologie, CHU Lille, University Lille, inserm U1285-CNRS UMR 8576, 59000 Lille, France
| | - L Marceau
- Plateforme de Biologie Moléculaire, Institut de Microbiologie, CHU Lille, Lille, France
| | - C Fichet
- Service d'Anatomopathologie, CHU Lille, Lille, France
| | - S Loridant
- Laboratoire de Parasitologie Mycologie, CHU Lille, University Lille, inserm U1285-CNRS UMR 8576, 59000 Lille, France
| | - B Sendid
- Laboratoire de Parasitologie Mycologie, CHU Lille, University Lille, inserm U1285-CNRS UMR 8576, 59000 Lille, France.
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Thornton CR. Detection of the 'Big Five' mold killers of humans: Aspergillus, Fusarium, Lomentospora, Scedosporium and Mucormycetes. ADVANCES IN APPLIED MICROBIOLOGY 2019; 110:1-61. [PMID: 32386603 DOI: 10.1016/bs.aambs.2019.10.003] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Fungi are an important but frequently overlooked cause of morbidity and mortality in humans. Life-threatening fungal infections mainly occur in immunocompromised patients, and are typically caused by environmental opportunists that take advantage of a weakened immune system. The filamentous fungus Aspergillus fumigatus is the most important and well-documented mold pathogen of humans, causing a number of complex respiratory diseases, including invasive pulmonary aspergillosis, an often fatal disease in patients with acute leukemia or in immunosuppressed bone marrow or solid organ transplant recipients. However, non-Aspergillus molds are increasingly reported as agents of disseminated diseases, with Fusarium, Scedosporium, Lomentospora and mucormycete species now firmly established as pathogens of immunosuppressed and immunocompetent individuals. Despite well-documented risk factors for invasive fungal diseases, and increased awareness of the risk factors for life-threatening infections, the number of deaths attributable to molds is likely to be severely underestimated driven, to a large extent, by the lack of readily accessible, cheap, and accurate tests that allow detection and differentiation of infecting species. Early diagnosis is critical to patient survival but, unlike Aspergillus diseases, where a number of CE-marked or FDA-approved biomarker tests are now available for clinical diagnosis, similar tests for fusariosis, scedosporiosis and mucormycosis remain experimental, with detection reliant on insensitive and slow culture of pathogens from invasive bronchoalveolar lavage fluid, tissue biopsy, or from blood. This review examines the ecology, epidemiology, and contemporary methods of detection of these mold pathogens, and the obstacles to diagnostic test development and translation of novel biomarkers to the clinical setting.
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Ramadorai A, Ravi P, Narayanan V. Rhinocerebral Mucormycosis: A Prospective Analysis of an Effective Treatment Protocol. Ann Maxillofac Surg 2019; 9:192-196. [PMID: 31293952 PMCID: PMC6585200 DOI: 10.4103/ams.ams_231_18] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Objective: The objective of this study was to prospectively analyze the effectiveness of a treatment protocol in patients diagnosed with rhinocerebral mucormycosis. Materials and Methods: This series included ten patients who reported with suspicious clinical signs of mucormycosis. The diagnosis was established by histopathology, and computed tomography imaging was used to assess the extent of spread. All patients were treated with immediate radical surgical debridement and antifungal chemotherapy with amphotericin B. Simultaneous correction of the underlying immunosuppressive condition was carried out. The primary outcome assessed was disease-free survival, and the patients were followed up for up to 6 months after discharge. Results: In this series, the cause of immunosuppression was uncontrolled diabetes mellitus in all patients. All the patients responded to the treatment protocol and were free of the disease up to 6 months of follow-up. Conclusion: Mucormycosis is an invasive and potentially fatal disease. Prognosis can be improved by early recognition and prompt treatment with aggressive resection, intravenous amphotericin B, and control of the patient's underlying systemic condition.
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Affiliation(s)
- Ashok Ramadorai
- Department of Oral and Maxillofacial Surgery, Saveetha Dental College, Chennai, Tamil Nadu, India
| | - Poornima Ravi
- Department of Oral and Maxillofacial Surgery, SRM Dental College, Chennai, Tamil Nadu, India
| | - Vinod Narayanan
- Department of Oral and Maxillofacial Surgery, Saveetha Dental College, Chennai, Tamil Nadu, India
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Radiological-Pathological Correlation in Plasmablastic Lymphoma in an Immunocompromised Patient. Case Rep Ophthalmol Med 2018; 2018:4746050. [PMID: 30420931 PMCID: PMC6215577 DOI: 10.1155/2018/4746050] [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] [Received: 04/10/2018] [Accepted: 09/20/2018] [Indexed: 11/25/2022] Open
Abstract
Plasmablastic lymphoma (PBL) is a malignant, rare, and aggressive form of non-Hodgkin's lymphoma with poor response to treatment that most commonly involves the oral mucosa of immunodeficient patients. The orbit might be primarily or secondarily involved; on the other hand other pathological conditions, i.e., fungal infections, may localize in the orbit in both immunocompromised patients and drug user, which might have similar radiological features. We describe the clinical, radiological, and pathological features of an orbital plasmablastic lymphoma (PBL) in an immunocompromised HIV positive drug user patient.
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Vaughan C, Bartolo A, Vallabh N, Leong SC. A meta-analysis of survival factors in rhino-orbital-cerebral mucormycosis-has anything changed in the past 20 years? Clin Otolaryngol 2018; 43:1454-1464. [PMID: 29947167 DOI: 10.1111/coa.13175] [Citation(s) in RCA: 70] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2018] [Accepted: 06/22/2018] [Indexed: 01/05/2023]
Abstract
BACKGROUND Rhino-orbital-cerebral mucormycosis (ROCM) is an uncommon yet potentially lethal fungal infection. Although most cases originate from developing countries, an ageing population and increased prevalence of chronic illness may mean some clinicians practicing in developed countries will encounter ROCM cases in their careers. Yohai et al published a systematic review of 145 case reports from 1970 to 1993 assessing prognostic factors for patients presenting with ROCM. We present an updated review of the literature and assess whether survival outcomes have changed in the two decades since that seminal paper. SEARCH STRATEGY An extensive Medline literature search was performed for case reports published between 1994 and 2015. RESULTS In total, 210 published cases were identified from the literature review, of which 175 patients from 140 papers were included in this review. Fifty-five were female, with an overall mean age of 43 years. Overall survival rate was 59.5%, which was not significantly better than the previous series reported (60%) reported by Yohai et al. Survival rates in patients with chronic renal disease had improved, from 19% to 52%, and in patients with leukaemia (from 13% to 50%). Facial necrosis and hemiplegia remained poor prognostic indicators (33% and 39% survival rates, respectively). Early commencement of medical treatment related to better survival outcomes (61% if commenced within first 12 days of presentation, compared to 33% if after 13 days). Timing of surgery had less of an effect on overall survival. However, in 28 cases that did not receive any surgical treatment, survival was only 21%. CONCLUSIONS Although overall survival rates have not improved, survival in patients with renal disease were better, potentially due to the introduction of liposomal amphotericin B which is less nephrotoxic. Prompt recognition of ROCM, reversal of predisposing co-morbidities and aggressive medical treatment remain the cornerstone of managing this highly aggressive disease.
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Affiliation(s)
- Casey Vaughan
- Department of Otorhinolaryngology - Head and Neck Surgery, Aintree University Hospital NHS Foundation Trust, Liverpool, UK
| | - Amanda Bartolo
- Department of Otorhinolaryngology - Head and Neck Surgery, Aintree University Hospital NHS Foundation Trust, Liverpool, UK
| | - Nimisha Vallabh
- Department of Otorhinolaryngology - Head and Neck Surgery, Aintree University Hospital NHS Foundation Trust, Liverpool, UK
| | - Samuel C Leong
- Department of Otorhinolaryngology - Head and Neck Surgery, Aintree University Hospital NHS Foundation Trust, Liverpool, UK
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25
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Abstract
Ocular or eye pain is a frequent complaint encountered not only by eye care providers but neurologists. Isolated eye pain is non-specific and non-localizing; therefore, it poses significant differential diagnostic problems. A wide range of neurologic and ophthalmic disorders may cause pain in, around, or behind the eye. These include ocular and orbital diseases and primary and secondary headaches. In patients presenting with an isolated and chronic eye pain, neuroimaging is usually normal. However, at the beginning of a disease process or in low-grade disease, the eye may appear "quiet," misleading a provider lacking familiarity with underlying disorders and high index of clinical suspicion. Delayed diagnosis of some neuro-ophthalmic causes of eye pain could result in significant neurologic and ophthalmic morbidity, conceivably even mortality. This article reviews some recent advances in imaging of the eye, the orbit, and the brain, as well as research in which neuroimaging has advanced the discovery of the underlying pathophysiology and the complex differential diagnosis of eye pain.
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26
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Seven cases of localized invasive sino-orbital aspergillosis. Jpn J Ophthalmol 2017; 61:179-188. [PMID: 28097453 DOI: 10.1007/s10384-016-0494-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Accepted: 11/30/2016] [Indexed: 10/20/2022]
Abstract
PURPOSE To describe the clinical manifestations and prognoses in 7 patients with invasive sino-orbital aspergillosis (ISOA). METHODS This was a retrospective study of consecutive patients who were diagnosed as having ISOA at the Gifu University Hospital and Gifu Municipal Hospital between January 1993 and December 2015. Data were collected on demographics, initial manifestations, examination findings, treatments, clinical course, and outcomes. RESULTS The median age of the 7 patients with ISOA was 68 years; 5 of them had diabetes. The initial symptoms were reduced blurred vision (57%), unilateral headaches (43%), unilateral abnormal sensations or numbness of the periorbital area (43%), and external ophthalmoplegia (43%). The medical department that the patients first visited was the ophthalmology department in 57% of the cases. The initial CT showed bone destruction in 71% and calcification in 14% of the patients. Six of the 7 cases were misdiagnosed. The definitive diagnosis of ISOA was made by histopathologic examinations of the biopsy specimens, with an average of 2.6 biopsies. All patients received aggressive antifungal treatments after the diagnosis. However, the final visual outcome was no light perception in 86% and death related to the ISOA in 43% of the patients. Patients who were older at the onset had lower survival rates. CONCLUSIONS The prognosis for patients with ISOA is poor in terms of both vision and life. Ophthalmologists are often the first examiner. ISOA should be considered in the differential diagnosis for patients with a gradually progressive orbital mass, unilateral headaches, numbness of the periorbital area, and a decrease in visual acuity of unknown origin.
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27
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Kim SY, Ko SJ, Choi KH, Kim SD. Treatment of Rhino-Orbito-Cerebral Aspergillosis with Combination of Amphotericin, Posaconazole and Amphotericin Irrigation: A Case Report. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2017. [DOI: 10.3341/jkos.2017.58.6.718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Sang Yeop Kim
- Department of Ophthalmology, Wonkwang University School of Medicine, Iksan, Korea
- Institute of Wonkwang Medical Science, Wonkwang University, Iksan, Korea
| | - Sang Jun Ko
- Department of Ophthalmology, Wonkwang University School of Medicine, Iksan, Korea
- Institute of Wonkwang Medical Science, Wonkwang University, Iksan, Korea
| | - Keum Ha Choi
- Institute of Wonkwang Medical Science, Wonkwang University, Iksan, Korea
- Department of Pathology, Wonkwang University School of Medicine, Iksan, Korea
| | - Sang Duck Kim
- Department of Ophthalmology, Wonkwang University School of Medicine, Iksan, Korea
- Institute of Wonkwang Medical Science, Wonkwang University, Iksan, Korea
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Yan Y, Zhao Z, Wan H, Wu R, Fang J, Liu H. A novel fungus concentration-dependent rat model for acute invasive fungal rhinosinusitis: an experimental study. BMC Infect Dis 2014; 14:3856. [PMID: 25526739 PMCID: PMC4297382 DOI: 10.1186/s12879-014-0713-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2014] [Accepted: 12/11/2014] [Indexed: 12/14/2022] Open
Abstract
Background Acute invasive fungal rhinosinusitis is a lethal infectious process afflicting immunocompromised individuals. Knowledge about this disease is still limited due to the scarcity of animal models designed to study the pathogenesis of this infection. Mast cells are tissue-resident immune cells that participate in a variety of allergic and inflammatory conditions. Limited attention has been given to the role of mast cells in acute invasive fungal rhinosinusitis. Therefore, the objectives of this study were to create a rat model of acute invasive fungal rhinosinusitis based on analyzing the impact of different fungal concentrations on establishing infection, and to observe the changes of mast cells in rats with this disease. Methods Sprague–Dawley rats were divided randomly into four groups, three of which were experimental and received different concentrations of Aspergillus fumigatus inoculations, and one was a control group (D). The inoculated Aspergillus fumigatus concentrations were 5 × 107 conidia/ml in group A, 107 conidia/ml in group B, and 106 conidia/ml in group C. Before fungal inoculation, rats were immunosuppressed using cyclophosphamide and cortisone acetate, and had Merocel sponges inserted into the right nares. Hematology and histopathology investigations were then performed. Results An acute invasive fungal rhinosinusitis rat model was established successfully with an incidence rate of 90% in group A, 50% in group B and 10% in group C. Aspergillus fumigatus invasion was observed in 20% of the lungs in group A, but was not seen in the remaining groups. In addition, no fungi invaded the orbital tissue, brains, livers, spleens or kidneys of any rat. Compared with the control set, the total number of mast cells in the experimental groups was not significantly increased, but mast cell degranulation, on the other hand, was only found in infected nasal cavities. Conclusions This investigation illustrates that various fungal concentrations have different effects on the incidence of acute invasive fungal rhinosinusitis, and it also demonstrates the feasibility of using this model to study the process of fungal rhinosinusoidal invasion. In addition, the results suggest that mast cells may play a role in the protection of sinuses against acute Aspergillus fumigatus infection and in the clearance of established hyphal masses. Electronic supplementary material The online version of this article (doi:10.1186/s12879-014-0713-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Yuyan Yan
- Department of Pathology, Affiliated Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, People's Republic of China.
| | - Zuotao Zhao
- Department of Dermatology, First Hospital, Peking University, Beijing, 100034, People's Republic of China.
| | - Hongfei Wan
- Department of Pathology, Affiliated Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, People's Republic of China.
| | - Ruochen Wu
- Department of Pathology, Affiliated Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, People's Republic of China.
| | - Jugao Fang
- Department of ENT, Affiliated Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, People's Republic of China.
| | - Honggang Liu
- Department of Pathology, Affiliated Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, People's Republic of China.
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Peral-Cagigal B, Redondo-González LM, Verrier-Hernández A. Invasive maxillary sinus aspergillosis: A case report successfully treated with voriconazole and surgical debridement. J Clin Exp Dent 2014; 6:e448-51. [PMID: 25593673 PMCID: PMC4282918 DOI: 10.4317/jced.51571] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2014] [Accepted: 03/27/2014] [Indexed: 11/23/2022] Open
Abstract
Introduction: Invasive aspergillosis of the paranasal sinuses is a rare disease and often misdiagnosed; however, its incidence has seen substancial growth over the past 2 decades. Definitive diagnosis of these lesions is based on histological examination and fungal culture.
Case Report: An 81-year-old woman with a history of pain in the left maxillary region is presented. The diagnosis was invasive maxillary aspergillosis in immunocompetent patient, which was successfully treated with voriconazole and surgical debridement. Possible clinical manifestations, diagnostic imaging techniques and treatment used are discussed. Since the introduction of voriconazole, there have been several reports of patients with invasive aspergillosis who responded to treatment with this new antifungal agent.
Conclusions: We report the importance of early diagnosis and selection of an appropriate antifungal agent to achieve a successful treatment.
Key words:Invasive aspergillosis, voriconazole, fungal sinusitis, antifungal agent, open sinus surgery.
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Affiliation(s)
- Beatriz Peral-Cagigal
- Department of Oral and Maxillofacial Surgery. Río Hortega Hospital, Valladolid, Spain
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Srivastava RM, Rijuneeta, Gupta AK, Patro SK, Avasthi A. Quality of life, disability scores, and distress index in fungal rhinosinusitis. Med Mycol 2014; 52:706-14. [PMID: 25031427 DOI: 10.1093/mmy/myu037] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Our goal was to determine quality of life (QOL), disability, and distress in the day-to-day lives of patients suffering from fungal rhinosinusitis (FRS) based on a prospective questionnaire. The study included 125 patients suffering from FRS, excluding those with acute fulminant FRS and any other comorbid illness. The data were compared with data for 50 age- and sex-matched controls who did not have any other chronic illness and obtained outpatient services from the Department of Otolaryngology and Head and Neck Surgery of our institute. Analysis showed that patients with FRS had worse QOL, with an average score of 87.34 compared with 94.15 for the control group. QOL score further decreased to 85.31 for patients with extensive disease that included intracranial or intraorbital extension and to 71.1 in those with recurrent disease. Patients showed significant disability and had decreased work efficiency in disability parameters. Distress among these patients was also greater and further increased in those with extensive disease or recurrence. We conclude that patients with FRS have worse QOL, more disability, and more distress compared with age- and sex-matched controls. This issue needs to be addressed while treating cases of FRS.
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Affiliation(s)
- Rishi Mani Srivastava
- Department of Otolaryngology, Head and Neck Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Rijuneeta
- Department of Otolaryngology, Head and Neck Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Ashok K Gupta
- Department of Otolaryngology, Head and Neck Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Sourabha K Patro
- Department of Otolaryngology, Head and Neck Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Ajit Avasthi
- Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Leyngold I, Olivi A, Ishii M, Blitz A, Burger P, Subramanian PS, Gallia G. Acute chiasmal abscess resulting from perineural extension of invasive sino-orbital aspergillosis in an immunocompetent patient. World Neurosurg 2013; 81:203.e1-6. [PMID: 23973515 DOI: 10.1016/j.wneu.2013.08.018] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2011] [Revised: 05/30/2013] [Accepted: 08/14/2013] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Intracranially invasive sino-orbital aspergillosis is a rare entity seen predominantly in immunocompromised individuals. We report a unique case of an acute chiasmal abscess resulting from perineural extension of an indolent invasive sino-orbital aspergillosis in an immunocompetent patient. CASE DESCRIPTION A 61-year-old healthy Ukrainian man presented with severe left retro-orbital pain and a gradual ipsilateral monocular vision loss with rapid progression to a contralateral temporal visual field cut. He was found to have an intracranially invasive sino-orbital Aspergillus fumigatus infection with perineural extension along the optic nerve complicated by an acute chiasmal abscess. RESULTS The patient was managed with surgical debridement and adjuvant antifungal chemotherapy. The patient's life and vision were preserved. CONCLUSIONS The case demonstrates that it is possible to successfully control advanced intracranial aspergillosis with tissue-sparing surgery and adjuvant antifungal chemotherapy in immunocompetent individuals.
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Affiliation(s)
- Ilya Leyngold
- Department of Ophthalmology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
| | - Alessandro Olivi
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Masaru Ishii
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Ari Blitz
- Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Peter Burger
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Prem S Subramanian
- Department of Ophthalmology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Gary Gallia
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA; Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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32
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Thurtell MJ, Chiu ALS, Goold LA, Akdal G, Crompton JL, Ahmed R, Madge SN, Selva D, Francis I, Ghabrial R, Ananda A, Gibson J, Chan R, Thompson EO, Rodriguez M, McCluskey PJ, Halmagyi GM. Neuro-ophthalmology of invasive fungal sinusitis: 14 consecutive patients and a review of the literature. Clin Exp Ophthalmol 2013; 41:567-76. [PMID: 23279383 DOI: 10.1111/ceo.12055] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2012] [Accepted: 12/04/2012] [Indexed: 11/29/2022]
Abstract
BACKGROUND Invasive fungal sinusitis is a rare condition that usually occurs in immunocompromised patients and often presents as an orbital apex syndrome. It is frequently misdiagnosed on presentation and is almost always lethal without early treatment. DESIGN Retrospective case series of 14 consecutive patients with biopsy-proven invasive fungal sinusitis from four tertiary hospitals. PARTICIPANTS Fourteen patients (10 men and 4 women; age range 46-82 years). METHODS Retrospective chart review of all patients presenting with invasive fungal sinusitis between 1994 and 2010 at each hospital, with a close analysis of the tempo of the disease to identify any potential window of opportunity for treatment. MAIN OUTCOME MEASURES Demographic data, background medical history (including predisposing factors), symptoms, signs, radiological findings, histopathological findings, treatment approach and subsequent clinical course were recorded and analysed. RESULTS Only one patient was correctly diagnosed at presentation. Only two patients were not diabetic or immunocompromised. The tempo was acute in two patients, subacute in nine patients and chronic in three patients. In the subacute and chronic cases, there was about 1 week of opportunity for treatment, from the time there was a complete orbital apex syndrome, and still a chance for saving the patient, to the time there was central nervous system invasion, which was invariably fatal. Only two patients survived - both had orbital exenteration, as well as antifungal drug treatment. CONCLUSIONS Invasive fungal sinusitis can, rarely, occur in healthy individuals and should be suspected as a possible cause of a progressive orbital apex syndrome.
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Affiliation(s)
- Matthew J Thurtell
- Department of Ophthalmology and Visual Sciences, University of Iowa, Iowa City, USA.
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van Dellen JR. Flesh-Eating Bugs. World Neurosurg 2012; 78:437-9. [DOI: 10.1016/j.wneu.2012.01.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2012] [Accepted: 01/12/2012] [Indexed: 11/27/2022]
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Abstract
MR imaging without and with gadolinium-based contrast agents (GBCAs) is an important imaging tool for defining normal anatomy and characteristics of lesions. GBCAs have been used in contrast-enhanced MR imaging in defining and characterizing lesions of the central nervous system for more than 20 years. The combination of unenhanced and GBCA-enhanced MR imaging is the clinical gold standard for the noninvasive detection and delineation of most intracranial and spinal lesions. MR imaging has a high predictive value that rules out neoplasm and most inflammatory and demyelinating processes of the central nervous system.
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Affiliation(s)
- Bum-soo Kim
- Department of Radiology, The Catholic University of Korea, Seoul, Korea
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Arora V, Nagarkar NM, Dass A, Malhotra A. Invasive rhino-orbital aspergillosis. Indian J Otolaryngol Head Neck Surg 2012; 63:325-9. [PMID: 23024936 DOI: 10.1007/s12070-011-0240-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2009] [Accepted: 01/31/2010] [Indexed: 12/01/2022] Open
Abstract
Invasive aspergillosis usually affects immune-compromised patients and is common in diabetics. Proptosis, visual loss and ophthalmoplegia due to intra-orbital extension are common presentations. Three out of five patients in our series were immune-compromised. All the patients had visual loss and three patients presented with unilateral blindness. Three patients were treated by surgical debridement followed by Amphotericin B therapy. Two patients who had intra-cranial extension of the disease died during the treatment. Only one patient had improvement in vision following the treatment. High index of suspicion in immune-compromised patients, early diagnosis and prompt aggressive treatment is required to achieve clinical cure.
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Affiliation(s)
- Vipin Arora
- Government Medical College & Hospital, Chandigarh, India
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36
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Tarkan O, Karagün B, Ozdemir S, Tuncer U, Sürmelioğlu O, Cekiç E, Kara K. Endonasal treatment of acute invasive fungal rhinosinusitis in immunocompromised pediatric hematology-oncology patients. Int J Pediatr Otorhinolaryngol 2012; 76:1458-64. [PMID: 22795740 DOI: 10.1016/j.ijporl.2012.06.021] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2012] [Revised: 05/30/2012] [Accepted: 06/03/2012] [Indexed: 10/28/2022]
Abstract
OBJECTIVES Acute invasive fungal rhinosinusitis (AIFR) is an aggressive fungal infection in immunocompromised patients with high mortality rates. The aim of this study is to present our experiences on endonasal treatment in immunocompromised pediatric hematology-oncology patients with AIFR. METHODS Thirteen pediatric hematology-oncology patients treated for AIFR between March 2006 and December 2011 were analyzed retrospectively. We reviewed the following data for all patients: age, gender, predisposing disease, initial symptoms, pathological diagnosis, microbiological results, laboratory findings, surgical procedure, number of operations and treatment outcomes. RESULTS Nine of 13 patients with lesions confined to sinonasal cavity were operated with endoscopic approach. Open surgery was performed in four patients, three of them had palatal and buccal lesions and one had facial skin involvement. Endoscopic approach was also used for sinonasal lesions of these four patients. A total of 7 patients died: 4 patients with progression of the underlying disease, 2 patients with sepsis and 1 patient due to renal failure. Survival rate in surgically treated patients was found 46% (6/13 patients). CONCLUSIONS Endonasal endoscopic approach is both feasible and efficient technique, also enables excellent local control with less morbidity compared to open surgery. This approach is suitable for patients who are diagnosed in the early stages of AIFR and also presents a less traumatic option for patients with poor health status. Open surgical procedure should be preferred in patients with disease extending out of the sinonasal cavity.
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Affiliation(s)
- Ozgür Tarkan
- Çukurova University, Faculty of Medicine, Department of Otolaryngology-Head and Neck Surgery, Adana 01330, Turkey.
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Sa HS, Ko KS, Woo KI, Peck KR, Kim YD. A case of sino-orbital infection caused by the Schizophyllum commune. Diagn Microbiol Infect Dis 2012; 73:376-7. [PMID: 22673964 DOI: 10.1016/j.diagmicrobio.2012.05.005] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2012] [Revised: 05/04/2012] [Accepted: 05/05/2012] [Indexed: 11/19/2022]
Abstract
Schizophyllum commune, a basidiomycetous fungus, is a rare cause of mycotic disease in humans. We describe the first case of sino-orbital infection caused by S. commune in an immunocompetent woman who presented with maxillary sinusitis and inferior orbital tumor. Identification of the organism was confirmed by rRNA sequencing.
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MESH Headings
- Adult
- DNA, Fungal/chemistry
- DNA, Fungal/genetics
- DNA, Ribosomal/chemistry
- DNA, Ribosomal/genetics
- DNA, Ribosomal Spacer/chemistry
- DNA, Ribosomal Spacer/genetics
- Eye Infections, Fungal/complications
- Eye Infections, Fungal/diagnosis
- Female
- Genes, rRNA
- Head/diagnostic imaging
- Humans
- Microscopy
- Mycoses/diagnosis
- Mycoses/microbiology
- RNA, Fungal/genetics
- RNA, Ribosomal/genetics
- RNA, Ribosomal, 5.8S/genetics
- Schizophyllum/isolation & purification
- Sequence Analysis, DNA
- Sinusitis/complications
- Sinusitis/diagnosis
- Tomography, X-Ray Computed
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Affiliation(s)
- Ho-Seok Sa
- Department of Ophthalmology, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, South Korea
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38
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Rammaert B, Lanternier F, Poirée S, Kania R, Lortholary O. Diabetes and mucormycosis: A complex interplay. DIABETES & METABOLISM 2012; 38:193-204. [DOI: 10.1016/j.diabet.2012.01.002] [Citation(s) in RCA: 84] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/18/2011] [Accepted: 01/09/2012] [Indexed: 01/13/2023]
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Abstract
A 61-year-old male underwent a cardiac transplant for congenital dilated cardiomyopathy. Two months post-transplantation, after a complicated clinical course, he was noted to have progressive proptosis and limitation of motility OD. Computed tomography showed opacification of the right maxillary sinus with the suggestion of a fungus ball and soft tissue infiltration along the floor of the orbit adjacent to the inferior rectus, extending posteriorly to within millimeters of the superior and inferior orbital fissures. An orbital biopsy demonstrated the presence of fungal hyphae and A. fumigatus was cultured. The patient was treated with systemic antifungal therapy and intralesional retrobulbar amphotericin B (without debridement) with successful eradication of the fungal pathogen. Intralesional amphotericin in combination with systemic antifungal therapy without limited debridement is rarely reported and may be an alternative to limited debridement or exenteration in orbital aspergillosis.
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Affiliation(s)
- Norman Mainville
- Department of Ophthalmology, University of Ottawa Eye Institute and The Ottawa Hospital, 301 O'Connor St., Ottawa, Ontario, Canada
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40
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Endoscopic management of rhinocerebral mucormycosis with topical and intravenous amphotericin B. The Journal of Laryngology & Otology 2011; 125:807-10. [DOI: 10.1017/s0022215111001289] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
AbstractObjective:Mucormycosis is an aggressive fungal infection which may still cause fatal complications. However, the rarity of this disease has made optimal treatment a controversial issue. This study aimed to evaluate the use of topical amphotericin B in endoscopic management of rhinocerebral mucormycosis.Subjects and methods:Thirty patients with infection limited to the nose and sinuses were selected. Patients underwent endoscopic debridement of all necrotic tissue; cottonoid pledgets soaked in amphotericin B solution were then placed in the nasal cavity. Subsequently, long-term antifungal therapy was administered.Results:The overall survival rate was 60 per cent (18 cases); survival rates in the diabetic and malignancy groups were 70.58 and 40 per cent, respectively. Apart from predisposing factors, orbital and maxillary sinus involvement also had a significant correlation with patient outcome.Conclusion:Topical use of amphotericin B combined with endoscopic surgical debridement, followed by intravenous amphotericin B treatment, may constitute acceptable management for selected patients, with less morbidity than conventional treatments.
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41
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Kasapoglu F, Coskun H, Ozmen OA, Akalin H, Ener B. Acute invasive fungal rhinosinusitis: Evaluation of 26 patients treated with endonasal or open surgical procedures. Otolaryngol Head Neck Surg 2010; 143:614-20. [DOI: 10.1016/j.otohns.2010.08.017] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2010] [Revised: 07/29/2010] [Accepted: 08/13/2010] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Acute invasive fungal rhinosinusitis (AIFRS) is a serious disease with a high mortality and morbidity rate, which almost always affects immunocompromised patients and/or patients with diabetes mellitus. Our purpose was to present the diagnostic and therapeutic management and outcome of these patients. STUDY DESIGN Case series with chart review. SETTING Tertiary care university hospital. SUBJECTS AND METHODS Twenty-six patients, who were operated on because of AIFRS between September 1999 and June 2009, were retrospectively evaluated in this study. Endoscopic surgery was used in 19 patients, and open surgical debridement was performed in seven patients. RESULTS Overall survival rate of the patients in the open surgery group (4 of 7; 57.1%) was similar to that of the endoscopically treated group (9 of 19; 47.3%). Thirteen patients (50%) died of complications related to the underlying disease (9 of 13; 69.2%) and AIFRS (4 of 13; 30.7%). AIFRS-specific survival rate is 76.5 percent; 90 percent (9 of 10) and 57.1 percent (4 of 7) for endoscopic and open surgery groups, respectively. Four patients who died had pathological diagnosis of mucormycosis ( P = 0.52). CONCLUSION AIFRS can be successfully treated with a combination of endonasal surgical debridement and antifungal medications. Endonasal approach is suitable for patients diagnosed in the early stages of the disease and provides a less traumatic option in those patients who already have a poor health status. Open surgery should be preferred in the presence of intraorbital extension, palatinal, and/or intracerebral involvement. Reversing the underlying disease process and immunosuppression is as important as the surgical and antifungal treatment.
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Affiliation(s)
- Fikret Kasapoglu
- From the Faculty of Medicine, Department of Otorhinolaryngology–Head and Neck Surgery, Uludağ University, Bursa, Turkey
| | - Hakan Coskun
- From the Faculty of Medicine, Department of Otorhinolaryngology–Head and Neck Surgery, Uludağ University, Bursa, Turkey
| | - Omer Afsin Ozmen
- From the Faculty of Medicine, Department of Otorhinolaryngology–Head and Neck Surgery, Uludağ University, Bursa, Turkey
| | - Halis Akalin
- From the Faculty of Medicine, Department of Otorhinolaryngology–Head and Neck Surgery, Uludağ University, Bursa, Turkey
| | - Beyza Ener
- From the Faculty of Medicine, Department of Otorhinolaryngology–Head and Neck Surgery, Uludağ University, Bursa, Turkey
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Friedman DI, Frishberg B. Neuro-ophthalmology and its contribution to headaches: a case-based approach. Expert Rev Neurother 2010; 10:1467-78. [DOI: 10.1586/ern.10.113] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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43
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Nithyanandam S, Correa MA. Rhino-orbital mucormycosis and aspergillosis: differences in outcome, clinical and imaging characteristics. Eur Arch Otorhinolaryngol 2009; 267:161-2. [PMID: 19890658 DOI: 10.1007/s00405-009-1136-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2009] [Accepted: 10/15/2009] [Indexed: 11/29/2022]
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