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Egger M, Hoenigl M, Thompson GR, Carvalho A, Jenks JD. Let's talk about Sex Characteristics - as a Risk Factor for Invasive Fungal Diseases. Mycoses 2022; 65:599-612. [PMID: 35484713 DOI: 10.1111/myc.13449] [Citation(s) in RCA: 32] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 04/21/2022] [Accepted: 04/22/2022] [Indexed: 12/01/2022]
Abstract
Biological sex, which comprises differences in host sex hormone homeostasis and immune responses, can have a substantial impact on the epidemiology of infectious diseases. Comprehensive data on sex distributions in invasive fungal diseases (IFDs) is lacking. In this review we performed a literature search of in vitro/animal studies, clinical studies, systematic reviews, and meta-analyses of invasive fungal infections. Females represented 51.2% of invasive candidiasis cases, mostly matching the proportions of females among the general population in the United States and Europe (>51%). In contrast, other IFDs were overrepresented in males, including invasive aspergillosis (51% males), mucormycosis (60%), cryptococcosis (74%), coccidioidomycosis (70%), histoplasmosis (61%), and blastomycosis (66%). Behavioral variations, as well as differences related to biological sex, may only in part explain these findings. Further investigations concerning the association between biological sex/gender and the pathogenesis of IFDs is warranted.
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Affiliation(s)
- Matthias Egger
- Division of Infectious Diseases, Medical University of Graz, Austria
| | - Martin Hoenigl
- Division of Infectious Diseases, Medical University of Graz, Austria.,Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, La Jolla, CA, USA.,Clinical and Translational Fungal - Working Group, University of California San Diego, La Jolla, CA, USA
| | - George R Thompson
- University of California Davis Center for Valley Fever, California, USA.,Department of Internal Medicine, Division of Infectious Diseases, University of California Davis Medical Center, California, USA.,Department of Medical Microbiology and Immunology, University of California Davis, California, USA
| | - Agostinho Carvalho
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal.,ICVS/3B's -, PT Government Associate Laboratory, Braga/Guimarães, Portugal
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2
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Treviño-Gonzalez JL, Santos-Santillana KM, Maldonado-Chapa F, Morales-Del Angel JA, Gomez-Castillo P, Cortes-Ponce JR. "Chronic granulomatous invasive fungal rhinosinusitis associated with SARS-CoV-2 infection: A case report". Ann Med Surg (Lond) 2021; 72:103129. [PMID: 34873446 PMCID: PMC8636311 DOI: 10.1016/j.amsu.2021.103129] [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: 10/21/2021] [Revised: 11/22/2021] [Accepted: 11/30/2021] [Indexed: 11/18/2022] Open
Abstract
Introduction and importance Granulomatous chronic invasive fungal rhinosinusitis (GCIFR) is a rare entity with scarce cases reported mainly in subtropical areas. Its prevalence among individuals with clinical suspicion of fungal rhinosinusitis has been reported in approximately 20% in subtropical populations, unlike North America with a prevalence of 0.5%. It is typically associated with Aspergillus flavus and the presence of noncaseating granulomas or Langerhans giant cells on histopathologic examination. Case presentation We describe a case of a patient with clinical history of recent SARS-CoV-2 infection and development of intense cephalalgia, visual impairment, palpebral ptosis, and limitation of extraocular movements. MRI demonstrated the presence of opacification of paranasal sinuses, and a left intraconal abscess. A surgical endoscopic approach was performed and histopathologic examination revealed frontal GCIFR and maxillary fungus ball. Treatment with IV azoles provided adequate clinical response. Clinical discussion The spectrum of the fungal rhinosinusitis disease is not clear. However, non-invasive fungal rhinosinusitis is not often found concomitantly with invasive types. GCIFR typically manifests with an indolent and gradual progression at early stages. Advanced stages can exhibit orbital and intracranial involvement leading to visual impairment, frequent relapses, and a poor prognosis. A higher incidence of invasive fungal rhinosinusitis has been reported in patients with SARS-CoV-2 infection despite an unremarkable medical history, associated with immune dysregulation. Conclusion GCIFR is a rare condition with few cases reported in America. Because of its uncommonness, its diagnosis is often delayed leading to increased morbidity and mortality. Granulomatous chronic invasive fungal rhinosinusitis is a rare entity with scarce cases reported. Non-invasive fungal rhinosinusitis is not often found concomitantly with invasive types. A higher incidence of invasive fungal rhinosinusitis is observed in SARS-CoV-2 infection. Early diagnosis of fungal rhinosinusitis is essential due to possibly fatal outcome. Physicians should be aware of atypical manifestations for a prompt diagnosis.
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Affiliation(s)
| | | | | | - Josefina Alejandra Morales-Del Angel
- Corresponding author. Otolaryngology and Head and Neck Surgery Division, School of Medicine and University Hospital “Dr. Jose E. González”, Universidad Autónoma de Nuevo León, Ave. Madero y Gonzalitos s/n, Mitras Centro, 64460, Monterrey, Nuevo Leon, Mexico.
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3
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Zhou YB, Li DM, Houbraken J, Sun TT, de Hoog GS. Fatal Rhinofacial Mycosis Due to Aspergillus nomiae: Case Report and Review of Published Literature. Front Microbiol 2021; 11:595375. [PMID: 33414771 PMCID: PMC7782315 DOI: 10.3389/fmicb.2020.595375] [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: 08/16/2020] [Accepted: 11/27/2020] [Indexed: 11/30/2022] Open
Abstract
Background A 73-year-old female suffering from acute myeloid leukemia presented with progressive rhinofacial mycosis. Suspecting it to be mucormycosis, the antifungal amphotericin B (AMB) was administered empirically, but the patient did not respond as planned. The fungus was then isolated from the biopsied tissue and morphologically identified as a species of Aspergillus. Necrosis progressed and she died of cerebral hemorrhage. Since Aspergillus flavus is susceptible to AMB, and several other Aspergillus species can be misidentified as A. flavus, the observed resistance necessitated a re-examination of the fungal isolate. Methods The fungal strain was re-isolated and re-examined morphologically. Additionally, genomic DNA was extracted from the fungus and sequences were obtained from three genomic regions [the rDNA internal transcribed spacer (ITS) region, and portions of the β-tubulin and calmodulin genes] to more accurately identify this Aspergillus strain. Its antifungal susceptibility was assessed using multiple compounds and our findings were compared with literature data. Results The fungal culture again yielded an Aspergillus isolate morphologically identical to A. flavus. Molecular analyses, however, revealed the strain to be A. nomiae, a close relative of A. flavus in section Flavi, and it exhibited resistance to AMB. Reviewing the literature, only five other cases of A. nomiae infection in humans have been reported worldwide. Conclusion and Clinical Importance The rhinofacial mycosis of the patient was actually due to A. nomiae. The initial misidentification of the fungus, coupled with its resistance to AMB, could be the reason treatment did not help the patient. We postulate that clinical A. nomiae infections may be underreported and that accurate and speedy pathogen identification is important so that an effective antifungal regimen can be administered.
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Affiliation(s)
- Ya Bin Zhou
- Mycological Laboratory, Department of Dermatology, Peking University Third Hospital, Beijing, China
| | - Dong Ming Li
- Mycological Laboratory, Department of Dermatology, Peking University Third Hospital, Beijing, China
| | - Jos Houbraken
- Westerdijk Fungal Biodiversity Institute, Utrecht, Netherlands
| | - Ting Ting Sun
- Mycological Laboratory, Department of Dermatology, Peking University Third Hospital, Beijing, China
| | - G Sybren de Hoog
- Center of Expertise in Mycology, Radboud University Medical Center/Canisius Wilhelmina Hospital, Nijmegen, Netherlands
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Ahamefule CS, Ezeuduji BC, Ogbonna JC, Moneke AN, Ike AC, Wang B, Jin C, Fang W. Marine Bioactive Compounds against Aspergillus fumigatus: Challenges and Future Prospects. Antibiotics (Basel) 2020; 9:E813. [PMID: 33207554 PMCID: PMC7698247 DOI: 10.3390/antibiotics9110813] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Revised: 11/09/2020] [Accepted: 11/12/2020] [Indexed: 12/11/2022] Open
Abstract
With the mortality rate of invasive aspergillosis caused by Aspergillus fumigatus reaching almost 100% among some groups of patients, and with the rapidly increasing resistance of A. fumigatus to available antifungal drugs, new antifungal agents have never been more desirable than now. Numerous bioactive compounds were isolated and characterized from marine resources. However, only a few exhibited a potent activity against A. fumigatus when compared to the multitude that did against some other pathogens. Here, we review the marine bioactive compounds that display a bioactivity against A. fumigatus. The challenges hampering the discovery of antifungal agents from this rich habitat are also critically analyzed. Further, we propose strategies that could speed up an efficient discovery and broaden the dimensions of screening in order to obtain promising in vivo antifungal agents with new modes of action.
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Affiliation(s)
- Chukwuemeka Samson Ahamefule
- National Engineering Research Center for Non-Food Biorefinery, Guangxi Academy of Sciences, Nanning 530007, Guangxi, China; (C.S.A.); (B.W.)
- College of Life Science and Technology, Guangxi University, Nanning 530005, Guangxi, China
- Department of Microbiology, University of Nigeria, Nsukka 410001, Enugu State, Nigeria; (J.C.O.); (A.N.M.); (A.C.I.)
| | | | - James C. Ogbonna
- Department of Microbiology, University of Nigeria, Nsukka 410001, Enugu State, Nigeria; (J.C.O.); (A.N.M.); (A.C.I.)
| | - Anene N. Moneke
- Department of Microbiology, University of Nigeria, Nsukka 410001, Enugu State, Nigeria; (J.C.O.); (A.N.M.); (A.C.I.)
| | - Anthony C. Ike
- Department of Microbiology, University of Nigeria, Nsukka 410001, Enugu State, Nigeria; (J.C.O.); (A.N.M.); (A.C.I.)
| | - Bin Wang
- National Engineering Research Center for Non-Food Biorefinery, Guangxi Academy of Sciences, Nanning 530007, Guangxi, China; (C.S.A.); (B.W.)
- State Key Laboratory of Non-food Biomass and Enzyme Technology, Guangxi Academy of Sciences, Nanning 530007, Guangxi, China
| | - Cheng Jin
- National Engineering Research Center for Non-Food Biorefinery, Guangxi Academy of Sciences, Nanning 530007, Guangxi, China; (C.S.A.); (B.W.)
- College of Life Science and Technology, Guangxi University, Nanning 530005, Guangxi, China
| | - Wenxia Fang
- National Engineering Research Center for Non-Food Biorefinery, Guangxi Academy of Sciences, Nanning 530007, Guangxi, China; (C.S.A.); (B.W.)
- State Key Laboratory of Non-food Biomass and Enzyme Technology, Guangxi Academy of Sciences, Nanning 530007, Guangxi, China
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Barrs VR, Talbot JJ. Fungal Rhinosinusitis and Disseminated Invasive Aspergillosis in Cats. Vet Clin North Am Small Anim Pract 2019; 50:331-357. [PMID: 31866094 DOI: 10.1016/j.cvsm.2019.10.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Fungal rhinosinusitis, including sinonasal aspergillosis (SNA) and sino-orbital aspergillosis (SOA), is the most common type of aspergillosis encountered in cats. Other focal forms of aspergillosis including disseminated invasive aspergillosis occur less frequently. SOA is an invasive mycosis that is increasingly recognized and is most commonly caused by Aspergillus felis, a close relative of Aspergillus fumigatus. SNA can be invasive or noninvasive and is most commonly caused by A fumigatus and Aspergillus niger. Molecular methods are required to correctly identify the fungi that cause SNA and SOA. SNA has a favorable prognosis with treatment, whereas the prognosis for SOA remains poor.
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Affiliation(s)
- Vanessa R Barrs
- City University of Hong Kong, Department of Infectious Diseases & Public Health, Jockey Club College of Veterinary Medicine, Kowloon, Hong Kong SAR, China.
| | - Jessica J Talbot
- Faculty of Veterinary Science, University Veterinary Teaching Hospital, Sydney, University of Sydney, Faculty of Science, Sydney School of Veterinary Science, Camperdown, New South Wales 2006, Australia
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Whitney JL, Krockenberger MB, Day MJ, Beatty JA, Dhand NK, Barrs VR. Immunohistochemical Analysis of Leucocyte Subsets in the Sinonasal Mucosa of Cats with Upper Respiratory Tract Aspergillosis. J Comp Pathol 2016; 155:130-140. [PMID: 27576043 DOI: 10.1016/j.jcpa.2016.08.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Revised: 07/22/2016] [Accepted: 08/01/2016] [Indexed: 12/25/2022]
Abstract
Leucocyte populations in the sinonasal mucosa of cats with and without upper respiratory tract aspergillosis were compared using immunohistochemistry and computer-aided morphometry. Inflammation was identified in the nasal mucosa of all affected cats, comprising predominantly of lymphoplasmacytic infiltration of the lamina propria associated with epithelial proliferation and degeneration. There was intense and diffuse expression of class II antigens of the major histocompatibility complex, associated with sites of hyphal invasion with hyperplasia and ulceration of the epithelium adjacent to fungal elements. Significantly more CD79b(+) cells, total lymphocytes, immunoglobulin (Ig)-expressing cells and MAC387(+) cells infiltrated the epithelium and more IgG(+) cells and total Ig-expressing cells infiltrated the lamina propria in affected cats compared with controls. Importantly, the inflammatory profile in affected cats was not consistent with the T helper (Th)1 and Th17 cell-mediated response that confers protective acquired immunity against invasive aspergillosis in dogs and people and in murine models of the infection. This finding may help to explain the development of invasive aspergillosis in systemically immunocompetent cats.
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Affiliation(s)
- J L Whitney
- University of Sydney, Faculty of Veterinary Science, School of Life and Environmental Sciences, Sydney, Australia.
| | - M B Krockenberger
- University of Sydney, Faculty of Veterinary Science, School of Life and Environmental Sciences, Sydney, Australia
| | - M J Day
- School of Veterinary Sciences, University of Bristol, Langford, North Somerset, UK
| | - J A Beatty
- University of Sydney, Faculty of Veterinary Science, School of Life and Environmental Sciences, Sydney, Australia
| | - N K Dhand
- University of Sydney, Faculty of Veterinary Science, School of Life and Environmental Sciences, Sydney, Australia
| | - V R Barrs
- University of Sydney, Faculty of Veterinary Science, School of Life and Environmental Sciences, Sydney, Australia
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Azulay-Abulafia L, Sousa MAJ, Pussanti A, Coimbra DD, Vega H, Bernardes Filho F. Invasive aspergillosis in a user of inhaled cocaine: rhinosinusitis with bone and cartilage destruction. Rev Soc Bras Med Trop 2015; 47:533-6. [PMID: 25229300 DOI: 10.1590/0037-8682-0086-2014] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2014] [Accepted: 05/09/2014] [Indexed: 11/21/2022] Open
Abstract
Aspergillosis is an infection caused by saprophytic fungi of the genus Aspergillus, which typically occurs in immunosuppressed individuals, but has also been reported in immunocompetent patients. The main routes of entry are the respiratory tract, skin, cornea, and ear, and the infection may be localized or disseminated by contiguity or vascular invasion. We report a severe case of rhinosinusitis with cutaneous involvement, caused by invasive aspergillosis, in an immunocompetent user of inhaled cocaine. Invasive aspergillosis related to cocaine abuse has not yet been reported in the literature. After itraconazole treatment and surgical debridement, complete clinical remission was achieved. Nasal reconstruction with a skin graft over a silicone prosthesis resulted in a satisfactory esthetic outcome.
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Affiliation(s)
- Luna Azulay-Abulafia
- Instituto de Dermatologia Professor Rubem Davi Azulay, Santa Casa de Misericórdia do Rio de Janeiro, Rio de Janeiro, RJ, Brasil
| | | | | | | | - Hernando Vega
- Corporación Universitaria Rafael Nunez de Cartagena, Cartagena, Colombia
| | - Fred Bernardes Filho
- Instituto de Dermatologia Professor Rubem Davi Azulay, Santa Casa de Misericórdia do Rio de Janeiro, Rio de Janeiro, RJ, Brasil
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8
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Isolated Cerebral Aspergillosis in Immunocompetent Patients. World Neurosurg 2014; 82:e325-33. [DOI: 10.1016/j.wneu.2013.09.037] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2013] [Accepted: 09/18/2013] [Indexed: 12/17/2022]
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Nagasawa DT, Choy W, Spasic M, Yew A, Trang A, Garcia HM, Yang I. An analysis of intracranial epidermoid tumors with malignant transformation: treatment and outcomes. Clin Neurol Neurosurg 2012; 115:1071-8. [PMID: 23219403 DOI: 10.1016/j.clineuro.2012.10.026] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2012] [Accepted: 10/29/2012] [Indexed: 11/26/2022]
Abstract
OBJECTIVE While typically benign, epidermoid tumors upon rare occasion can undergo malignant transformation, which carries a poor prognosis. Here, we reviewed treatment strategies and analyzed outcomes for every case of malignant epidermoid tumor reported since its original description in 1912. METHODS A comprehensive literature review identified all reported cases of malignant transformation of intracranial epidermoid tumor. Treatments were categorized as follows: palliative management, stereotactic radiosurgery (SRS), chemotherapy, and surgery plus multiple (2+) adjuvant therapies. Survival data of these groups were compared to treatment outcomes for patients receiving only surgical resection, as reported in our previous study. RESULTS We identified 58 cases of intracranial epidermoid tumor with malignant degeneration. Average survival regardless of therapy was 11.8 months. Mean survival outcomes for groups treated with palliative management, chemotherapy, SRS, and multiple postoperative adjuvant therapies were 5.3 months, 25.7 months, 29.2 months, and 36.3 months, respectively. Outcomes for the groups including SRS, chemotherapy, and multiple post-operative adjuvant therapies were statistically significant compared to surgical resection alone. CONCLUSION While there remains a lack of consensus regarding the best approach to the management of patients with malignant epidermoid tumors, our systematic analysis characterizes and confirms the added benefit of SRS, chemotherapy, and multimodal adjuvant therapies.
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Affiliation(s)
- Daniel T Nagasawa
- UCLA Department of Neurological Surgery, University of California Los Angeles, Los Angeles, CA 90095-1761, USA
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Hejchman E, Ostrowska K, Maciejewska D, Kossakowski J, Courchesne WE. Synthesis and antifungal activity of derivatives of 2- and 3-benzofurancarboxylic acids. J Pharmacol Exp Ther 2012; 343:380-8. [PMID: 22892340 DOI: 10.1124/jpet.112.196980] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
We found that amiodarone has potent antifungal activity against a broad range of fungi, potentially defining a new class of antimycotics. Investigations into its molecular mechanisms showed amiodarone mobilized intracellular Ca2+, which is thought to be an important antifungal characteristic of its fungicidal activity. Amiodarone is a synthetic drug based on the benzofuran ring system, which is contained in numerous compounds that are both synthetic and isolated from natural sources with antifungal activity. To define the structural components responsible for antifungal activity, we synthesized a series of benzofuran derivatives and tested them for the inhibition of growth of two pathogenic fungi, Cryptococcus neoformans and Aspergillus fumigatus, to find new compounds with antifungal activity. We found several derivatives that inhibited fungal growth, two of which had significant antifungal activity. We were surprised to find that calcium fluxes in cells treated with these derivatives did not correlate directly with their antifungal effects; however, the derivatives did augment the amiodarone-elicited calcium flux into the cytoplasm. We conclude that antifungal activity of these new compounds includes changes in cytoplasmic calcium concentration. Analyses of these benzofuran derivatives suggest that certain structural features are important for antifungal activity. Antifungal activity drastically increased on converting methyl 7-acetyl-6-hydroxy-3-methyl-2-benzofurancarboxylate (2b) into its dibromo derivative, methyl 7-acetyl-5-bromo-6-hydroxy-3-bromomethyl-2-benzofurancarboxylate (4).
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Affiliation(s)
- Elzbieta Hejchman
- Department of Organic Chemistry, Faculty of Pharmacy, Medical University of Warsaw, Warsaw, Poland
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Abstract
Invasive aspergillosis has been classically associated with certain risk factors: cytotoxic chemotherapy, prolonged neutropenia, corticosteroids, transplantation, AIDS. However, the literature is growing that this mycosis, particularly pulmonary aspergillosis, can be seen in patients lacking these factors. Many of the latter patients are in the intensive care unit. Other associated conditions include influenza, nonfungal pneumonia, chronic obstructive lung disease, immaturity, sepsis, liver failure, alcoholism, chronic granulomatous disease and surgery. Certain focal sites, such as sinusitis or cerebral aspergillosis, have additional risk factors. This emphasizes the potential importance of a positive culture for Aspergillus in the critically ill, the need for awareness about possible aspergillosis in patients lacking the classical risk factors, and readiness to proceed with appropriate diagnostic maneuvers.
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Affiliation(s)
- David A Stevens
- Department of Medicine, Santa Clara Valley Medical Center, 751 So. Bascom Ave., San Jose, CA 95128-2699, USA.
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Abstract
ABSTRACT
Invasive sinus Aspergillus infection has been reported in the last decade with increased frequency, most commonly in the setting of hematologic malignancy, neutropenia, HIV infection and other states of immunosuppression. Fungal rhinosinusitis can be broadly classified into two varieties-invasive and noninvasive on the basis of tissue invasion. Invasive fungal sinusitis are acute invasive, chronic invasive (both granulomatous and nongranulomatous forms), whereas noninvasive are fungus balls and allergic fungal sinusitis. Invasive fungal sinusitis is one of the most challenging forms of sinonasal pathology to manage, most commonly presenting in immunocompromised individuals. Chronic invasive being sinus aspergillosis (CISA) is being reported in immunocompetent patients at an increasing rate while most of these cases are being reported from the India subcontinent and middle east. Invasive fungal sinusitis is on the rise worldwide and especially in north India as it is endemic in this part of the country. It is affecting immunocompetent young and middle aged population causing a great morbidity and mortality. This entity needs to be picked up early by spreading awareness among the family physicians, internists, otolaryngologists, ophthalmologists, neurosurgeons, pulmonary physicians, critical care specialists so that an early management can initiated to achieve better control over the disease. This review is an attempt to initiate an interdisciplinary approach to achieve a better outcome.
How to cite this article
Gupta AK, Bansal S, Rijuneeta, Gupta B. Invasive Fungal Sinusitis. Clin Rhinol An Int J 2012;5(2): 63-71.
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Survival outcomes for radiotherapy treatment of epidermoid tumors with malignant transformation. J Clin Neurosci 2011; 19:21-6. [PMID: 22024232 DOI: 10.1016/j.jocn.2011.06.002] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2011] [Revised: 06/09/2011] [Accepted: 06/11/2011] [Indexed: 11/21/2022]
Abstract
Epidermoid tumors are intracranial lesions that may occasionally undergo malignant transformation. Although surgical resection is the first-line treatment for malignant epidermoids, postoperative radiotherapy has been intermittently reported with favorable findings. Our analysis identified all previously reported patients with malignant epidermoids treated with surgical resection alone or surgery plus radiotherapy to examine the potential role for this adjuvant therapy. Whereas patients treated with surgery only had an overall survival of 6.6 months, those treated with postoperative radiotherapy demonstrated a statistically significant increase in survival to 12.7 months (log-rank test, p<0.003). Furthermore, the mean dosage of radiation given to this patient population was 52.2 Gy, with no appreciable survival benefit for the utilization of levels of radiation greater than 50 Gy. When determining the management for malignant transformation of epidermoid tumors, the combination of surgical resection and radiotherapy may be associated with improved short-term survival.
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Abstract
ABSTRACT
Introduction
Invasive sinus aspergillosis infection has been reported with increasing frequency in the last decade, especially, in immunocompromised patients with chronic invasive sinus aspergillosis (CISA). The gold standard for treatment has been wide surgical debridement, intravenous administration of antifungal agents, such as amphotericin B, but the prognosis remains poor. Newer antifungal agents are being tried but no standard treatment option with new antifungal agents has yet been established for chronic invasive fungal sinusitis. Therefore, we undertook this study to evaluate the efficacy of voriconazole in patients of chronic invasive sinus aspergillosis.
Materials and methods
This study is a prospective randomized unblinded study with primary aim of evaluating the feasibility and effectivity of voriconazole in patients of chronic invasive sinus aspergillosis with intraorbital or intracranial extension, and secondarily to compare voriconazole with amphotericin B therapy in patients with chronic invasive sinus aspergillosis.
Observations and results
Thirty-three patients who fulfilled the eligibility criteria were included in this study. There were 18 patients enrolled in group I who received amphotericin therapy and 15 patients in group II who received voriconazole therapy. Out of 33 patients, 9 patients had complete response, 10 had partial response, in eight patients disease became stable and there were seven failures. Overall 50% patients had a successful outcome in group I, whereas 60% had a successful outcome in group II receiving oral voriconazole. On comparing only in extradural group, 5/10 had a successful outcome in group I receiving amphotericin B, whereas 8/12 (66.7%) had a successful outcome in group 2 receiving voriconazole. There was significant difference between adverse reactions of the two drugs, with amphotericin B having a significant renal and cardiotoxicity as compared to voriconazole; though patients on voriconazole developed skin rashes which were transient and disappeared on completion of the therapy.
Conclusion
The present series demonstrates that oral voriconazole can be the primary line of therapy in chronic invasive sinus aspergillosis in carefully monitored immunocompetent cases. Multicentric, randomized studies are required to define disease definition, duration and successful outcome.
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