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Munafo' C, Loperfido A, Mammarella F, Crosti A, Iannilli F, Millarelli FR, Bellocchi G, Tritapepe L. Safety and efficacy of remifentanil target-controlled infusion for conscious sedation in a pregnant woman: a case report. J Med Case Rep 2024; 18:143. [PMID: 38454441 PMCID: PMC10921671 DOI: 10.1186/s13256-023-04303-3] [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: 07/27/2023] [Accepted: 12/05/2023] [Indexed: 03/09/2024] Open
Abstract
BACKGROUND Every year 2% of pregnant women undergo nonobstetric surgical interventions worldwide. According to the American College of Obstetricians and Gynecologists Committee on Obstetric Practice, pregnant women should never be denied the most appropriate surgical treatment, regardless of the trimester of pregnancy. However, additional attention should be paid during the first trimester since it has the highest risk of inducing teratogenic mutations; additionally, during the third trimester, due to the possibility of preterm birth and low birth weight of the newborn, great care should be paid. CASE PRESENTATION We present the case of a Caucasian 36-year-old woman during her 21st week of pregnancy, with a normal-sized fetus, according to the gestational age on ultrasound exam, and with no additional risk factors. The patient referred to an increasing nasal obstruction associated with rhinorrhea of the left nasal cavity. She also reported episodes of sleep apnea and hyposmia. The patient received a detailed otolaryngological examination, which allowed for identification of a mass within the left nasal cavity. The subsequent nasal endoscopy confirmed a grayish polypoid mass lesion with a multinodular surface occupying the entire left nasal fossa. The lesion totally obliterated the left maxillary sinus, resulting in obstruction of the anterior osteomeatal unit and ethmoidal sinusitis. She was referred for a functional endoscopic sinus surgery using analgosedation with remifentanil target-controlled infusion. DISCUSSION AND CONCLUSION To the very best of our knowledge, this is the first case described in English literature about the use of analgosedation with remifentanil target-controlled infusion for otolaryngology surgery, specifically in functional endoscopic sinus surgery. It could be an interesting option to avoid the use of inhaled anesthetics that could induce fetal damage, especially during the first months of pregnancy. Furthermore, patient intubation is not necessary, which avoids cases of difficult intubation or any trauma to the airways. An adequate informed consent and appropriate compliance are elements of paramount importance in tailoring the anesthetic strategy for pregnant women who need nonobstetric surgical management.
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Affiliation(s)
- Camilla Munafo'
- Anaesthesia and Intensive Care Division, San Camillo-Forlanini Hospital Rome, Rome, Italy
| | | | | | - Arianna Crosti
- Anaesthesia and Intensive Care Division, University of Rome "La Sapienza", Rome, Italy.
| | - Federico Iannilli
- Anaesthesia and Intensive Care Division, University of Rome "La Sapienza", Rome, Italy
| | | | | | - Luigi Tritapepe
- Anaesthesia and Intensive Care Division, San Camillo-Forlanini Hospital Rome, Rome, Italy
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Samaddar A, Shrimali T, Tiwari S, Sharma A. First report of human infection caused by Curvularia warraberensis, manifesting as invasive sinusitis with intracranial involvement. J Mycol Med 2023; 33:101337. [PMID: 36274521 DOI: 10.1016/j.mycmed.2022.101337] [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: 08/09/2022] [Revised: 10/11/2022] [Accepted: 10/17/2022] [Indexed: 03/01/2023]
Abstract
Curvularia species are saprophytic dematiaceous fungi commonly isolated from environmental sources. Most often, they are responsible for allergic fungal rhinosinusitis, an intense, allergic inflammatory sinus disease in immunocompetent individuals. Though invasive infections are rare and more commonly observed in immunocompromised patients, recent reports indicate an increasing trend of invasive sinusitis caused by Curvularia species in immunocompetent hosts. Over the past few years, new species of the genus Curvularia are increasingly being recognized as human pathogens. Here, we report the first human infection caused by Curvularia warraberensis, a cryptic species of Curvularia primarily described as an endophyte in Australian grasses. The 33-year-old female presented with chronic invasive sinusitis of the sphenoid and ethmoid sinuses that progressed to involve the pituitary gland, mid-brain, the facial-vestibulocochlear nerve complex, and basilar artery. The patient underwent endoscopic sinus surgery. Histopathology, microscopic examination and culture of biopsy tissues revealed a dematiaceous fungus that was identified as C. warraberensis, based on sequencing the internal transcribed spacer (ITS) and large subunit (LSU) regions of ribosomal DNA. Antifungal susceptibility testing (AFST) showed low minimum inhibitory concentrations (MICs) for amphotericin B (1 µg/mL), itraconazole (0.25 µg/mL) and posaconazole (0.125 µg/mL). Accurate identification and AFST are crucial for making treatment decisions as some Curvularia species demonstrate variable susceptibility to antifungal agents. The patient died despite combined surgical and medical intervention owing to late presentation and delay in initiating antifungal therapy. A high index of suspicion together with an early diagnosis and aggressive treatment may improve the outcome in such cases.
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Affiliation(s)
- Arghadip Samaddar
- Department of Microbiology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India.
| | - Twishi Shrimali
- Department of Microbiology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Sarbesh Tiwari
- Department of Diagnostic and Interventional Radiology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Anuradha Sharma
- Department of Microbiology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
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Breakthrough Acute Necrotizing Invasive Fungal Rhinosinusitis by Alternariaalternata in a Patient with Acute Lymphoblastic Leukemia on Anidulafungin Therapy and Case-Based Literature Review. J Fungi (Basel) 2022; 8:jof8080879. [PMID: 36012868 PMCID: PMC9410131 DOI: 10.3390/jof8080879] [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: 07/10/2022] [Revised: 08/05/2022] [Accepted: 08/17/2022] [Indexed: 11/16/2022] Open
Abstract
Alternaria spp. have emerged as opportunistic pathogens particularly in immunosuppressed patients. A case of a breakthrough acute invasive fungal rhinosinusitis (AIFRS), caused by Alternaria alternata, is reported in a patient with acute lymphoblastic leukemia (ALL) on anidulafungin therapy, who was successfully treated with liposomal amphotericin B and surgical intervention. To date, 20 cases of AIFRS due to Alternaria spp. have been described, 19 in the USA and 1 in Chile, making this case report the first case of AIFRS due to Alternaria in Europe. The patients had median (range) age 25 (2-56) years (65% female), almost all of them (19/20) with hematological diseases and severe neutropenia (8-41 days pre-infection). Amphotericin B was the most frequently used antifungal agent, either alone or in combination. In all of the cases, systemic antifungal therapy was combined with surgery. Despite stabilization or improvement of the AIFRS, mortality was 38% (5 days to 8 months post-surgical debridement) due to their underlying disease or other infections without sign of AIFRS at autopsy.
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Alsulaiman HM, Elkhamary SM, Alrajeh M, Al-Alsheikh O, Al-Ghadeer H. Invasive sino-orbital aspergillosis with brain invasion in an immunocompetent pregnant patient. Am J Ophthalmol Case Rep 2021; 24:101210. [PMID: 34611568 PMCID: PMC8476652 DOI: 10.1016/j.ajoc.2021.101210] [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: 12/17/2020] [Revised: 07/02/2021] [Accepted: 09/20/2021] [Indexed: 12/01/2022] Open
Abstract
Purpose Invasive Fungal Sinusitis (IFS) is a potentially life-threatening condition that can progress rapidly to the orbit and the brain, especially if it goes on undetected for a long period. We report a case of a 28-year-old pregnant woman in her second trimester with sino-orbital Aspergillosis and subsequent brain involvement who tragically developed deterioration of her neurological status and a spontaneous abortion. Observations The patient presented to the ophthalmology emergency department, King Khaled Eye Specialist Hospital, Riyadh, complaining of left upper eyelid fullness with a palpable eyelid mass and chronic relapsing remitting dull pain for 4 months. Clinical examination was significant for reduced colour vision in the left eye, limited left supraduction, left upper eyelid firm palpable mass, inferior dystopia and proptosis of 4 mm. Magnetic Resonance Imaging (MRI) done without contrast-enhancement due to her pregnancy revealed aggressive infiltrative sinonasal, nasal septum, cribriform plate, orbital, intracranial infiltration with extensive brain edema and midline falcine herniation patterns. Endoscopic endonasal biopsy of the lesions showed septate hyphae branching at acute angles, suggestive of Aspergillosis. Her neurological status deteriorated with a spontaneous abortion during admission. Conclusions and Importance This case demonstrates that IFS could present only with proptosis, eyelid fullness, chronic pain without external inflammatory signs and should be considered in such presentation even in immunocompetent patients. Early detection and management are crucial. Whether pregnancy presents a relative immune susceptibility to IFS is an issue that needs further in-depth investigation.
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Affiliation(s)
- Hamad M Alsulaiman
- Oculoplastic and Reconstructive Surgery Division, King Khaled Eye Specialist Hospital, Riyadh, Kingdom of Saudi Arabia
| | - Sahar M Elkhamary
- Department of Radiology, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
| | - Mohammed Alrajeh
- Oculoplastic and Reconstructive Surgery Division, King Khaled Eye Specialist Hospital, Riyadh, Kingdom of Saudi Arabia
| | - Osama Al-Alsheikh
- Oculoplastic and Reconstructive Surgery Division, King Khaled Eye Specialist Hospital, Riyadh, Kingdom of Saudi Arabia
| | - Huda Al-Ghadeer
- Emergency Department, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
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The learning hospital: From theory to practice in a hospital infection prevention program. Infect Control Hosp Epidemiol 2020; 41:86-97. [DOI: 10.1017/ice.2019.318] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
AbstractThe learning hospital is distinguished by ceaseless evolution of erudition, enhancement, and implementation of clinical best practices. We describe a model for the learning hospital within the framework of a hospital infection prevention program and argue that a critical assessment of safety practices is possible without significant grant funding. We reviewed 121 peer-reviewed manuscripts published by the VCU Hospital Infection Prevention Program over 16 years. Publications included quasi-experimental studies, observational studies, surveys, interrupted time series analyses, and editorials. We summarized the articles based on their infection prevention focus, and we provide a brief summary of the findings. We also summarized the involvement of nonfaculty learners in these manuscripts as well as the contributions of grant funding. Despite the absence of significant grant funding, infection prevention programs can critically assess safety strategies under the learning hospital framework by leveraging a diverse collaboration of motivated nonfaculty learners. This model is a valuable adjunct to traditional grant-funded efforts in infection prevention science and is part of a successful horizontal infection control program.
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Ito C, Sharbel D, McMullen A, Kountakis S. In vitro analysis of growth patterns of invasive fungal species on commonly used endonasal hemostatic agents. Am J Otolaryngol 2019; 40:101-105. [PMID: 30472131 DOI: 10.1016/j.amjoto.2018.09.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Accepted: 09/23/2018] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Previous studies have not examined the potential role of endonasal hemostatic agents in facilitating growth of fungal species. We aim to determine the possibility of these to serve as a nutrient source for fungal growth. METHODS Cultures of Aspergillus, Fusarium, and Mucor were harvested and placed in solution in sterile saline at standardized high and low concentrations. Thrombin gelatin matrix, carboxyl methylcelluose, and potato starch derivative agents were prepared following manufacturer instructions and applied to two separate Petri dishes per agent. Each substrate was then inoculated with either high or low concentrations of fungal species. Negative and positive control plates with each organism were included. Dishes were sealed, incubated, and examined daily for fourteen days for microscopic and macroscopic growth. RESULTS Thrombin gelatin matrix was relatively resilient to growth, although Fusarium growth was noted on all packing material by day three. Carboxyl methylcellulose also supported growth of high-concentration Mucor appreciated on day five. The potato starch derivative supported fulminant growth of all fungal species. CONCLUSIONS Endonasal hemostatic agents may be nutrient sources that facilitate growth of fungal species. This may be a consideration in a surgeon's decision to use a hemostatic agent. Prompt initial post-operative debridement may be warranted in select patients. Our findings serve as a model for further testing of fungal growth on other hemostatic materials. Future studies are needed to confirm the clinical significance of these findings in vivo.
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Affiliation(s)
- Christopher Ito
- Department of Otolaryngology-Head and Neck Surgery, University of Massachusetts Medical School, 55 N. Lake Ave., Worcester, MA 01605, United States of America.
| | - Daniel Sharbel
- Department of Otolaryngology-Head and Neck Surgery, Augusta University, 1120 15th Street, BP-4109, Augusta, GA 30912, United States of America
| | - Allison McMullen
- Department of Pathology, Augusta University, 1120 15th Street, Augusta, GA 30912, United States of America
| | - Stilianos Kountakis
- Department of Otolaryngology-Head and Neck Surgery, Augusta University, 1120 15th Street, BP-4109, Augusta, GA 30912, United States of America
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Hernández-Restrepo M, Madrid H, Tan Y, da Cunha K, Gené J, Guarro J, Crous P. Multi-locus phylogeny and taxonomy of Exserohilum. PERSOONIA 2018; 41:71-108. [PMID: 30728600 PMCID: PMC6344813 DOI: 10.3767/persoonia.2018.41.05] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Accepted: 12/13/2017] [Indexed: 12/19/2022]
Abstract
Exserohilum includes a number of plant pathogenic, saprobic and clinically relevant fungi. Some of these species are of great importance in human activities, but the genus has never been revised in a phylogenetic framework. In this study, we revise Exserohilum based on available ex-type cultures from worldwide collections, observation of the holotypes and/or protologues, and additional isolates from diverse substrates and geographical origins. Based on nine nuclear loci, i.e., ITS, LSU, act, tub2, cam, gapdh, his, tef1 and rpb2, as well as phenotypic data, the genus and species boundaries are assessed for Exserohilum. Three species, i.e., E. novae-zelandiae, E. paspali and E. sorghicola, are excluded from the genus and reallocated in Sporidesmiella and Curvularia, respectively, whereas E. heteropogonicola and E. inaequale are confirmed as members of Curvularia. Exserohilum rostratum is revealed as conspecific with species previously described in Exserohilum such as E. antillanum, E. gedarefense, E. leptochloae, E. longirostratum, E. macginnisii and E. prolatum. Additionally, E. curvatum is revealed as synonym of E. holmii, and E. fusiforme of E. oryzicola. A total of 11 Exserohilum phylogenetic species are described, illustrated and discussed, including one novel taxon, E. corniculatum. The placements of 15 other doubtful species are discussed, and E. elongatum is validated.
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Affiliation(s)
- M. Hernández-Restrepo
- Westerdijk Fungal Biodiversity Institute, P.O. Box 85167, 3508 AD Utrecht, The Netherlands
- Department of Microbiology and Plant Pathology, Forestry and Agricultural Biotechnology Institute (FABI), University of Pretoria, Pretoria 0002, South Africa
| | - H. Madrid
- Centro de Genómica y Bioinformática, Facultad de Ciencias, Universidad Mayor de Chile, Camino La Pirámide 5750, Huechuraba, Santiago, Chile
| | - Y.P. Tan
- Plant Pathology Herbarium, Department of Agriculture and Fisheries, Ecosciences Precinct, 41 Boggo Road, Dutton Park, QLD 4102, Australia
| | - K.C. da Cunha
- Dermatology Laboratory, Service of Laboratory Medicine, University Hospital of Geneva 4, CH-1 205 Geneva, Switzerland
| | - J. Gené
- Unitat de Micologia, Facultat de Medicina i Ciències de la Salut and IISPV, Univeristat Rovira i Virgili, Reus, Spain
| | - J. Guarro
- Unitat de Micologia, Facultat de Medicina i Ciències de la Salut and IISPV, Univeristat Rovira i Virgili, Reus, Spain
| | - P.W. Crous
- Westerdijk Fungal Biodiversity Institute, P.O. Box 85167, 3508 AD Utrecht, The Netherlands
- Department of Microbiology and Plant Pathology, Forestry and Agricultural Biotechnology Institute (FABI), University of Pretoria, Pretoria 0002, South Africa
- Wageningen University and Research Centre (WUR), Laboratory of Phytopathology, Droevendaalsesteeg 1, 6708 PB Wageningen, The Netherlands
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Gilde JE, Xiao CC, Epstein VA, Liang J. Deadly Sphenoid Fungus-Isolated Sphenoid Invasive Fungal Rhinosinusitis: A Case Report. Perm J 2018; 21:17-032. [PMID: 29236649 DOI: 10.7812/tpp/17-032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Acute invasive fungal rhinosinusitis (AIFRS) is a potentially fatal infection, usually affecting immunocompromised patients. Isolated sphenoid sinus involvement is rare and has been reported in only a few cases. We discuss the clinical characteristics, histopathologic features, and differential diagnosis of AIFRS of the sphenoid sinus. CASE PRESENTATION A 57-year-old man with a history of refractory non-Hodgkin lymphoma and neutropenia presented with a 1-week duration of left-sided headache and ipsilateral cheek paresthesia. Nasal endoscopy showed mucoid drainage from the sphenoethmoidal recess. Magnetic resonance imaging demonstrated left sphenoid mucosal thickening and enhancement along the adjacent skull base. The patient underwent endoscopic sinus surgery with extended sphenoidotomy and débridement. The lateral wall and recess of the left sphenoid sinus demonstrated pale mucosa and fungal debris. Pathologic analysis demonstrated necrotic tissue and fungal hyphae with angioinvasion. Microbiology studies isolated Aspergillus fumigatus. The right maxillary sinus contained a synchronous fungal ball, which was removed during surgery; there was no evidence of tissue necrosis or invasive fungus in the maxillary sinus. He was treated with long-term voriconazole therapy, and 6-month follow-up showed disease resolution. DISCUSSION AIFRS should be considered in the differential diagnosis of immunocompromised patients with nonspecific sinonasal symptoms. Usually, AIFRS is diffuse with multiple sinus involvement; however, isolated sphenoid AIFRS can occur. This is one of the few cases of AIFRS demonstrating isolated sphenoid involvement and is thought to be the first case showing a synchronous noninvasive fungal ball of another sinus cavity. Prompt recognition and surgical treatment may be curative and lifesaving.
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Affiliation(s)
- Jason E Gilde
- Otolaryngology and Head and Neck Surgery Resident at the Oakland Medical Center in CA.
| | - Christopher C Xiao
- Otolaryngology and Head and Neck Surgery Resident at the Oakland Medical Center in CA.
| | | | - Jonathan Liang
- Head and Neck Surgeon at the Oakland Medical Center in CA.
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Lyskova P, Kubanek M, Hubka V, Sticova E, Voska L, Kautznerova D, Kolarik M, Hamal P, Vasakova M. Successful Posaconazole Therapy of Disseminated Alternariosis due to Alternaria infectoria in a Heart Transplant Recipient. Mycopathologia 2016; 182:297-303. [DOI: 10.1007/s11046-016-0094-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Accepted: 11/14/2016] [Indexed: 10/20/2022]
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Abstract
Fungal rhinosinusitis (FRS) comprises a spectrum of disease processes that vary in clinical presentation, histologic appearances, and biological significance. FRS can be acute or chronic and is most commonly classified as non-invasive or invasive based on whether fungi have invaded into tissue. This manuscript will review the pathologic classification of FRS.
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Yew SM, Chan CL, Lee KW, Na SL, Tan R, Hoh CC, Yee WY, Ngeow YF, Ng KP. A five-year survey of dematiaceous fungi in a tropical hospital reveals potential opportunistic species. PLoS One 2014; 9:e104352. [PMID: 25098697 PMCID: PMC4123927 DOI: 10.1371/journal.pone.0104352] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2014] [Accepted: 07/11/2014] [Indexed: 01/06/2023] Open
Abstract
Dematiaceous fungi (black fungi) are a heterogeneous group of fungi present in diverse environments worldwide. Many species in this group are known to cause allergic reactions and potentially fatal diseases in humans and animals, especially in tropical and subtropical climates. This study represents the first survey of dematiaceous fungi in Malaysia and provides observations on their diversity as well as in vitro response to antifungal drugs. Seventy-five strains isolated from various clinical specimens were identified by morphology as well as an internal transcribed spacer (ITS)-based phylogenetic analysis. The combined molecular and conventional approach enabled the identification of three classes of the Ascomycota phylum and 16 genera, the most common being Cladosporium, Cochliobolus and Neoscytalidium. Several of the species identified have not been associated before with human infections. Among 8 antifungal agents tested, the azoles posaconazole (96%), voriconazole (90.7%), ketoconazole (86.7%) and itraconazole (85.3%) showed in vitro activity (MIC ≤1 µg/mL) to the largest number of strains, followed by anidulafungin (89.3%), caspofungin (74.7%) and amphotericin B (70.7%). Fluconazole appeared to be the least effective with only 10.7% of isolates showing in vitro susceptibility. Overall, almost half (45.3%) of the isolates showed reduced susceptibility (MIC >1 µg/mL) to at least one antifungal agent, and three strains (one Pyrenochaeta unguis-hominis and two Nigrospora oryzae) showed potential multidrug resistance.
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Affiliation(s)
- Su Mei Yew
- Department of Medical Microbiology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Chai Ling Chan
- Department of Medical Microbiology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Kok Wei Lee
- Codon Genomics SB, Jalan Bandar Lapan Belas, Pusat Bandar Puchong, Selangor Darul Ehsan, Malaysia
| | - Shiang Ling Na
- Department of Medical Microbiology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Ruixin Tan
- Department of Medical Microbiology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Chee-Choong Hoh
- Codon Genomics SB, Jalan Bandar Lapan Belas, Pusat Bandar Puchong, Selangor Darul Ehsan, Malaysia
| | - Wai-Yan Yee
- Codon Genomics SB, Jalan Bandar Lapan Belas, Pusat Bandar Puchong, Selangor Darul Ehsan, Malaysia
| | - Yun Fong Ngeow
- Department of Medical Microbiology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Kee Peng Ng
- Department of Medical Microbiology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
- * E-mail:
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Gupta A, Xess I, Sharma SC, Mallick S. Invasive rhinosinusitis by Exserohilum rostratum in an immunocompetent child. BMJ Case Rep 2014; 2014:bcr-2013-202380. [PMID: 24711469 DOI: 10.1136/bcr-2013-202380] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Exserohilum is a saprophytic fungal pathogen responsible for a wide spectrum of infections in humans. It causes life-threatening acute invasive infections in the immunocompromised individuals, particularly those having haematological disorders. We report a proven case of chronic invasive rhinosinusitis with orbital involvement by Exserohilum rostratum in an immunocompetent child. The patient responded well to endoscopic sinus surgery followed by oral itraconazole. An aggressive surgical approach is required for improving the outcome of patients with invasive infections. A microbiological diagnosis may help in deciding the systemic antifungal agent in fungal rhinosinusitis.
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Affiliation(s)
- Ayush Gupta
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India
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Chowdhary A, Meis J, Guarro J, de Hoog G, Kathuria S, Arendrup M, Arikan-Akdagli S, Akova M, Boekhout T, Caira M, Guinea J, Chakrabarti A, Dannaoui E, van Diepeningen A, Freiberger T, Groll A, Hope W, Johnson E, Lackner M, Lagrou K, Lanternier F, Lass-Flörl C, Lortholary O, Meletiadis J, Muñoz P, Pagano L, Petrikkos G, Richardson M, Roilides E, Skiada A, Tortorano A, Ullmann A, Verweij P, Cornely O, Cuenca-Estrella M. ESCMID and ECMM joint clinical guidelines for the diagnosis and management of systemic phaeohyphomycosis: diseases caused by black fungi. Clin Microbiol Infect 2014; 20 Suppl 3:47-75. [DOI: 10.1111/1469-0691.12515] [Citation(s) in RCA: 216] [Impact Index Per Article: 21.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2013] [Revised: 12/13/2013] [Accepted: 12/16/2013] [Indexed: 11/28/2022]
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14
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Smith RM, Tipple M, Chaudry MN, Schaefer MK, Park BJ. Relapse of fungal meningitis associated with contaminated methylprednisolone. N Engl J Med 2013; 368:2535-6. [PMID: 23718153 DOI: 10.1056/nejmc1306560] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Saxby AJ, Pace-Asciak P, Dar Santos RC, Chadha NK, Kozak FK. The rhinological manifestations of women's health. Otolaryngol Head Neck Surg 2013; 148:717-31. [PMID: 23426708 DOI: 10.1177/0194599813477837] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To systematically review the literature and appraise the evidence reporting the effects of women's health, including pregnancy, postpartum, menstruation, oral contraception, menopause, and hormone replacement therapy, on common rhinological pathologies and nasal physiology. DATA SOURCES Systematic search strategy using MEDLINE (1966-2012) and EMBASE (1980-2012) databases. REVIEW METHODS Title review, abstract screening, and then full paper analysis were undertaken by 2 authors independently. Level of evidence was graded according to the Oxford Centre of Evidence Based Medicine 2011 criteria and risk of bias assessment using the Jadad scale for randomized controlled trials and Newcastle-Ottawa Scale for cohort and case-controlled studies. RESULTS Over the 46 years analyzed, the search strategy produced 2904 titles. In total, 314 abstracts were screened, from which 192 full-text articles were evaluated, and 145 research papers met all the criteria for inclusion in the study. Overall, the available evidence was of low quality. Seventy percent of studies (102 of 145) were case reports or case series from which only limited conclusions can be drawn. Only 3% of the included papers (4 of 145) were randomized controlled studies. The remaining data were mainly of a prospective cohort design. Study heterogeneity in design and measured outcomes resulted in data synthesis being limited to a descriptive/exploratory review. Study findings are presented by women's health category and then by rhinological manifestation with important clinical correlations highlighted. CONCLUSION Physiological and hormonal changes occurring as a normal part of women's health have an important influence on rhinological function and disease.
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Affiliation(s)
- Alexander J Saxby
- Division of Otolaryngology, Head and Neck Surgery, Children's and Women's Hospital, Vancouver, BC, Canada.
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Reflections on the approach to treatment of a mycologic disaster. Antimicrob Agents Chemother 2013; 57:1567-72. [PMID: 23384533 DOI: 10.1128/aac.02242-12] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Molecular identification and in vitro response to antifungal drugs of clinical isolates of Exserohilum. Antimicrob Agents Chemother 2012; 56:4951-4. [PMID: 22733074 DOI: 10.1128/aac.00488-12] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Exserohilum is an agent of human and animal mycoses. Although classification has been based on a few subtle morphological differences, three species of clinical interest have been traditionally accepted. In this study, by using a multigene sequence analysis, we have demonstrated that Exserohilum longirostratum and E. mcginnisii are probable synonyms of E. rostratum. The isolates tested were mainly from the nasal region. Antifungal susceptibility testing demonstrated high activity of the eight agents tested against this fungus.
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Montone KT, LiVolsi VA, Lanza DC, Kennedy DW, Palmer J, Chiu AG, Feldman MD, Loevner LA, Nachamkin I. In situ hybridization for specific fungal organisms in acute invasive fungal rhinosinusitis. Am J Clin Pathol 2011; 135:190-9. [PMID: 21228359 DOI: 10.1309/ajcpqlyzbdf30htm] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
Acute invasive fungal rhinosinusitis (AIFRS) most commonly occurs in immunosuppressed patients. The identification of fungal subtypes is important for management, and cultures can be negative. We studied 55 specimens from 23 patients with AIFRS (Rhizopus sp, 6; Aspergillus sp, 8; Fusarium sp, 1; Alternaria sp, 1; and culture negative, 7) using in situ hybridization (ISH) with biotin-labeled oligonucleotide probes targeting Aspergillus sp, Fusarium sp, Rhizopus sp, and a sequence identified in dematiaceous fungi. Ribosomal RNA preservation was established by using a pan-fungal probe. Nucleic acid preservation was seen in 18 patients (33 specimens [60%]). ISH using the specific fungal probes highlighted the respective fungal organisms in all culture-positive cases with adequate negative controls. Of the 7 culture-negative AIFRS cases, 4 had preserved fungal sequences. Of these cases, 2 additional cases of Aspergillus and 1 additional case of dematiaceous species were identified. In our study, 60% of AIFRS cases had fungal nucleic acid preservation. ISH can effectively identify fungi in AIFRS. ISH for specific fungal pathogens may aid in species identification in specimens with negative cultures.
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Affiliation(s)
- Kathleen T. Montone
- Department of Pathology and Laboratory Medicine, University of Pennsylvania Medical Center, Philadelphia, PA
| | - Virginia A. LiVolsi
- Department of Pathology and Laboratory Medicine, University of Pennsylvania Medical Center, Philadelphia, PA
| | | | - David W. Kennedy
- Department of Otorhinolaryngology, University of Pennsylvania Medical Center, Philadelphia, PA
| | - James Palmer
- Department of Otorhinolaryngology, University of Pennsylvania Medical Center, Philadelphia, PA
| | - Alexander G. Chiu
- Department of Otorhinolaryngology, University of Pennsylvania Medical Center, Philadelphia, PA
| | - Michael D. Feldman
- Department of Pathology and Laboratory Medicine, University of Pennsylvania Medical Center, Philadelphia, PA
| | - Laurie A. Loevner
- Department of Radiology, University of Pennsylvania Medical Center, Philadelphia, PA
| | - Irving Nachamkin
- Department of Pathology and Laboratory Medicine, University of Pennsylvania Medical Center, Philadelphia, PA
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