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Sawhney A, Rajaratnam N, Finkel D. Progression of chronic rhinosinusitis to invasive cerebro-orbital aspergillosis following steroid treatment: A case of induced immunosuppression. IDCases 2023; 32:e01772. [PMID: 37207174 PMCID: PMC10189251 DOI: 10.1016/j.idcr.2023.e01772] [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: 03/26/2023] [Revised: 04/20/2023] [Accepted: 04/21/2023] [Indexed: 05/21/2023] Open
Abstract
Invasive aspergillosis is a classic fungal infection of immunocompromised hosts which rarely manifests in immunocompetent patients. In this report, we present a case of invasive aspergillosis which resulted from induced immunosuppression through corticosteroid treatment of chronic rhinosinusitis. Further investigation is necessary into the epidemiology of mixed fungal rhinosinusitis and providers should be wary of invasive disease in those receiving chronic steroids.
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Affiliation(s)
| | - Nishan Rajaratnam
- Rutgers New Jersey Medical School, Department of Medicine, Division of Infectious Diseases, United States
- Corresponding author.
| | - Diana Finkel
- Rutgers New Jersey Medical School, Department of Medicine, Division of Infectious Diseases, United States
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Abstract
Infections due to Aspergillus species are an acute threat to human health; members of the Aspergillus section Fumigati are the most frequently occurring agents, but depending on the local epidemiology, representatives of section Terrei or section Flavi are the second or third most important. Aspergillus terreus species complex is of great interest, as it is usually amphotericin B resistant and displays notable differences in immune interactions in comparison to Aspergillus fumigatus. The latest epidemiological surveys show an increased incidence of A. terreus as well as an expanding clinical spectrum (chronic infections) and new groups of at-risk patients being affected. Hallmarks of these non-Aspergillus fumigatus invasive mold infections are high potential for tissue invasion, dissemination, and possible morbidity due to mycotoxin production. We seek to review the microbiology, epidemiology, and pathogenesis of A. terreus species complex, address clinical characteristics, and highlight the underlying mechanisms of amphotericin B resistance. Selected topics will contrast key elements of A. terreus with A. fumigatus. We provide a comprehensive resource for clinicians dealing with fungal infections and researchers working on A. terreus pathogenesis, aiming to bridge the emerging translational knowledge and future therapeutic challenges on this opportunistic pathogen.
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Zhang H, Jiang N, Lin X, Wanggou S, Olson JJ, Li X. Invasive sphenoid sinus aspergillosis mimicking sellar tumor: a report of 4 cases and systematic literature review. Chin Neurosurg J 2020; 6:10. [PMID: 32922939 PMCID: PMC7398181 DOI: 10.1186/s41016-020-00187-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Accepted: 03/03/2020] [Indexed: 11/29/2022] Open
Abstract
Background Invasive sphenoid sinus aspergillosis is a rare but life-threatening condition usually found in immunocompromised patients. When involving cavernous sinus and surrounding structures, patients are frequently misdiagnosed with a neoplasm or sellar abscess. Timely diagnosis and intervention are crucial to patients’ outcomes. The objective of this study is to review cases of invasive sphenoid sinus aspergillosis to describe disease manifestations, imaging features, treatment, and outcome. Case presentation We describe four patients with invasive sphenoid sinus aspergillosis misdiagnosed as sellar tumors preoperatively. The mass was completely removed in three patients and partially removed in one patient microscopically. Pathological examinations confirmed Aspergillus in all cases. All four patients received anti-fungal agents postoperatively. There was no recurrence at the time of each patient’s follow-up date. One patient with complete resection was lost to follow-up while the other three patients’ neurologic function improved. Additionally, we performed a systematic review regarding invasive sphenoid sinus aspergillosis of existing English literature. Conclusion With regard to clinical symptoms, headache, vision impairment, and ophthalmoplegia were observed in over half of the patients in the literature. A sellar mass with bone destruction on CT and involvement of cavernous sinus is highly suggestive of invasive fungal sphenoid sinusitis. Immediate surgical removal of the lesion is recommended for invasive sphenoid sinus aspergillosis to preserve nerve function and increase the likelihood of survival.
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Affiliation(s)
- Hanwen Zhang
- Department of Neurosurgery, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, 410008 Hunan People's Republic of China.,Department of Neurosurgery, Emory University School of Medicine, Atlanta, GA 30322 USA
| | - Nian Jiang
- Department of Neurosurgery, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, 410008 Hunan People's Republic of China
| | - Xuelei Lin
- Department of Neurosurgery, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, 410008 Hunan People's Republic of China
| | - Siyi Wanggou
- Department of Neurosurgery, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, 410008 Hunan People's Republic of China
| | - Jeffrey J Olson
- Department of Neurosurgery, Emory University School of Medicine, Atlanta, GA 30322 USA
| | - Xuejun Li
- Department of Neurosurgery, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, 410008 Hunan People's Republic of China
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Garcia-Giraldo AM, Mora BL, Loaiza-Castaño JM, Cedano JA, Rosso F. Invasive fungal infection by Aspergillus flavus in immunocompetent hosts: A case series and literature review. Med Mycol Case Rep 2019; 23:12-15. [PMID: 30450275 PMCID: PMC6226581 DOI: 10.1016/j.mmcr.2018.10.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Revised: 09/29/2018] [Accepted: 10/22/2018] [Indexed: 02/09/2023] Open
Abstract
Invasive aspergillosis usually affects immunocompromised hosts with variable manifestations depending on the site of infection. In this article, we present two cases of invasive Aspergillosis in two non-immunocompromised patients; both cases had a paranasal sinuses infection, with intraorbital and intracranial extension, requiring surgery and antifungal treatment with Voriconazole. These cases were initially diagnosed as paranasal sinus neoplasms. However, the pathology and microbiology studies revealed invasive fungal infection by Aspergillus flavus.
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Affiliation(s)
| | - Barbara Lucia Mora
- Clinical Research Center, Fundación Valle del Lili, Carrera 98 #18–49, Cali, Colombia
| | | | - Jorge Andrés Cedano
- Clinical Research Center, Fundación Valle del Lili, Carrera 98 #18–49, Cali, Colombia
| | - Fernando Rosso
- Clinical Research Center, Fundación Valle del Lili, Carrera 98 #18–49, Cali, Colombia
- Infectious Diseases Service, Fundación Valle del Lili, Carrera 98 #18–49, Cali, Colombia
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Abstract
PURPOSE OF REVIEW To summarize diagnostic techniques for invasive fungal rhinosinusitis and provide a review of treatment options once disease has spread to the orbit. RECENT FINDINGS Improved imaging criteria, polymerase chain reaction and other serologic tests show promise in advancing our ability to accurately diagnose invasive fungal disease. Currently, there exists three treatment options for infected orbital tissue: exenteration, conservative debridement and transcutaneous retrobulbar injection of amphotericin B. Exenteration, the most frequently reported intervention, has not been proven to enhance survival. Conservative debridement and transcutaneous retrobulbar injection of amphotericin B are increasingly considered reasonable first-line options. SUMMARY Although investigative tools are improving, invasive fungal rhinosinusitis can still pose a diagnostic challenge. No one treatment option for the orbit has been proven superior to another. Therefore, it is justified to initiate therapy by prioritizing less morbid procedures. If deterioration is continually noted, more invasive interventions can then be employed. The treatment algorithm established at our institution is provided.
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Isolated Orbital Aspergillosis in Immunocompetent Patients: A Multicenter Study. Am J Ophthalmol 2016; 165:125-32. [PMID: 26973050 DOI: 10.1016/j.ajo.2016.03.007] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Revised: 03/01/2016] [Accepted: 03/04/2016] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To report clinicopathologic features, radiologic findings, and treatment outcomes of isolated, orbital aspergillosis. DESIGN Multicenter, retrospective case series. METHODS setting: Multicenter. PARTICIPANTS There were 8 lesions in 8 eyes of 8 patients with isolated, orbital aspergillosis. PROCEDURE Review of medical records and histopathology slides. MAIN OUTCOME MEASURES Disease control. RESULTS Of 34 patients with orbital aspergillosis, 8 (23.5%) had isolated orbital involvement at presentation. The mean age at presentation was 34.5 years (median, 43 years: range, 0.5-72 years). Gradually progressive proptosis and eyelid swelling were the most common presenting features (each 4/8). Proptosis ranged from 4 mm to 9 mm (median, 5.5 mm; mean, 5.75 mm). Restriction of ocular motility was seen in all 8 patients. Other examination findings included palpable mass (2/8), conjunctival chemosis (2/8), hyperglobus (1/8), hypoglobus (1/8), and resistance to retropulsion (1/8). Microbial culture results were available in 1 patient and showed Aspergillus fumigatus. Two patients were treated with complete surgical excision alone while 6 were treated with antifungal medications. Complete resolution of proptosis and restoration of ocular motility were seen in all patients following treatment. Visual disturbances present in 1 were corrected following treatment. Recurrence was observed in 1 patient. CONCLUSION Isolated orbital aspergillosis, though rare, should be considered in the differential diagnosis of a patient presenting with a gradually progressive orbital mass, especially in Asian individuals. Early recognition will help reduce the morbidity and mortality associated with this disease.
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Elsawy A, Faidah H, Ahmed A, Mostafa A, Mohamed F. Aspergillus terreus Meningitis in Immunocompetent Patient: A Case Report. Front Microbiol 2015; 6:1353. [PMID: 26648927 PMCID: PMC4664626 DOI: 10.3389/fmicb.2015.01353] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Accepted: 11/16/2015] [Indexed: 11/13/2022] Open
Abstract
We present a description of a rare but dangerous case of fungal meningitis caused by Aspergillus terreus in an immunocompetent patient with a history of sinus disease.
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Affiliation(s)
- Abdelrahman Elsawy
- Medical Microbiology Department, Al-Noor Specialist Hospital, Ministry of Health Makkah, Saudi Arabia ; Department of Microbiology, Al-Azhar Faculty of Medicine, Al-Azhar University Cairo, Egypt
| | - Hani Faidah
- Medical Microbiology Department, Al-Noor Specialist Hospital, Ministry of Health Makkah, Saudi Arabia ; Department of Microbiology, College of Medicine, Umm Al-Qura University Makkah, Saudi Arabia
| | - Abdalla Ahmed
- Department of Microbiology, College of Medicine, Umm Al-Qura University Makkah, Saudi Arabia
| | - Asmaa Mostafa
- Medical Microbiology Department, Al-Noor Specialist Hospital, Ministry of Health Makkah, Saudi Arabia ; Department of Microbiology, Tanta Faculty of Medicine, Tanta University Tanta, Egypt
| | - Farah Mohamed
- Department of Medicine, Al-Noor Specialist Hospital, Ministry of Health Makkah, Saudi Arabia
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Invasive Aspergillosis Associated with a Foreign Body. Case Rep Pathol 2015; 2015:875168. [PMID: 26064750 PMCID: PMC4442003 DOI: 10.1155/2015/875168] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2014] [Accepted: 04/29/2015] [Indexed: 11/30/2022] Open
Abstract
Invasive aspergillosis is a serious complication in immunocompromised individuals. It is associated with a high mortality rate, which demands a combined approach involving radical surgery and antifungal therapy. Here, we describe a patient who presented with nonspecific fever, refractory to antimicrobial agents. Though it primarily involved the nasal cavity and sinuses, it perforated into the oral cavity causing palatal changes. Surprisingly, a foreign body was found in the involved tissues that might have acted as a nidus of infection. A sufficient dose (3 mg/kg/day) of liposomal amphotericin B was initiated soon after a thorough debridement procedure and the patient survived.
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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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Chahed H, Bachraoui R, Kedous S, Ghorbel H, Houcine A, Mediouni A, Marrakchi J, Zainine R, Ben Amor M, Beltaief N, Besbes G. [Management of ocular and orbital complications in acute sinusitis]. J Fr Ophtalmol 2014; 37:702-6. [PMID: 25264151 DOI: 10.1016/j.jfo.2014.02.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2013] [Revised: 02/16/2014] [Accepted: 02/26/2014] [Indexed: 11/25/2022]
Abstract
PURPOSE Describe the clinical presentations of orbital complications of acute sinusitis and discuss therapeutic approaches. METHODS Retrospective study of 29 cases of acute sinusitis with orbital extension hospitalized over a period of 12years (2000 to 2012). RESULTS There were 23 men and 6 women. The mean age was 15.75years. The average time until consultation was 7.68 days. Sinusitis was ethmoido-maxillary in 20 cases, ethmoidal in 6 cases, and frontal in 3 cases. Orbital extension was grouped according to the Chandler classification: stage I (3 cases), stage II (3 cases), stage III (15 cases), stage IV (8 cases). Antibiotic therapy was prescribed in all cases. Surgery was performed in 22 cases. Bacterial cultures revealed streptococcus (2 cases), aspergillus fumigatus (1 case) and were negative in 8 cases. The outcome was favorable in 27 cases. In two cases, the outcome was unfavorable with associated intracranial complications. DISCUSSION Oculoorbital extension of acute sinusitis is a diagnostic and therapeutic emergency. Paranasal sinus CT is essential to confirm orbital extension and identify the causative sinus. Intravenous antibiotic therapy is the main treatment. The roles of corticosteroid and heparin therapy remain controversial. Surgery is indicated in the case of abscess or high visual risk. Endoscopic endonasal surgery appears to have a double role, in diagnosis and treatment.
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Affiliation(s)
- H Chahed
- Service ORL et chirurgie maxillofaciale, hôpital de la Rabta, La Rabta Jebbari, 1007 Tunis, Tunisie.
| | - R Bachraoui
- Service ORL et chirurgie maxillofaciale, hôpital de la Rabta, La Rabta Jebbari, 1007 Tunis, Tunisie
| | - S Kedous
- Service ORL et chirurgie maxillofaciale, hôpital de la Rabta, La Rabta Jebbari, 1007 Tunis, Tunisie
| | - H Ghorbel
- Service ORL et chirurgie maxillofaciale, hôpital de la Rabta, La Rabta Jebbari, 1007 Tunis, Tunisie
| | - A Houcine
- Service ORL et chirurgie maxillofaciale, hôpital de la Rabta, La Rabta Jebbari, 1007 Tunis, Tunisie
| | - A Mediouni
- Service ORL et chirurgie maxillofaciale, hôpital de la Rabta, La Rabta Jebbari, 1007 Tunis, Tunisie
| | - J Marrakchi
- Service ORL et chirurgie maxillofaciale, hôpital de la Rabta, La Rabta Jebbari, 1007 Tunis, Tunisie
| | - R Zainine
- Service ORL et chirurgie maxillofaciale, hôpital de la Rabta, La Rabta Jebbari, 1007 Tunis, Tunisie
| | - M Ben Amor
- Service ORL et chirurgie maxillofaciale, hôpital de la Rabta, La Rabta Jebbari, 1007 Tunis, Tunisie
| | - N Beltaief
- Service ORL et chirurgie maxillofaciale, hôpital de la Rabta, La Rabta Jebbari, 1007 Tunis, Tunisie
| | - G Besbes
- Service ORL et chirurgie maxillofaciale, hôpital de la Rabta, La Rabta Jebbari, 1007 Tunis, Tunisie
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Mody KH, Ali MJ, Vemuganti GK, Nalamada S, Naik MN, Honavar SG. Orbital aspergillosis in immunocompetent patients. Br J Ophthalmol 2014; 98:1379-84. [DOI: 10.1136/bjophthalmol-2013-303763] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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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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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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Schwartz S, Reisman A, Troke PF. The efficacy of voriconazole in the treatment of 192 fungal central nervous system infections: a retrospective analysis. Infection 2011; 39:201-10. [PMID: 21512792 DOI: 10.1007/s15010-011-0108-6] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2010] [Accepted: 03/29/2011] [Indexed: 10/18/2022]
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15
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Clinical features and outcomes of four patients with invasive fungal sinusitis. Auris Nasus Larynx 2011; 38:289-94. [DOI: 10.1016/j.anl.2010.08.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2009] [Revised: 07/20/2010] [Accepted: 08/02/2010] [Indexed: 11/20/2022]
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Akhaddar A, Zalagh M, Gazzaz M, Boucetta M. Brain abscess as a complication of intranasal ethmoidectomy for sinonasal polyposis. Surg Infect (Larchmt) 2011; 11:483-5. [PMID: 20575665 DOI: 10.1089/sur.2009.031] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Chakrabarti A, Chatterjee SS, Das A, Shivaprakash MR. Invasive aspergillosis in developing countries. Med Mycol 2010; 49 Suppl 1:S35-47. [PMID: 20718613 DOI: 10.3109/13693786.2010.505206] [Citation(s) in RCA: 84] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
To review invasive aspergillosis (IA) in developing countries, we included those countries, which are mentioned in the document of the International Monetary Fund (IMF), called the Emerging and Developing Economies List, 2009. A PubMed/Medline literature search was performed for studies concerning IA reported during 1970 through March 2010 from these countries. IA is an important cause of morbidity and mortality of hospitalized patients of developing countries, though the exact frequency of the disease is not known due to inadequate reporting and facilities to diagnose. Only a handful of centers from India, China, Thailand, Pakistan, Bangladesh, Sri Lanka, Malaysia, Iran, Iraq, Saudi Arabia, Egypt, Sudan, South Africa, Turkey, Hungary, Brazil, Chile, Colombia, and Argentina had reported case series of IA. As sub-optimum hospital care practice, hospital renovation work in the vicinity of immunocompromised patients, overuse or misuse of steroids and broad-spectrum antibiotics, use of contaminated infusion sets/fluid, and increase in intravenous drug abusers have been reported from those countries, it is expected to find a high rate of IA among patients with high risk, though hard data is missing in most situations. Besides classical risk factors for IA, liver failure, chronic obstructive pulmonary disease, diabetes, and tuberculosis are the newly recognized underlying diseases associated with IA. In Asia, Africa and Middle East sino-orbital or cerebral aspergillosis, and Aspergillus endophthalmitis are emerging diseases and Aspergillus flavus is the predominant species isolated from these infections. The high frequency of A. flavus isolation from these patients may be due to higher prevalence of the fungus in the environment. Cerebral aspergillosis cases are largely due to an extension of the lesion from invasive Aspergillus sinusitis. The majority of the centers rely on conventional techniques including direct microscopy, histopathology, and culture to diagnose IA. Galactomannan, β-D glucan test, and DNA detection in IA are available only in a few centers. Mortality of the patients with IA is very high due to delays in diagnosis and therapy. Antifungal use is largely restricted to amphotericin B deoxycholate and itraconazole, though other anti-Aspergillus antifungal agents are available in those countries. Clinicians are aware of good outcome after use of voriconazole/liposomal amphotericin B/caspofungin, but they are forced to use amphotericin B deoxycholate or itraconazole in public-sector hospitals due to economic reasons.
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Affiliation(s)
- Arunaloke Chakrabarti
- Department of Medical Microbiology, Postgraduate Institute of Medical Education & Research, Chandigarh, India.
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Akhaddar A, Elouennass M, Baallal H, Boucetta M. Focal intracranial infections due to Actinomyces species in immunocompetent patients: diagnostic and therapeutic challenges. World Neurosurg 2010; 74:346-50. [PMID: 21492568 DOI: 10.1016/j.wneu.2010.05.029] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2010] [Accepted: 05/03/2010] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Actinomyces spp. are often underestimated as causes of central nervous system infection because they are not looked for routinely and are difficult to detect. We try to determine the optimal management of these problematic intracranial infectious diseases in neurosurgical practice. METHODS Five cases of intracranial suppurations due to Actinomyces spp. treated between December 2007 and February 2009 are reported. The relevant clinicobacteriologic features and treatment outcomes are analyzed. RESULTS There were two brain abscesses, two subdural empyemas, and one frontal sinus pyomucocele with intracranial extension. Among them, three cases were previously operated and two patients were previously treated for otorhinolaryngeal infection. All cases were immunocompetent. In addition to Actinomyces sp., three patients had coinfectious bacteria (Pseudomonas aeruginosa, Staphylococcus warneri, and Escherichia coli). Complete resolution of the infection was achieved by means of aggressive surgical treatment and relatively short course of antibiotic therapy with a full recovery. CONCLUSION Actinomycotic focal cerebral infections may occur with greater frequency than previously recognized. Polymicrobial bacteria may be seen. This rare anaerobic organism should be considered in patients with a history of head trauma, previous surgery, or otorhinolaryngeal infection who present with a long duration of neurologic symptoms with or without an accompanying fever. Patients may be candidates for surgical debridement with relative shorter term of antibiotic therapy (ciprofloxacin).
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Affiliation(s)
- Ali Akhaddar
- Department of Neurosurgery, Mohammed V Military Teaching Hospital, Rabat, Morocco.
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19
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Chronic Invasive Sinus Aspergillosis in Immunocompetent Hosts: A Geographic Comparison. Mycopathologia 2010; 170:403-10. [DOI: 10.1007/s11046-010-9338-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2010] [Accepted: 06/11/2010] [Indexed: 11/26/2022]
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Nathoo N, Narotam PK, van Dellen JR. Garré disease. J Neurosurg 2010; 112:475-6; author reply 476. [PMID: 20121381 DOI: 10.3171/2009.8.jns091069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Fungal infections of the nervous system: Current perspective and controversies in management. Int J Surg 2010; 8:591-601. [DOI: 10.1016/j.ijsu.2010.07.293] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2009] [Revised: 06/06/2010] [Accepted: 07/21/2010] [Indexed: 01/23/2023]
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Abstract
Abstract
Fungal rhinosinusitis (FRS) refers to a spectrum of disease ranging from benign colonization of the nose and sinuses by pathogenic fungi to acute invasive and fatal inflammation extending to the orbit and brain. FRS is classified into two categories: invasive and noninvasive. Invasive FRS may again be subcategorized into acute invasive (fulminant) FRS, granulomatous invasive FRS, and chronic invasive FRS; while noninvasive FRS is subcategorized into localized fungal colonization, sinus fungal ball and eosinophil related FRS (including allergic fungal rhinosinusitis, eosinophilic fungal rhinosinusitis). This classification is not without controversies, and intermediate and semi-invasive forms may also exist in particular patients. Acute invasive FRS is an increasingly common disease worldwide among the immunocompromised patients and caused most frequently by Rhizopus oryzae, and Aspergillus spp. Granulomatous invasive FRS has mostly been reported from Sudan, India, and Pakistan and is characterized by noncaseating granuloma formation, vascular proliferation, vasculitis, perivascular fibrosis, sparse hyphae in tissue, and isolation of A. flavus from sinus contents. Chronic invasive FRS is an emerging entity occurring commonly in diabetics and patients on corticosteroid therapy, and is characterized by dense accumulation of hyphae, occasional presence of vascular invasion, sparse inflammatory reaction, involvement of local structures, and isolation of A. fumigatus. While localized fungal colonization describes the most benign of all fungal sinusitis in the superficial nasal crusts, sinus fungal ball is a dense mycetoma like aggregate of fungal hyphae in diseased sinuses. Common in southern Europe, especially France, majority of them are sterile on culture while 30-50% may yield Aspergillus spp. The definitions and pathogenesis of the group of syndromes in eosinophil related FRS (AFRS, EFRS) are contentious and a matter of intense research among otolaryngologists, pathologists, immunologists and microbiologists. While dematiaceous fungi are the foremost initiators of these syndromes in the west, Aspergillus flavus is the predominant pathogen in India and the Middle-East.
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