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Tovmasyan AS, Shadrin GB, Kolbanova IG, Ramazanov SR, Mosin VV, Filina EV. [Chronic fungal sinusitis caused by Schizophyllum commune]. Vestn Otorinolaringol 2023; 88:89-92. [PMID: 37184561 DOI: 10.17116/otorino20228802189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
Treatment of patients with fungal sinusitis, in some cases, does not lead to complete sinus sanitation, which may be due to insufficient surgical intervention and/or incorrectly selected antimycotic therapy. Treatment of such patients must necessarily include the complete removal of fungal masses from the affected sinus and the further use of antimycotics that ensure complete elimination of the pathogen. A clinical case of chronic fungal operated isolated sphenoiditis caused by the fungus Schizophyllum commune is presented. For extensive drainage of the sphenoid sinus, the patient underwent translamellar sphenoidotomy on the right with further antifungal therapy.
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Affiliation(s)
- A S Tovmasyan
- Sverzhevsky Research Clinical Institute of Otorhinolaryngology, Moscow, Russia
| | - G B Shadrin
- Sverzhevsky Research Clinical Institute of Otorhinolaryngology, Moscow, Russia
| | - I G Kolbanova
- Sverzhevsky Research Clinical Institute of Otorhinolaryngology, Moscow, Russia
| | - S R Ramazanov
- Sverzhevsky Research Clinical Institute of Otorhinolaryngology, Moscow, Russia
| | - V V Mosin
- Sverzhevsky Research Clinical Institute of Otorhinolaryngology, Moscow, Russia
| | - E V Filina
- Sverzhevsky Research Clinical Institute of Otorhinolaryngology, Moscow, Russia
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2
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Li Q, Kong D, Wang Y, Dou Z, Huang W, Hu B, Dong F, Jiang H, Lv Q, Zheng Y, Ren Y, Liu G, Liu P, Jiang Y. Characterization of a rare clinical isolate of A. spinulosporus following a central nervous system infection. Microbes Infect 2022; 24:104973. [DOI: 10.1016/j.micinf.2022.104973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 03/08/2022] [Accepted: 03/23/2022] [Indexed: 10/18/2022]
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3
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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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4
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Alotaibi NH, Omar OA, Altahan M, Alsheikh H, Al Mana F, Mahasin Z, Othman E. Chronic Invasive Fungal Rhinosinusitis in Immunocompetent Patients: A Retrospective Chart Review. Front Surg 2020; 7:608342. [PMID: 33392248 PMCID: PMC7772145 DOI: 10.3389/fsurg.2020.608342] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Accepted: 11/16/2020] [Indexed: 11/13/2022] Open
Abstract
Objective: We report cases of Chronic Invasive Fungal Sinusitis (CIFS) in patients considered as immunocompetent at tertiary care center (King Faisal Specialist Hospital), to analyze their clinical, biological, radiological features, and management. Material and methods: A retrospective chart review of CIFS in immunocompetent patients. The inclusion criteria as the following: immunocompetent patients of any age with histopathological findings of CIFS. Immunocompromised patients, acute Invasive Fungal Sinusitis (IFS), non-invasive fungal rhinosinusitis, and no positive histological findings were excluded. Results: Seventeen (17) patients were included. The species isolated included: Aspergillus (most frequent) & Mucor. Surgical treatment approaches were described. Complications reported include CSF leak, blindness, recurrence, and death. Conclusions: Early diagnosis and management of CIFS improve clinical outcomes.
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Affiliation(s)
- Naif H Alotaibi
- Department of Otolaryngology, Head and Neck Surgery and Communication Sciences, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia.,College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Omar Abu Omar
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Mays Altahan
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Haifa Alsheikh
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Fawziah Al Mana
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Zeyad Mahasin
- Department of Otolaryngology, Head and Neck Surgery and Communication Sciences, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia
| | - Eyas Othman
- Department of Otolaryngology, Head and Neck Surgery and Communication Sciences, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia.,College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
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5
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Abstract
BACKGROUND Allergic fungal rhinosinusitis (AFRS) is a common condition in which sinusitis develops as an IgE-mediated response to common sinonasal fungal organisms. If that response leads to blockage of sinus ostia, bone expansion and erosion by expansive cysts containing dense inspissated debris may occur with the potential for critical neurovascular compression including damage to the anterior visual pathway. METHODS Review of clinical and imaging features of 2 patients who sustained catastrophic clinical outcomes. RESULTS The first patient had pansinusitis with massive mucocele-like cysts expanding the sphenoid sinus and cranial base and causing compression of the anterior visual pathway that led to persistent severe vision loss despite extensive sinus surgery. The second patient developed sphenoethmoidal expansion with a marked inflammatory response and presumed conversion to invasive fungal sinusitis that caused anterior visual pathway vision loss, bilateral ocular motor palsies from extension into the cavernous sinuses, and death from a large middle cerebral artery stroke. CONCLUSIONS Although AFRS is most often benign and treatable, it may rarely produce catastrophic outcomes, especially if the sphenoid sinus is involved. Irreversible vision loss may occur from compression, and ocular motor palsies and death from conversion to invasive fungal disease. Close ophthalmologic and imaging monitoring is necessary in patients with expanded sinuses, and prophylactic sinus surgery may be indicated in certain cases.
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6
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Abstract
Fungal rhinosinusitis (FRS), once considered a rare disease, has seen a steep rise in incidence in recent times. This global rise in the burden of fungal disease is a consequence of an increment in the population with weakened immune systems. Increased life expectancy with rise in conditions like diabetes mellitus, medical advancements with invasive interventions, use of immunosuppressive drugs and chemo-radiotherapy all lead to unique risk situations. The situation becomes more alarming with the fact that there has been a significant rise in cases in immune-competent hosts with no predisposing factors. FRS represents a wide spectrum of disease ranging from the mild form of superficial colonization, allergic manifestations to life threatening extensive invasive disease. The categorization of disease into acute and chronic and invasive or noninvasive is important factor with implications in disease management and prognosis and this has been emphasized greatly in recent years. Diagnosis of FRS has been a challenge as the presenting clinical signs and symptoms and radiographic manifestations are often nonspecific. Definitive diagnosis requires direct fungi identification and hence culture and microscopic examination remain the gold standard. Availability of advanced and rapid diagnostic techniques is rare in majority of developing nations. Therapeutic dilemmas are another aspect of the management of FRS as in spite of the availability of new antifungal drugs, treatment is often empirical due to non-availability of early diagnosis, rapid disease progression and high costs of antifungal drugs. A description of the different types of FRS, their diagnosis and management has been presented in this review.
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Affiliation(s)
- Virendra Singh
- Department of Oral and maxillofacial Surgery, PGIDS, Pt. BD Sharma University of Health Sciences, Rohtak, Haryana 124001 India
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7
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Debbarma S, Gupta R, Patro SK, Gupta AK, Pandhi P, Shafiq N. Randomised Comparison of Safety Profile and Short Term Response of Itraconazole, Voriconazole and Amphotericin B in the Management of Chronic Invasive Fungal Rhinosinusitis. Indian J Otolaryngol Head Neck Surg 2019; 71:2165-2175. [PMID: 31763315 DOI: 10.1007/s12070-019-01602-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Accepted: 01/17/2019] [Indexed: 10/27/2022] Open
Abstract
Chronic invasive fungal rhino sinusitis (CIFS) is a well described clinical entity characterized by mucosal and sub mucosal infiltration of mycotic organisms and angio-centric extension into orbital and intracranial structures. Itraconazole, Voriconazole and Amphotericin B are commonly used for CIFS. In the present study we have evaluated short term clinical response of these drugs. Thirty diagnosed patients of CIFS who presented to us from January 2011 to December 2015 were divided into three groups randomly. Group A, B and C received Itraconazole, Voriconazole and Amphotericin respectively. Visual Analogue scale (VAS), Lund Mackay (LM) radiological scores and Kupferberg's nasal endoscopic grades were seen and compared in all patients before treatment, after primary surgical debridement and biopsy and after post biopsy antifungal drug treatment. We assessed the serum drug levels using HPLC assay at 4 and 8 weeks of therapy and correlated them for efficacy and safety. All the groups had significant improvement after treatment compared to beginning of study. Inter group comparison showed that mean LM, NE and VAS scores were significantly better in Voriconazole group compared to Itraconazole and amphotericin B therapy. The reduction of these objective parameters with treatment was also significantly high in Voriconazole group compared to the other two groups. Voriconazole has shown to be the most effective treatment modality for chronic invasive fungal sinusitis compared to other commonly used drugs such as Itraconazole and Amphotericin B.
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Affiliation(s)
- Santosh Debbarma
- 1Department of Otolaryngology, Head and Neck Surgery, Post Graduate Institute of Medical Education and Research, PGIMER, Sector-12, Chandigarh, India
| | - Rijuneeta Gupta
- 1Department of Otolaryngology, Head and Neck Surgery, Post Graduate Institute of Medical Education and Research, PGIMER, Sector-12, Chandigarh, India
| | - Sourabha K Patro
- 1Department of Otolaryngology, Head and Neck Surgery, Post Graduate Institute of Medical Education and Research, PGIMER, Sector-12, Chandigarh, India.,3Department of Otolaryngology and Head and Neck Surgery, AIIMS, Jodhpur, India
| | - Ashok K Gupta
- 1Department of Otolaryngology, Head and Neck Surgery, Post Graduate Institute of Medical Education and Research, PGIMER, Sector-12, Chandigarh, India
| | - Promila Pandhi
- 2Department of Pharmacology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Nusrat Shafiq
- 2Department of Pharmacology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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8
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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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9
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Ni Mhurchu E, Ospina J, Janjua AS, Shewchuk JR, Vertinsky AT. Fungal Rhinosinusitis: A Radiological Review with Intraoperative Correlation. Can Assoc Radiol J 2017; 68:178-186. [DOI: 10.1016/j.carj.2016.12.009] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Accepted: 12/30/2016] [Indexed: 10/19/2022] Open
Abstract
The interaction between fungi and the sinonasal tract results in a range of clinical presentations with a broad spectrum of clinical severity. The most commonly accepted classification system divides fungal rhinosinusitis into invasive and noninvasive subtypes based on histopathological evidence of tissue invasion by fungi. Invasive fungal rhinosinusitis is subdivided into acute invasive and chronic invasive categories. The chronic invasive category includes a subcategory of chronic granulomatous disease. Noninvasive fungal disease includes localized fungal colonization, fungal ball, and allergic fungal rhinosinusitis. Noninvasive disease is simply fungal material (or the products of the inflammatory reaction of the sinus mucosa) that fills the sinuses but does not invade tissue. Bone loss is related to expansion of the sinus(es). Invasive disease causes tissue destruction, such that it expands past the bony confines of the sinuses. It can rapidly spread, causing acute necrosis. Alternatively, there may be slow tissue invasion characterized by symptoms confused with normal sinusitis, but destruction of normal nasal and paranasal structures.
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Affiliation(s)
- Elaine Ni Mhurchu
- Neuroradiology, University of British Columbia, Vancouver General Hospital, Vancouver, British Columbia, Canada
| | - Javier Ospina
- Otolaryngology - Head & Neck Surgery, University of British Columbia, Vancouver General Hospital and St Paul's Hospital, Vancouver, British Columbia, Canada
| | - Arif S. Janjua
- Otolaryngology - Head & Neck Surgery, University of British Columbia, Vancouver General Hospital and St Paul's Hospital, Vancouver, British Columbia, Canada
| | - Jason R. Shewchuk
- Neuroradiology, University of British Columbia, Vancouver General Hospital, Vancouver, British Columbia, Canada
| | - Alexandra T. Vertinsky
- Neuroradiology, University of British Columbia, Vancouver General Hospital, Vancouver, British Columbia, Canada
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10
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Cho DY, Hoffman KJ, Gill GS, Lim DJ, Skinner D, Mackey C, Rowe SM, Woodworth BA. Protective and antifungal properties of Nanodisk-Amphotericin B over commercially available Amphotericin B. World J Otorhinolaryngol Head Neck Surg 2017; 3:2-8. [PMID: 29204573 PMCID: PMC5683641 DOI: 10.1016/j.wjorl.2017.01.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2017] [Accepted: 01/23/2017] [Indexed: 11/29/2022] Open
Abstract
Objective Amphotericin B (AMB), a potent antifungal agent, has been employed as topical and systemic therapy for sinonasal fungal infections. A novel formulation of nanodisc (ND) containing super aggregated AMB (ND-AMB) for the treatment of fungal infections has been recently developed to provide greater protection from AMB toxicity than current, clinically approved lipid-based formulations. The objective of the current study was to evaluate the safety and potency of ND-AMB for sinonasal delivery using an in vitro model. Methods Human sinonasal tissue was harvested during endoscopic sinus surgery and grown at air–liquid interface until well-differentiated. Cultures were exposed to ND-AMB vs AMB and changes in K+ permeability and resistance were measured and recorded via Ussing chamber assay. Ciliary beat frequency (CBF) was analyzed in parallel as well as cytotoxic assay. Potency was assessed using real-time PCR measurement of the Aspergillus fumigatus 18S rRNA. Results Ussing chamber studies revealed K+ currents that increased rapidly within 30 s of adding AMB (10 μg/mL) to the apical side, indicating apical membranes had become permeable to K+ ions. In contrast, negligible induction of K+ current was obtained following addition of ND-AMB [AMB = (107.7 ± 15.9) μA/cm2 AMB vs ND-AMB = (2.3 ± 0.7) μA/cm2 ND-AMB; P = 0.005]. ND-AMB also protected nasal epithelial cells from cytotoxicity of AMB (P < 0.05). There was no difference in ciliary beat frequency between the two groups (P = 0.96). The expression of A. fumigatus 18S rRNA with exposure of lower dose of ND-AMB was significantly lower compared to that with AMB (P < 0.05). Conclusions Data from the present study suggests ND-AMB protects human nasal epithelia membranes from AMB toxicity by protecting against apical cell K+ permeability while maintaining uncompromised antifungal property compared to AMB. ND-AMB could provide a novel topical therapy for sinonasal fungal diseases.
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Affiliation(s)
- Do-Yeon Cho
- Department of Otolaryngology Head & Neck Surgery, University of Alabama at Birmingham, Birmingham, AL, USA.,Gregory Fleming James Cystic Fibrosis Research Center, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Kyle J Hoffman
- Department of Otolaryngology Head & Neck Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Gobind S Gill
- Department of Otolaryngology Head & Neck Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Dong-Jin Lim
- Department of Otolaryngology Head & Neck Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Daniel Skinner
- Department of Otolaryngology Head & Neck Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Calvin Mackey
- Department of Otolaryngology Head & Neck Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Steven M Rowe
- Gregory Fleming James Cystic Fibrosis Research Center, University of Alabama at Birmingham, Birmingham, AL, USA.,Departments of Medicine, Pediatrics, Cell Developmental and Integrative Biology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Bradford A Woodworth
- Department of Otolaryngology Head & Neck Surgery, University of Alabama at Birmingham, Birmingham, AL, USA.,Gregory Fleming James Cystic Fibrosis Research Center, University of Alabama at Birmingham, Birmingham, AL, USA
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11
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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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12
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Shah SR, Keshri A, Patadia S, Marak RSK, Behari S. Invasive Aspergillosis of Anterior Skull Base in the Immunocompetent Host: Outcomes with a Combined Treatment Modality-An Institutional Experience. J Neurol Surg B Skull Base 2016; 78:89-95. [PMID: 28180049 DOI: 10.1055/s-0036-1585089] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2016] [Accepted: 05/27/2016] [Indexed: 10/21/2022] Open
Abstract
Objectives To study outcomes with voriconazole therapy in immunocompetent individuals following maximal safe endoscopic resection in invasive aspergillosis of the anterior skull base. Design Retrospective study of patients with chronic invasive aspergillosis including symptomatology, extent of disease, and response to voriconazole following maximal safe resection in immunocompetent individuals. Setting Tertiary care superspeciality referral center. Participants Ten consecutive patients of invasive aspergillosis of anterior skull base managed over a period of 2 years. Main Outcome Measures Symptom resolution with systemic voriconazole and radiologic evaluation following systemic antifungals as per predefined protocol. Conclusions Maximal safe resection via transnasal endoscopic route followed by systemic antifungals provides excellent outcomes in invasive skull base aspergillosis. Although liver and renal functions, besides visual acuity, need serial monitoring, voriconazole is well tolerated by our patients.
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Affiliation(s)
- Saurin R Shah
- Department of Neurosurgery, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Amit Keshri
- Department of Neurosurgery, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Simple Patadia
- Department of Neurosurgery, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Rungmei S K Marak
- Department of Microbiology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Sanjay Behari
- Department of Neurosurgery, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
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13
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Wang RX, Zhang JT, Chen Y, Huang XS, Jia WQ, Yu SY. Cerebral aspergillosis: a retrospective analysis of eight cases. Int J Neurosci 2016; 127:339-343. [PMID: 26978276 DOI: 10.3109/00207454.2016.1155573] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Ruo-Xi Wang
- Department of Neurology, General Hospital of the People ’s Liberation Army, Beijing, China
| | - Jia-Tang Zhang
- Department of Neurology, General Hospital of the People ’s Liberation Army, Beijing, China
| | - Yu Chen
- Department of Neurology, General Hospital of the People ’s Liberation Army, Beijing, China
| | - Xu-Sheng Huang
- Department of Neurology, General Hospital of the People ’s Liberation Army, Beijing, China
| | - Wei-Quan Jia
- Department of Neurology, General Hospital of the People ’s Liberation Army, Beijing, China
| | - Sheng-Yuan Yu
- Department of Neurology, General Hospital of the People ’s Liberation Army, Beijing, China
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14
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Maman E, Morin AS, Soussan M, Coignard H, Lortholary O, Fain O. Multifocal bone aspergillosis by Aspergillus terreus in an apparently immunocompetent patient. Presse Med 2015; 44:1064-6. [PMID: 26337362 DOI: 10.1016/j.lpm.2015.07.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Revised: 07/08/2015] [Accepted: 07/16/2015] [Indexed: 10/23/2022] Open
Affiliation(s)
- Esther Maman
- AP-HP, hôpital Jean-Verdier, université Paris 13, service de médecine interne, 93140, Bondy, France
| | - Anne-Sophie Morin
- AP-HP, hôpital Jean-Verdier, université Paris 13, service de médecine interne, 93140, Bondy, France
| | - Michael Soussan
- AP-HP, hôpital Avicenne, université Paris 13, service de médecine nucléaire, 93000 Bobigny, France
| | - Hélène Coignard
- AP-HP, hôpital Necker, université Paris 5, service de maladies infectieuses, 75015 Paris, France
| | - Olivier Lortholary
- AP-HP, hôpital Necker, université Paris 5, service de maladies infectieuses, 75015 Paris, France
| | - Olivier Fain
- AP-HP hôpital Saint-Antoine, DHU i2B, Université Paris 6, service de médecine interne, 75014 Paris, France.
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15
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Dhirawani R, Asrani S, Pathak S, Sharma A. Facial translocation approach for management of invasive sinonasal aspergillosis. J Maxillofac Oral Surg 2015; 14:482-7. [PMID: 25848162 DOI: 10.1007/s12663-014-0691-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2014] [Accepted: 09/10/2014] [Indexed: 10/24/2022] Open
Abstract
Aspergillosis is an uncommon fungal disease seen commonly in paranasal sinuses. It may be of noninvasive variety which is restricted to paranasal sinuses seen in healthy and immunocompetent hosts or may present as invasive form seen in immunocompromised hosts especially in diabetics and patients under long term immunosuppressant therapy. Along with paranasal sinuses invasive forms may encroach upon surrounding adjacent structures involving the orbit and extend intracranially. Orbital and intracranial involvement have a high mortality rate. Early diagnosis of the lesion and prompt aggressive management is important for better prognosis. Aggressive treatment includes surgical debulking and medical management mainly with systemic amphotericin B and other azoles. In orbito-cranial involvement, due to limited access to cranial base, it becomes difficult to surgically debulk the lesion with safety to surrounding important structures. Facial translocation approach gives adequate access to paranasal sinuses, orbit and anterior cranial base. Reported here are two cases of invasive cranio-orbito-nasal aspergillosis treated with facial translocation approach.
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Affiliation(s)
- Rajesh Dhirawani
- Department of Oral and Maxillofacial Surgery, Hitkarini Dental College & Hospital, Jabalpur, 482001 Madhya Pradesh India
| | - Sumit Asrani
- Department of Oral and Maxillofacial Surgery, Hitkarini Dental College & Hospital, Jabalpur, 482001 Madhya Pradesh India
| | - Sanyog Pathak
- Department of Oral and Maxillofacial Surgery, Hitkarini Dental College & Hospital, Jabalpur, 482001 Madhya Pradesh India
| | - Ankit Sharma
- Department of Oral and Maxillofacial Surgery, Hitkarini Dental College & Hospital, Jabalpur, 482001 Madhya Pradesh India
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Fukui I, Hayashi Y, Kita D, Nakanishi S, Tachibana O. Aspergillus Sphenoiditis Associated with an Artificial Bone Graft Used for Transsphenoidal Surgery. NMC Case Rep J 2015; 2:68-71. [PMID: 28663968 PMCID: PMC5364913 DOI: 10.2176/nmccrj.2014-0187] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2014] [Accepted: 10/28/2014] [Indexed: 11/23/2022] Open
Abstract
Cerebrospinal fluid (CSF) leakage is a major complication during and after transsphenoidal surgery (TSS) for intra- and suprasellar tumors. To prevent postoperative CSF leakage, various surgical techniques have been used, including sellar floor reconstruction with artificial bone grafts. However, some authors have recently reported infections associated with artificial bone grafts. Most cases are associated with bacterial infection, and fungal infection is extremely rare. We present the case of a 53-year-old woman with sphenoiditis caused by Aspergillus infection that developed 8 years after TSS and following local radiation therapy for a non-functioning pituitary adenoma. An artificial bone graft prepared from polymethylmethacrylate was used for sellar floor reconstruction. The patient presented to our department with a complaint of bloody nasal discharge. Magnetic resonance imaging showed that a fungal lump had formed around the bone graft, which had broken into two pieces and dropped out into the sphenoid sinus, without tumor recurrence. Histological examination of an endoscopic biopsy specimen led to a diagnosis of aspergillosis. Subsequent complete removal of both the bone graft and fungal lump resulted in a good postoperative outcome. Although fungal infection is an extremely rare complication after TSS using artificial bone grafts, it should be diagnosed as early as possible, and removal of both the fungal lump and the bone graft should be performed in a timely manner after clinical and radiological confirmation.
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Affiliation(s)
- Issei Fukui
- Department of Neurosurgery, Graduate School of Medical Science, Kanazawa University, Kanazawa, Ishikawa
| | - Yasuhiko Hayashi
- Department of Neurosurgery, Graduate School of Medical Science, Kanazawa University, Kanazawa, Ishikawa
| | - Daisuke Kita
- Department of Neurosurgery, Graduate School of Medical Science, Kanazawa University, Kanazawa, Ishikawa
| | - Sayaka Nakanishi
- Department of Otolaryngology, Graduate School of Medical Science, Kanazawa University, Kanazawa, Ishikawa
| | - Osamu Tachibana
- Department of Neurosurgery, Kanazawa Medical University, Kanazawa, Ishikawa
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Fukui I, Hayashi Y, Kita D, Nakanishi S, Tachibana O. Aspergillus Sphenoiditis Associated with an Artificial Bone Graft Used for Transsphenoidal Surgery. NMC Case Rep J 2015. [DOI: 10.2176/nmccrj.cr.2014-0187] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Issei Fukui
- Department of Neurosurgery, Graduate School of Medical Science, Kanazawa University
| | - Yasuhiko Hayashi
- Department of Neurosurgery, Graduate School of Medical Science, Kanazawa University
| | - Daisuke Kita
- Department of Neurosurgery, Graduate School of Medical Science, Kanazawa University
| | - Sayaka Nakanishi
- Department of Otolaryngology, Graduate School of Medical Science, Kanazawa University
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Srivastava RM, Rijuneeta, Gupta AK, Patro SK, Avasthi A. Quality of life, disability scores, and distress index in fungal rhinosinusitis. Med Mycol 2014; 52:706-14. [PMID: 25031427 DOI: 10.1093/mmy/myu037] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Our goal was to determine quality of life (QOL), disability, and distress in the day-to-day lives of patients suffering from fungal rhinosinusitis (FRS) based on a prospective questionnaire. The study included 125 patients suffering from FRS, excluding those with acute fulminant FRS and any other comorbid illness. The data were compared with data for 50 age- and sex-matched controls who did not have any other chronic illness and obtained outpatient services from the Department of Otolaryngology and Head and Neck Surgery of our institute. Analysis showed that patients with FRS had worse QOL, with an average score of 87.34 compared with 94.15 for the control group. QOL score further decreased to 85.31 for patients with extensive disease that included intracranial or intraorbital extension and to 71.1 in those with recurrent disease. Patients showed significant disability and had decreased work efficiency in disability parameters. Distress among these patients was also greater and further increased in those with extensive disease or recurrence. We conclude that patients with FRS have worse QOL, more disability, and more distress compared with age- and sex-matched controls. This issue needs to be addressed while treating cases of FRS.
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Affiliation(s)
- Rishi Mani Srivastava
- Department of Otolaryngology, Head and Neck Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Rijuneeta
- Department of Otolaryngology, Head and Neck Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Ashok K Gupta
- Department of Otolaryngology, Head and Neck Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Sourabha K Patro
- Department of Otolaryngology, Head and Neck Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Ajit Avasthi
- Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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El Naderi S, Rodriguez C, Devars Du Mayne M, Badoual C. Une rhinosinusite fongique invasive chez un patient immunocompétent. Ann Pathol 2013; 33:410-3. [DOI: 10.1016/j.annpat.2013.10.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2013] [Revised: 09/18/2013] [Accepted: 10/01/2013] [Indexed: 11/28/2022]
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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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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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Abir B, Abouchadi A, Hamama J, Oukabli M, Nassih M, Rzin A. [Invasive aspergillosis of the maxillary sinus in an immunocompetent patient]. ACTA ACUST UNITED AC 2012; 113:127-30. [PMID: 22285744 DOI: 10.1016/j.stomax.2011.12.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2010] [Revised: 06/06/2011] [Accepted: 12/23/2011] [Indexed: 10/14/2022]
Abstract
INTRODUCTION Invasive aspergillosis of the maxillary sinus is a severe infection most commonly observed in immunocompromised patients. We report a pseudo-tumoral presentation of invasive aspergillosis of the maxillary sinus, in immunocompetent adult. CASE REPORT A 70-year-old female patient consulted for chronic rhino-sinusitis resistant to medical treatment. Computed tomography scan revealed a hyperdense mass filling the left maxillary antrum, with erosion of sinus walls. The ethmoidal and right frontal sinuses were involved. The histological and mycological examination of the surgical resection confirmed the diagnosis of invasive aspergillosis. The patient was given voriconazole as first line treatment. The outcome was good at 18 months. DISCUSSION Invasive aspergillosis of the maxillary sinus is a rare disease, usually observed in immunodepressed patients. It is very rarely observed in immunocompetent patients.
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Affiliation(s)
- B Abir
- Service de chirurgie plastique et stomatologie, hôpital militaire d'instruction Mohamed-V, Rabat, Maroc.
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Mehta R, Panda NK, Mohindra S, Chakrabarti A, Singh P. Comparison of efficacy of amphotericin B and itraconazole in chronic invasive fungal sinusitis. Indian J Otolaryngol Head Neck Surg 2012; 65:288-94. [PMID: 24427663 DOI: 10.1007/s12070-011-0444-y] [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: 07/12/2010] [Accepted: 12/26/2011] [Indexed: 10/14/2022] Open
Abstract
Management of invasive fungal sinusitis includes both surgery and antifungal chemotherapy. To compare the efficacy of amphotericin B and itraconazole used alone in the management of chronic invasive fungal sinusitis. A prospective randomized unblinded study was conducted in the Department of Otolaryngology, Postgraduate Institute of Medical Education and Research, Chandigarh, India during December 2006 to June 2008. 26 immunocompetent patients were randomly divided into two groups-group A-received amphotericin B and group I-received itraconazole in conventional doses. The response to treatment was judged on the basis of symptomatic and radiologic resolution. Seven patients had complete cure (5/16-gr I; 2/10-gr A); Eleven patients had persistent disease (7/16-group-I; 4/10 in group A); four relapses were noted (3/16 in group I and 1/10 in group A); 3 deaths occurred; one patient was lost to follow up. Relative risk analysis did not show any statistically significant difference between the two drugs as regards their efficacy. Itraconazole and amphotericin B both have been found to be equally efficacious in the management of invasive fungal sinusitis. Itraconazole however, has fewer side effects compared to amphotericin B.
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Affiliation(s)
- Rupa Mehta
- Department of Otorhinolaryngology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012 India
| | - Naresh K Panda
- Department of Otorhinolaryngology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012 India
| | - Satyawati Mohindra
- Department of Otorhinolaryngology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012 India
| | - Arunaloke Chakrabarti
- Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012 India
| | - Paramjeet Singh
- Department of Radio Diagnosis, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012 India
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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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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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Decanini-Mancera A, Lessell S, Lee MS, Subramanian PS. Syphilis and the monk. Surv Ophthalmol 2010; 56:267-73. [PMID: 21056446 DOI: 10.1016/j.survophthal.2010.08.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2010] [Revised: 08/04/2010] [Accepted: 08/10/2010] [Indexed: 11/18/2022]
Abstract
Primary orbital aspergillus infection may occur in immunocompetent individuals. It frequently represents a diagnostic challenge for clinicians due to nonspecific clinical presentations and neuroimaging signs. We present a 47-year-old otherwise healthy man with an isolated unilateral optic neuropathy secondary to primary orbital aspergillosis. He had a remote history of tuberculosis and positive syphilis serologies. After he worsened despite intravenous penicillin therapy, a biopsy showed chronic inflammation. Corticosteroids treatment was followed by further deterioration of his clinical condition. Finally, a repeat biopsy revealed the aspergillus infection. Despite antifungal therapy, the outcome was unfavorable. A high index of suspicion should result in aggressive diagnostic testing and prompt institution of antifungal therapy in patients with primary orbital aspergillosis.
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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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Li CH, Lay CJ, Ho YH, Wang LS, Wang CL, Tsai CC. Successful Treatment of Two Cases of Invasive Aspergillus Sinusitis With Voriconazole. Tzu Chi Med J 2010. [DOI: 10.1016/s1016-3190(10)60050-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Ilie M, Hofman V, Butori C, Lassalle S, Hofman P. [Pathologic findings and main aetiologies of rhinosinusal infections]. Ann Pathol 2009; 29:313-22. [PMID: 19900636 DOI: 10.1016/j.annpat.2009.07.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2009] [Accepted: 07/22/2009] [Indexed: 12/17/2022]
Abstract
A large variety of infectious diseases may involve the rhinosinusal tract. They include bacterial, viral, fungal, and parasite infections. These infections can induce an acute and/or a chronic inflammatory reaction. They can develop both in immunocompetent or in immunodeficient patients. Clinically, the consequences of these infections are variable, but a few of them have to be rapidly diagnosed for an immediate specific treatment. This article describes the pathologic features of a variety of infectious diseases that surgical pathologists may encounter in analysis of biopsy specimens taken from the rhinosinusal tract.
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Affiliation(s)
- Marius Ilie
- Laboratoire de pathologie clinique et expérimentale, hôpital Pasteur, 30, avenue de la Voie-Romaine, BP 69, 06002 Nice cedex 01, France
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Atypical Aspergillus flavus isolates associated with chronic azole therapy. J Clin Microbiol 2009; 47:3372-5. [PMID: 19656977 DOI: 10.1128/jcm.00671-09] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
A case of chronic sinus disease due to morphologically atypical Aspergillus flavus is described. Multiple fungal isolates sporulated poorly or not at all, displaying unusual color and microscopic morphology, including the absence of typical vesicles and phialides, which caused the isolates to resemble several other fungal genera superficially. The patient received multiple antifungal therapies over at least 10 years with various azole drugs, including voriconazole, itraconazole, and posaconazole. We speculate that this lengthy exposure to azole antifungal drugs may have caused or promoted the atypical morphology seen in these isolates.
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Nakaya K, Oshima T, Kudo T, Aoyagi I, Katori Y, Ota J, Hidaka H, Oda K, Kobayashi T. New treatment for invasive fungal sinusitis: three cases of chronic invasive fungal sinusitis treated with surgery and voriconazole. Auris Nasus Larynx 2009; 37:244-9. [PMID: 19553042 DOI: 10.1016/j.anl.2009.05.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2009] [Revised: 04/21/2009] [Accepted: 05/19/2009] [Indexed: 10/20/2022]
Abstract
Invasive fungal sinusitis is a relatively rare disease and can be divided into acute fulminant, chronic, and granulomatous invasive fungal sinusitis. The conventional treatment is radical surgery combined with systemic amphotericin B administration, but the poor prognosis and unestablished treatment options require a better therapeutic strategy. We report three cases of chronic invasive fungal sinusitis successfully treated with a combination of surgery and voriconazole, a new antifungal agent, with good responses in all patients. Voriconazole administration could form the basis for a new standard treatment for invasive fungal sinusitis.
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Affiliation(s)
- Kazuhiro Nakaya
- Department of Otolaryngology-Head and Neck Surgery, Tohoku University Graduate School of Medicine, 1-1 Seiryo-cho, Aoba-ku, Sendai, Miyagi, Japan.
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Srinivasan US. Intracranial Aspergilloma in Immunocompetent Patients Successfully Treated with Radical Surgical Intervention and Antifungal Therapy – Case Series. ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 2008. [DOI: 10.47102/annals-acadmedsg.v37n9p783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
Introduction: Aspergillosis of the central nervous system is an uncommon infection, mainly occurring in immunocompromised patients with a high mortality. Surgical excision of the intracranial lesion combined with oral voriconazole has been proposed to improve the outcome in immunocompromised patients. Itraconazole has been considered not to be effective because of poor penetration into the brain tissue. We report the long-term outcome of 3 cases of intracranial aspergilloma in immunocompetent patients who were successfully treated with radical surgery combined with oral itraconazole.
Materials and Methods: This is a retrospective study in which chronic invasive intracranial aspergilloma was successfully treated in 3 apparently immunocompetent patients and followed-up for more than 5 years.
Results: Near complete or radical surgical removal of this localised chronic invasive intracranial aspergilloma whenever possible is the definitive treatment. When combined with the oral antifungal drug itraconazole, the management regimen is effective in achieving near complete long-term cure of more than 5 years. Oral itraconazole 200 mg twice daily should be given for a prolonged period of at least 6 months.
Conclusion: In chronic invasive intracranial aspergilloma in an immunocompetent patient, it was suggested that radical excision of the intracranial aspergilloma combined with oral antifungal drug belonging to triazole group that can be either itraconazole or voriconazole given for a period of 6 months was likely to improve the long-term outcome.
Key words: Central nervous system aspergillosis, Aspergilloma, Itraconazole, Voriconazole
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Nakanishi W, Fujishiro Y, Nishimura S, Fukaya T. Clinical significance of (1-->3)-beta-d-glucan in a patient with invasive sino-orbital aspergillosis. Auris Nasus Larynx 2008; 36:224-7. [PMID: 18650040 DOI: 10.1016/j.anl.2008.05.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2008] [Revised: 04/16/2008] [Accepted: 05/08/2008] [Indexed: 10/21/2022]
Abstract
OBJECTIVES The usefulness of BG as a marker has been reported in patients with pulmonary aspergillosis. However, no data have demonstrated the behavior of BG in sino-orbital IA. We encountered a case of sino-orbital IA and demonstrated changes in the BG level, radiological images, and pathological features. METHOD AND RESULTS A 63-year-old Japanese woman suffered from invasive sino-orbital aspergillosis. The serum BG level measured immediately before surgery was 37.2pg/mL (normal value <3.4pg/mL). Endoscopic sinus surgery revealed some necrotic tissue extending from the ethmoid sinus to the orbit. The infiltrating Aspergillus was revealed in the pathological examination. The BG level decreased to the normal value. However, CT revealed a high-density area; this may indicate that an aspergillosis lesion remained slightly in the orbit. CONCLUSION (1-->3)-beta-d-Glucan (BG) is a useful marker for diagnosing Aspergillus and evaluating the therapeutic effect of the treatment administered.
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Affiliation(s)
- Wakako Nakanishi
- Department of Otolaryngology, Tokyo Metropolitan Police Hospital, Japan.
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Akhaddar A, Gazzaz M, Albouzidi A, Lmimouni B, Elmostarchid B, Boucetta M. Invasive Aspergillus terreus sinusitis with orbitocranial extension: case report. SURGICAL NEUROLOGY 2008; 69:490-5; discussion 495. [PMID: 18262257 DOI: 10.1016/j.surneu.2007.02.059] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/25/2007] [Accepted: 02/24/2007] [Indexed: 11/16/2022]
Abstract
BACKGROUND Aspergillosis of the paranasal sinuses is infrequent and usually involves the species Aspergillus fumigatus and A. flavus. The maxillary sinus is the most common sinus to be affected. Invasive cranio-orbital aspergillosis originating in the sphenoid sinus is rare and mostly occurs in immunocompromised patients with poor outcomes. We present a case of invasive A. terreus sphenoidal sinusitis with intraorbital and intracranial extension in an immunocompetent patient. CASE DESCRIPTION This 62-year-old man presented with a 2-month history of left retroorbital pain followed by rapid decreasing vision and 2 episodes of epistaxis. Ophthalmologic examination revealed no light perception left. Computed tomographic scan and MR images demonstrated an enhanced sphenoid lesion within the left sphenoid sinus with bone destruction and intraorbital and cavernous sinus extensions. A malignant tumor was suspected. The patient underwent a transphenoidal biopsy of the sphenoid mass. Histologic analysis revealed numerous Aspergillus hyphea, and the species A. terreus was isolated from fungal cultures of specimens. No systemic fungal infection was found, and the patient had no evidence of immunosuppression. After 3 months' administration of oral voriconazole, the patient became well, and the orbitocranial mass regressed in size. It was stabilized on the ninth postoperative month. CONCLUSION A. terreus sinusitis with orbitocranial extension had never been reported in the literature. Even in an immunocompetent host, ISOA is difficult to eradicate using surgical debridement combined with optimal antifungal agents because of the intracranial extension and the relative resistance of conventional antifungal therapy. Early diagnosis is important to prevent an unfavorable outcome of this emergent infection.
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Affiliation(s)
- Ali Akhaddar
- Department of Neurosurgery, Mohammed V Military Hospital, Rabat, Morocco.
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Walsh TJ, Anaissie EJ, Denning DW, Herbrecht R, Kontoyiannis DP, Marr KA, Morrison VA, Segal BH, Steinbach WJ, Stevens DA, van Burik JA, Wingard JR, Patterson TF. Treatment of aspergillosis: clinical practice guidelines of the Infectious Diseases Society of America. Clin Infect Dis 2008; 46:327-60. [PMID: 18177225 DOI: 10.1086/525258] [Citation(s) in RCA: 1834] [Impact Index Per Article: 114.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Affiliation(s)
- Thomas J Walsh
- Pediatric Oncology Branch, National Cancer Institute, Bethesda, Maryland, USA
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Walsh T, Anaissie E, Denning D, Herbrecht R, Kontoyiannis D, Marr K, Morrison V, Segal B, Steinbach W, Stevens D, van Burik J, Wingard J, Patterson Y. Tratamiento de la Aspergilosis: Guías para la práctica clínica de la Sociedad de Enfermedades Infecciosas de los Estados Unidos de América (IDSA). Clin Infect Dis 2008. [DOI: 10.1086/590225] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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38
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Subramanian S, Kandpal H, Sharma R, Pushkar N, Sen S, Gamanagatti S, Vashist S. Invasive sinus aspergillosis with perineural spread in an immunocompetent patient. ACTA ACUST UNITED AC 2008; 51 Suppl:B189-92. [PMID: 17991060 DOI: 10.1111/j.1440-1673.2007.01838.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Invasive aspergillosis of paranasal sinuses is usually seen in immunocompromised patients and is associated with a very high mortality rate. The disease is distinctly uncommon in immunocompetent patients. A rare case of invasive aspergillosis of paranasal sinus and orbit with intracranial extradural extension via perineural spread along the maxillary division of the trigeminal nerve in an immunocompetent patient is presented.
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39
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Götze G, Bloching M, Hainz M, Knipping S. [Invasive aspergillosis of the skull base with orbit infiltration]. HNO 2007; 55:560-3. [PMID: 16625369 DOI: 10.1007/s00106-006-1407-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND [corrected] Aspergillosis of the paranasal sinuses is subdivided into noninvasive and invasive types, depending on invasion of the tissue. The invasive form often occurs in immunodeficient patients and can be divided further into granulomatous, chronic invasive, and acute fulminating forms. CASE REPORT We report the clinical course of an immunosuppressed 64-year-old male with invasive aspergillosis originating from the sphenoid sinus with infiltration of the orbit and intracranial extension into the cavernous sinus. The patient was referred to our hospital with loss of vision, ptosis, and ophthalmoplegia of 3-month duration. Additionally he suffered from diabetes mellitus II and kidney failure after kidney transplantation. After CT scanning, endonasal sinus debridement and decompression of the orbit were carried out immediately. Histology revealed invasive aspergillosis. Postoperatively, both systemic and local antimycotic therapy and antibiotic treatment were performed. According to recommendations of the Undersea and Hyperbaric Medicine Society, cerebral abscess is a certain indication of hyperbaric oxygenation. We decided to attempt therapy for that as well. The patient died 3 weeks after surgical intervention due to carotid dissection. CONCLUSION Invasive aspergillosis of the paranasal sinuses and the skull base of immunsuppressed patients is usually lethal because of intracranial complications. Therefore, fast diagnosis using CT and MRI and surgical and antimycotic therapy are necessary.
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Affiliation(s)
- G Götze
- Universitätsklinik und Poliklinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Medizinische Fakultät der Martin-Luther-Universität Halle-Wittenberg, Halle, Germany
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40
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Fric E, Rehak M, Vlckova I, Rehak J. Plötzlich aufgetretener einseitiger Sehverlust. Ophthalmologe 2007; 104:716-8. [PMID: 16977341 DOI: 10.1007/s00347-006-1424-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- E Fric
- Universitätsaugenklinik, I.P. Pavlova 6, 775 20, Olomouc, Tschechien.
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41
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Ghadiali MT, Deckard NA, Farooq U, Astor F, Robinson P, Casiano RR. Frozen-section biopsy analysis for acute invasive fungal rhinosinusitis. Otolaryngol Head Neck Surg 2007; 136:714-9. [PMID: 17478203 DOI: 10.1016/j.otohns.2007.01.002] [Citation(s) in RCA: 73] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2006] [Accepted: 01/02/2007] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To evaluate sensitivity and specificity of frozen-section biopsy in the diagnosis of acute invasive fungal rhinosinusitis (AIFRS). STUDY DESIGN AND SETTING Retrospective chart review of all patients treated for AIFRS at the University of Miami between 1993 and 2005. Twenty patients with the clinical diagnosis of AIFRS were identified. Histopathological data were collected to evaluate the use of frozen-section biopsy to diagnose the disease. RESULTS Permanent pathology sections were positive for AIFRS in all specimens. Frozen-section biopsies were positive for fungal features in all but five cases (four with Mucor and one with Aspergillus). High positive predictive values were found for both fungal types and for both sets of patients (bedside and intraoperative). CONCLUSION Frozen-section biopsy is a useful tool for rapid and effective diagnosis in patients with suspected AIFRS. A positive frozen-section result is highly predictive of invasive disease and merits prompt surgical intervention.
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Affiliation(s)
- Murtaza T Ghadiali
- University of Miami/Jackson Memorial Hospital, Department of Otolaryngology/Head and Neck Surgery, Miami, FL 33136, USA.
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42
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Knipping S, Holzhausen HJ, Koesling S, Bloching M. Invasive aspergillosis of the paranasal sinuses and the skull base. Eur Arch Otorhinolaryngol 2007; 264:1163-9. [PMID: 17534639 DOI: 10.1007/s00405-007-0336-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2006] [Accepted: 05/01/2007] [Indexed: 11/24/2022]
Abstract
Invasive aspergillosis (IA) originating from the paranasal sinuses can cause an intracranial growth mainly along the skull base and larger vessels. This study reports our experience in the diagnosis and treatment of a series of patients with IA. A retrospective chart review of four patients with chronic invasive intracranial aspergillosis was performed. Clinical signs, physical examinations, radiographs, histological samples, and outcome were demonstrated. The patients demonstrated different symptoms like exophthalmus, ophthalmoplegia, loss of vision, and hypaesthesia of the ophthalmic and maxillary nerve. Computed tomography and MRI revealed extensive sino-orbital and skull base lesions. The patients were treated with aggressive endonasal debridement, intravenous antifungal agents and daily irrigations with antimycotic suspensions. Furthermore, we applied hyperbaric oxygenation. Two patients died from complications due to subarachnoidal hemorrhage and accompanied complications respectively. Despite the high mortality rate patients with an invasive aspergillosis can be effectively treated in some cases by an early and rigorous treatment schedule using all surgical and conservative therapeutic options.
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Affiliation(s)
- Stephan Knipping
- Department of Otorhinolaryngology Head and Neck Surgery, Martin Luther University Halle-Wittenberg, Magdeburger Str 12, Halle/Saale, Germany.
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43
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Baumann A, Zimmerli S, Hausler R, Caversaccio M. Invasive sphenoidal aspergillosis: successful treatment with sphenoidotomy and voriconazole. ORL J Otorhinolaryngol Relat Spec 2006; 69:121-6. [PMID: 17159376 DOI: 10.1159/000097858] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2006] [Accepted: 04/12/2006] [Indexed: 12/23/2022]
Abstract
Treatment of invasive sphenoidal aspergillosis is surgical, followed by antifungal therapy, mostly amphotericin B. To optimize the adjuvant antifungal treatment, which is often limited by severe side effects, the new triazole antifungal agent voriconazole with broad coverage of fungal pathogens including Aspergillus was investigated in a study of 4 patients with clinical, radiological and histological signs of invasive sphenoidal aspergillosis. They first underwent endoscopic sphenoidotomy with drainage and extraction of the fungal mass. Postoperatively, 2 patients were immediately treated with voriconazole. Two patients initially received amphotericin B; but this treatment had to be stopped because of acute renal toxicity. Finally, all patients were treated orally with 200 mg voriconazole twice a day for 12-14 weeks. After this combined treatment all patients were asymptomatic and there were no endoscopic or radiological signs of residual fungal disease. The only side effects were nausea in one and transient visual disturbances in 2 other patients. In the 4 patients presented and treated, voriconazole was shown to be effective and less toxic than amphotericin B in adjuvant treatment of invasive sphenoidal aspergillosis.
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Affiliation(s)
- Ariane Baumann
- Department of ENT, Head and Neck Surgery, University Hospital, Inselspital, Berne, Switzerland
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44
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Chopra H, Dua K, Malhotra V, Gupta RP, Puri H. Invasive fungal sinusitis of isolated sphenoid sinus in immunocompetent subjects. Mycoses 2006; 49:30-6. [PMID: 16367816 DOI: 10.1111/j.1439-0507.2005.01170.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Invasive fungal sinusitis of the paranasal sinuses in a healthy immunocompetent person is uncommon. Isolated involvement of any paranasal sinus, particularly sphenoid sinus is rare. In this study, five immunocompetent patients who had no nasal complaints but obscure symptoms of headache and orbital symptoms such as diplopia, retro-orbital pain and loss of vision were diagnosed to be having fulminant fungal sinusitis of the sphenoid sinus. Three patients had aspergillosis and two patients had mucormycosis. These patients initially presented to neurologists and ophthalmologists because they had no ENT complaints. The diagnosis was made on endoscopy, radiology and histopathology. They were treated aggressively according to the standard protocols. The purpose of this paper is to bring to light the changing clinical spectrum of invasive fungal sinusitis. It can occur in immunocompetent patients and in the form of isolated sphenoid sinus involvement.
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45
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Hope WW, Walsh TJ, Denning DW. The invasive and saprophytic syndromes due to Aspergillus spp. Med Mycol 2005; 43 Suppl 1:S207-38. [PMID: 16110814 DOI: 10.1080/13693780400025179] [Citation(s) in RCA: 141] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
Aspergillus spp. produce a wide range of invasive and sapropytic syndromes which may involve any tissue. Within a given tissue or organ the pathology and pathogenesis varies enormously, ranging from angioinvasive disease to noninvasive saprophytic disease. The individual invasive and saprophytic syndromes in which a causative role can be attributed to Aspergillus spp. are detailed specifically with reference to the underlying pathology and pathogenesis, the clinical setting and features, and the manner in which a diagnosis can be established.
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Affiliation(s)
- W W Hope
- University of Manchester and Wythenshawe Hospital, Manchester UK
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46
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Wenzel S, Sagowski C, Kehrl W, Metternich FU. [Course and therapy of an invasive aspergilloma of the skull base in a non-immunocompromised patient]. HNO 2005; 52:724-8. [PMID: 15309253 DOI: 10.1007/s00106-003-0949-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Fulminant-invasive sinus aspergillosis affects immunocompromised patients and is usually lethal because of intracranial complications. Chronic-invasive and non-invasive types occur in non-immunocompromised patients. In these cases, intracranial extension is possible and life-threatening. The effective management of sinus aspergillosis requires early diagnosis by CT and histological classification, surgery, and if necessary, chemotherapy or steroids in case of allergy. Here we report a successfully treated case in a 29-year-old non-immunocompromised patient with chronic-invasive sinus aspergillosis. He presented a recurrent sphenoid sinus aspergillosis with destruction of the clivus and ophthalmoplegia. Diagnostic and therapeutic procedures are described.
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Affiliation(s)
- S Wenzel
- Klinik und Poliklinik für Hals-, Nasen- und Ohrenheilkunde des Universitätsklinikum Hamburg-Eppendorf.
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Abstract
Fungi may infect the cornea, orbit and other ocular structures. Species of Fusarium, Aspergillus, Candida, dematiaceous fungi, and Scedosporium predominate. Diagnosis is aided by recognition of typical clinical features and by direct microscopic detection of fungi in scrapes, biopsy specimens, and other samples. Culture confirms the diagnosis. Histopathological, immunohistochemical, or DNA-based tests may also be needed. Pathogenesis involves agent (invasiveness, toxigenicity) and host factors. Specific antifungal therapy is instituted as soon as the diagnosis is made. Amphotericin B by various routes is the mainstay of treatment for life-threatening and severe ophthalmic mycoses. Topical natamycin is usually the first choice for filamentous fungal keratitis, and topical amphotericin B is the first choice for yeast keratitis. Increasingly, the triazoles itraconazole and fluconazole are being evaluated as therapeutic options in ophthalmic mycoses. Medical therapy alone does not usually suffice for invasive fungal orbital infections, scleritis, and keratitis due to Fusarium spp., Lasiodiplodia theobromae, and Pythium insidiosum. Surgical debridement is essential in orbital infections, while various surgical procedures may be required for other infections not responding to medical therapy. Corticosteroids are contraindicated in most ophthalmic mycoses; therefore, other methods are being sought to control inflammatory tissue damage. Fungal infections following ophthalmic surgical procedures, in patients with AIDS, and due to use of various ocular biomaterials are unique subsets of ophthalmic mycoses. Future research needs to focus on the development of rapid, species-specific diagnostic aids, broad-spectrum fungicidal compounds that are active by various routes, and therapeutic modalities which curtail the harmful effects of fungus- and host tissue-derived factors.
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Affiliation(s)
- Philip A Thomas
- Department of Ocular Microbiology, Institute of Ophthalmology, Joseph Eye Hospital, Tiruchirapalli 620001, India.
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Lujber L, Gerlinger I, Kuncz Á, Pytel J. Combination therapy for chronic invasive rhinocerebral aspergillosis in a clinically immunocompetent patient. CURRENT THERAPEUTIC RESEARCH 2003; 64:473-83. [PMID: 24944397 PMCID: PMC4053017 DOI: 10.1016/s0011-393x(03)00111-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/30/2003] [Indexed: 11/28/2022]
Abstract
BACKGROUND Adequate therapy for chronic invasive rhinocerebral aspergillosis in immunocompetent patients is controversial. The incidence of the disease is high in the Sudan and the Middle East. Misinterpretation of diagnostic criteria, failure to verify tissue invasion of fungi, and a lack of understanding of the pathophysiology of various forms of fungal rhinosinusitis lead to controversies in nomenclature, diagnosis, and therapy. OBJECTIVE The aim of this report was to detail the clinical presentation and the endoscopic and imaging study findings of a patient with invasive Aspergillus rhinosinusitis with endocranial and orbital extension. This patient was treated with surgical débridement and a combination of antifungal drugs and immunomodulatory therapy. METHODS Endoscopic débridement and high-dose liposomal amphotericin B, in combination with flucytosine and immunomodulators, were used to treat this patient. RESULTS After treatment, the patient experienced 3 years of disease-free follow-up. CONCLUSION Surgical débridement and high-dose systemic combined antifungal therapy with immunomodulatory drugs produced an excellent long-term result for this apparently immunocompetent patient with extensive invasive fungal rhinosinusitis with cerebral and orbital involvement.
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Affiliation(s)
- László Lujber
- Faculty of Medicine, Department of Otorhinolaryngology, Pécs University, Pécs, Hungary
- Tawam Hospital, Abu Dhabi, United Arab Emirates
| | - Imre Gerlinger
- Department of Otolaryngology, Head and Neck Surgery, University of Nottingham, Queens Medical Centre, Nottingham, United Kingdom, and
| | - Ádám Kuncz
- Tawam Hospital, Abu Dhabi, United Arab Emirates
- Faculty of Medicine, Department of Neurosurgery, Szeged University, Szeged, Hungary
| | - József Pytel
- Faculty of Medicine, Department of Otorhinolaryngology, Pécs University, Pécs, Hungary
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49
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Nenoff P, Kellermann S, Horn LC, Keiner S, Bootz F, Schneider S, Haustein UF. Case report. Mycotic arteritis due to Aspergillus fumigatus in a diabetic with retrobulbar aspergillosis and mycotic meningitis. Mycoses 2001; 44:407-14. [PMID: 11766108 DOI: 10.1046/j.1439-0507.2001.00687.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
A 74-year-old man with diabetes mellitus type II, retinopathy and polyneuropathy suffered from exophthalmus, ptosis and diplopia. Magnetic resonance imaging and computer tomography showed a space-occupying process in the right orbital apex. An extranasal ethmoidectomy accompanied by an orbitotomia revealed the presence of septated hyphae. Aspergillus fumigatus was grown from the tissue. After surgical removal of the fungal masses, therapy with amphotericin B (1 mg kg(-1) body weight) plus itraconazole (Sempera, 200 mg per day) over 6 weeks was initiated. Five months later the patient's condition deteriorated again, with vomiting, nausea and pain behind the right eye plus increasing exophthalmus. Antifungal therapy was started again with amphotericin B and 5-fluorocytosine. Neutropenia did not occur. The patient became somnolent and deteriorated, a meningitis was suggested. Aspergillus antigen (titre 1:2, Pastorex) was detected in liquor. Anti-Aspergillus antibodies were not detectable. Both the right eye and retrobulbar fungal masses were eradicated by means of an exenteratio bulbi et orbitae. However, renal insufficiency and an apallic syndrome developed and the patient died. At autopsy, a mycotic aneurysm of the arteria carotis interna dextra was detected. The mycotic vasculitis of this aneurysm had caused a rupture of the blood vessel followed by a massive subarachnoidal haemorrhage. In addition, severe mycotic sphenoidal sinusitis and aspergillosis of the right orbit were seen, which had led to a bifrontal meningitis.
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50
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Abstract
To introduce the general mycologic aspects of fungal rhinosinusitis, this article reviews, in brief, the biology of fungi and the principles of fungal pathogenesis. A glossary of frequently used mycologic terms is provided. The basis of fungal classification and strategies for the diagnosis of mycotic infections are summarized. The morphologic criteria for the identification of the common etiologic agents of rhinosinusitis are presented.
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Affiliation(s)
- T G Mitchell
- Department of Microbiology, Duke University Medical Center, Durham, North Carolina 27710, USA
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