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Challenging management of a post-coronavirus disease 2019 invasive Aspergillus sinusitis in a person living with HIV. AIDS 2022; 36:1321-1323. [PMID: 35833686 DOI: 10.1097/qad.0000000000003243] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Chiou CA, Yoon MK. An Update on Fungal Orbital Infections. Int Ophthalmol Clin 2022; 62:55-69. [PMID: 35325910 DOI: 10.1097/iio.0000000000000407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Yuan M, Tandon A, Li A, Johnson E, Greer C, Tooley A, Tran AQ, Godfrey KJ, Dinkin M, Oliveira C. Orbital Apex Syndrome Secondary to Invasive Aspergillus Infection: A Case Series and Literature Review. J Neuroophthalmol 2021; 41:e631-e638. [PMID: 33110002 DOI: 10.1097/wno.0000000000001105] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Invasive fungal sinusitis carries high morbidity and mortality and often poses a diagnostic challenge. Orbital apex syndrome (OAS) is not an uncommon presentation in the setting of invasive fungal sinusitis. Delays in diagnosis and appropriate treatment can result in permanent visual dysfunction and, potentially, death. We present 2 cases of OAS secondary to invasive sinus aspergillosis, detailing the diagnostic process, treatment, and outcome for both patients. Subsequently, we present a review of the literature and combined analysis of our 2 patients plus 71 cases from previously published reports. METHODS Literature review was performed to identify demographic, diagnostic, clinical, and treatment data of patients with OAS caused by Aspergillus species. RESULTS The review resulted in 52 included articles with 71 patients, plus our 2 reported patients, leading to a total of 73 subjects included in the analysis. The average age of patients at presentation was 59.9 years. A combination of visual disturbance and pain (headache and/or periocular pain) was the most common presentation reported (46 cases; 63%). Diabetes mellitus was reported in 15 cases (21%), with more than half specifically noted to have poorly controlled diabetes. After diabetes, the second most common cause of immunocompromise was chronic steroid use (n = 13; 18%). Empiric antifungal treatment was started in 10 patients (14%), while 25 patients (34%) were first treated with systemic steroids due to a concern for an inflammatory etiology. Time to diagnosis from initial presentation was on average 7.4 weeks (range of 0.3-40 weeks). Approximately 78% of the cases (57 of 73) had biopsies with histology that confirmed Aspergillus fungal morphology, and 30/73 (41%) had diagnostic fungal cultures. The majority of the cases received monotherapy with intravenous (IV) amphotericin B (36 patients; 49%) and IV voriconazole (19 patients; 26%), with a combination of the 2 or more antifungal agents being used in 11 patients (15%). Forty patients (55%) showed signs of clinical improvement with treatment, while 33 (45%) patients did not experience any improvement or continued to deteriorate, and 23 (32%) died in the course of their reported follow-up. CONCLUSIONS The present cases illustrate well the challenge in the diagnosis and treatment of OAS due to invasive sinus aspergillosis. Our review and analysis of 73 cases support the notion that a high index of suspicion leading to early biopsy with histology and fungal culture is paramount for diagnosis. Early empiric antifungal treatment and debridement can potentially reduce morbidity and mortality.
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Affiliation(s)
- Melissa Yuan
- Weill Cornell Medical College (MY, AL), New York, New York; and Department of Ophthalmology (A. Tandon, EJ, CG, A. Tooley, A. Tran, KJG, MD, CO), Weill Cornell Medical College, New York, New York
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Saldaña Inda I, Sancho Saldaña A, García Rubio S, Sagarra Mur D. Síndrome de seno cavernoso secundario a aspergilosis invasiva con afectación carotídea en paciente VIH. Neurologia 2021. [DOI: 10.1016/j.nrl.2020.08.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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5
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Saldaña Inda I, Sancho Saldaña A, García Rubio S, Sagarra Mur D. Cavernous sinus syndrome secondary to invasive aspergilosis with carotid involvement in a HIV pacient. NEUROLOGÍA (ENGLISH EDITION) 2021; 36:552-554. [DOI: 10.1016/j.nrleng.2020.08.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 08/26/2020] [Indexed: 10/21/2022] Open
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Wells CLD, Moodley AA. HIV-associated cavernous sinus disease. South Afr J HIV Med 2019; 20:862. [PMID: 31061723 PMCID: PMC6494947 DOI: 10.4102/sajhivmed.v20i1.862] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Accepted: 02/05/2019] [Indexed: 11/01/2022] Open
Abstract
Introduction The underlying diagnosis of cavernous sinus disease is difficult to confirm in HIV-coinfected patients owing to the lack of histological confirmation. In this retrospective case series, we highlight the challenges in confirming the diagnosis and managing these patients. Results The clinical, laboratory and radiological data of 23 HIV-infected patients with cavernous sinus disease were analysed. The mean age of patients was 38 years. The mean CD4+ count was 390 cells/μL. Clinically, patients presented with unilateral disease (65%), headache (48%), diplopia (30%) and blurred vision (30%). Third (65%) and sixth (57%) nerve palsies in isolation and combination (39%) were most common. Isolated fourth nerve palsy did not occur. Tuberculosis (17%) was the most commonly identified disorder followed by high-grade B-cell lymphoma (13%), meningioma (13%), metastatic carcinoma (13%) and neurosyphilis (7%). In 22% of the patients, there was no confirmatory evidence for a diagnosis. The patients were either treated empirically for tuberculosis or improved spontaneously when antiretroviral therapy was started. Cerebrospinal fluid was helpful in 4/13 (31%) of patients where it was not contraindicated. Only 3/23 (13%) of the patients had a biopsy of the cavernous sinus mass. The outcomes varied, and follow-up was lacking in the majority of patients. Conclusion In HIV-infected patients, histological confirmation of cavernous sinus pathology is not readily available for various reasons. In resource-limited settings, one should first actively search for extracranial evidence of tuberculosis, lymphoma, syphilis and primary malignancy and manage appropriately. Only if such evidence is lacking should a referral for biopsy be considered.
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Affiliation(s)
- Cait-Lynn D Wells
- Department of Neurology, Greys Hospital, University of KwaZulu-Natal, Pietermaritzburg, South Africa
| | - Anand A Moodley
- Department of Neurology, Universitas Hospital, University of the Free State, Bloemfontein, South Africa
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Nabet C, Belzunce C, Blanchet D, Abboud P, Djossou F, Carme B, Aznar C, Demar M. Histoplasma capsulatum causing sinusitis: a case report in French Guiana and review of the literature. BMC Infect Dis 2018; 18:595. [PMID: 30477434 PMCID: PMC6258161 DOI: 10.1186/s12879-018-3499-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Accepted: 11/01/2018] [Indexed: 11/13/2022] Open
Abstract
Background American histoplasmosis is a mycosis caused by Histoplasma capsulatum. A variety of clinical features of histoplasmosis have been commonly described ranging from asymptomatic infections to severe pulmonary infections. In immunocompromised individuals, progressive disseminated forms are frequent, leading to fatal outcome if untreated. However, H. capsulatum sinusitis is unusual with a few cases documented over the last three decades and may be underdiagnosed or confused with other fungal aetiologies, especially outside endemic regions. Case presentation In this study, we report an atypical case of Histoplasma capsulatum sinus fungus ball-like in a patient with Acquired Immunodeficiency Syndrome due to Human Immunodeficiency Virus complicated by a disseminated histoplasmosis with a death ending. Diagnosis relied on CT-Scan imaging and on both direct examination of H. capsulatum yeast forms (Gomory methenamine Grocott) in the sinus specimen (aspirate, biopsy) and on positivity of the culture further confirmed by qPCR. Conclusions Since last few decades, among the eight reviewed patients, H. capsulatum sinusitis occurred mostly in HIV-immunocompromised patients and for three cases as a sinusitis with disseminated histoplasmosis. Even if this is a rare clinical presentation, its diagnosis is crucial as it could represent an early expression of an Histoplasma capsulatum exposure that can evolve into a disseminated fatal infection when immunity decreases.
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Affiliation(s)
- C Nabet
- AcademicLaboratory of Parasitology and Mycology, Andrée Rosemon Hospital, 97306, Cayenne, French Guiana.,Faculty of Medicine, University of French Guiana, EA 3593 EPaT, Amazonian Ecosystems and Tropical Disease, Cayenne, French Guiana
| | - C Belzunce
- Unit of infectious diseases and Tropical medicine, Andrée Rosemon Hospital, Cayenne, French Guiana
| | - D Blanchet
- AcademicLaboratory of Parasitology and Mycology, Andrée Rosemon Hospital, 97306, Cayenne, French Guiana.,Faculty of Medicine, University of French Guiana, EA 3593 EPaT, Amazonian Ecosystems and Tropical Disease, Cayenne, French Guiana
| | - P Abboud
- Unit of infectious diseases and Tropical medicine, Andrée Rosemon Hospital, Cayenne, French Guiana.,Faculty of Medicine, University of French Guiana, EA 3593 EPaT, Amazonian Ecosystems and Tropical Disease, Cayenne, French Guiana
| | - F Djossou
- Unit of infectious diseases and Tropical medicine, Andrée Rosemon Hospital, Cayenne, French Guiana.,Faculty of Medicine, University of French Guiana, EA 3593 EPaT, Amazonian Ecosystems and Tropical Disease, Cayenne, French Guiana
| | - B Carme
- AcademicLaboratory of Parasitology and Mycology, Andrée Rosemon Hospital, 97306, Cayenne, French Guiana.,Faculty of Medicine, University of French Guiana, EA 3593 EPaT, Amazonian Ecosystems and Tropical Disease, Cayenne, French Guiana
| | - C Aznar
- AcademicLaboratory of Parasitology and Mycology, Andrée Rosemon Hospital, 97306, Cayenne, French Guiana.,Faculty of Medicine, University of French Guiana, EA 3593 EPaT, Amazonian Ecosystems and Tropical Disease, Cayenne, French Guiana
| | - M Demar
- AcademicLaboratory of Parasitology and Mycology, Andrée Rosemon Hospital, 97306, Cayenne, French Guiana. .,Faculty of Medicine, University of French Guiana, EA 3593 EPaT, Amazonian Ecosystems and Tropical Disease, Cayenne, French Guiana.
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Wandell GM, Miller C, Rathor A, Wai TH, Guyer RA, Schmidt RA, Turner JH, Hwang PH, Davis GE, Humphreys IM. A multi-institutional review of outcomes in biopsy-proven acute invasive fungal sinusitis. Int Forum Allergy Rhinol 2018; 8:1459-1468. [DOI: 10.1002/alr.22172] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Revised: 06/01/2018] [Accepted: 06/07/2018] [Indexed: 12/20/2022]
Affiliation(s)
- Grace M. Wandell
- Department of Otolaryngology; University of Washington; Seattle WA
| | - Craig Miller
- Department of Otolaryngology; University of Washington; Seattle WA
| | | | - Travis Hee Wai
- Department of Biostatistics; University of Washington; Seattle WA
| | - Richard A. Guyer
- Department of Otolaryngology; Vanderbilt University; Nashville TN
| | | | - Justin H. Turner
- Department of Otolaryngology; Vanderbilt University; Nashville TN
| | - Peter H. Hwang
- Department of Otolaryngology; Stanford University; Stanford CA
| | - Greg E. Davis
- Department of Otolaryngology; University of Washington; Seattle WA
| | - Ian M. Humphreys
- Department of Otolaryngology; University of Washington; Seattle WA
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The spectrum of pulmonary aspergillosis. Respir Med 2018; 141:121-131. [PMID: 30053957 DOI: 10.1016/j.rmed.2018.06.029] [Citation(s) in RCA: 65] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Revised: 06/26/2018] [Accepted: 06/29/2018] [Indexed: 11/24/2022]
Abstract
Notable progress has been made in the past years in the classification, diagnosis and treatment of pulmonary aspergillosis. New criteria were proposed by the Working Group of the International Society for Human and Animal Mycology (ISHAM) for the diagnosis of allergic bronchopulmonary aspergillosis (ABPA). The latest classification of chronic pulmonary aspergillosis (CPA) suggested by the European Society for Clinical Microbiology and Infectious Diseases (ESCMID) has become widely accepted among clinicians. Subacute invasive pulmonary aspergillosis is now considered a type of CPA, yet it is still diagnosed and treated similarly to invasive pulmonary aspergillosis (IPA). Isavuconazole, an extended-spectrum triazole, has recently been approved by the Food and Drug Administration (FDA) and the European Medicines Agency (EMA) for the treatment of IPA. The most recent Infectious Diseases Society of America (IDSA) guidelines strongly recommend reducing mold exposure to patients at high risk for pulmonary aspergillosis. The excessive relapse rate following discontinuation of therapy remains a common reality to all forms of this semi-continuous spectrum of diseases. This highlights the need to continuously reassess patients and individualize therapy accordingly. Thus far, the duration of therapy and the frequency of follow-up have to be well characterized.
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Szalewski DA, Hinrichs VS, Zinniel DK, Barletta RG. The pathogenicity ofAspergillus fumigatus, drug resistance, and nanoparticle delivery. Can J Microbiol 2018; 64:439-453. [DOI: 10.1139/cjm-2017-0749] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The genus Aspergillus includes fungal species that cause major health issues of significant economic importance. These microorganisms are also the culprit for production of carcinogenic aflatoxins in grain storages, contaminating crops, and economically straining the production process. Aspergillus fumigatus is a very important pathogenic species, being responsible for high human morbidity and mortality on a global basis. The prevalence of these infections in immunosuppressed individuals is on the rise, and physicians struggle with the diagnosis of these deadly pathogens. Several virulence determinants facilitate fungal invasion and evasion of the host immune response. Metabolic functions are also important for virulence and drug resistance, since they allow fungi to obtain nutrients for their own survival and growth. Following a positive diagnostic identification, mortality rates remain high due, in part, to emerging resistance to frequently used antifungal drugs. In this review, we discuss the role of the main virulence, drug target, and drug resistance determinants. We conclude with the review of new technologies being developed to treat aspergillosis. In particular, microsphere and nanoparticle delivery systems are discussed in the context of improving drug bioavailability. Aspergillus will likely continue to cause problematic infections in immunocompromised patients, so it is imperative to improve treatment options.
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Affiliation(s)
- David A. Szalewski
- Department of Biological Systems Engineering, University of Nebraska, Lincoln, NE 68583-0726, USA
- Department of Microbiology, University of Nebraska, Lincoln, NE 68588-0664, USA
| | - Victoria S. Hinrichs
- College of Agricultural Sciences and Natural Resources, University of Nebraska, Lincoln, NE 68583-0702, USA
| | - Denise K. Zinniel
- School of Veterinary Medicine and Biomedical Sciences, University of Nebraska, Lincoln, NE 68583-0905, USA
| | - Raúl G. Barletta
- School of Veterinary Medicine and Biomedical Sciences, University of Nebraska, Lincoln, NE 68583-0905, USA
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