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Roh D, Shin JH, Kim SW, Kim SW, Kim BG, Cho JH, Park YJ, Kim DH. Sinonasal microbiome and inflammatory profiles in fungal ball and chronic rhinosinusitis. Auris Nasus Larynx 2024; 51:242-250. [PMID: 38061935 DOI: 10.1016/j.anl.2023.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Revised: 09/12/2023] [Accepted: 11/08/2023] [Indexed: 01/16/2024]
Abstract
OBJECTIVE Fungal balls (FB) are the main form of non-invasive fungal rhinosinusitis found in immunocompetent hosts. Bacterial coinfection affects clinical symptoms. We investigated the sinonasal microbiome and inflammatory profiles in FB and chronic rhinosinusitis (CRS) patients. METHODS Thirty-three participants were prospectively recruited. Nasal swab samples and sinonasal tissues were collected from controls, and FB and CRS patients. DNA extraction and microbiome analysis using V3-V4 region 16S rRNA sequencing were performed. Inflammatory cytokine levels in the sinonasal tissues, blood eosinophil counts, and serum total IgE were measured. RESULTS No significant differences were observed in species richness or evenness measures. The phylogenetic tree demonstrated that the FB samples were different from the controls. The sinus bacteria composition differed among the groups. At the phylum level, Firmicutes in FB were significantly depleted compared with those in CRS, while Proteobacteria were more enriched in FB than that in controls and CRS. At the genus level, in FB, Staphylococcus and Corynebacterium were significantly decreased compared to those in the controls. The prevalence of Haemophilus was the highest in FB. Blood eosinophil counts and IL-5 and periostin levels in the sinonasal tissue of the FB group were significantly lower than those in the CRS group. CONCLUSIONS FB patients had different microbiome compositions and fewer type 2 inflammatory profiles than CRS patients did. However, whether these findings cause FB or result from bacterial and/or fungal infection remains unclear. Further studies are needed to reveal how these differences occur and affect the development of FB and clinical symptoms.
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Affiliation(s)
- Daeyoung Roh
- Department of Psychiatry, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon-si, Gangwon-do, Republic of Korea; Mind-neuromodulation Laboratory, Hallym University College of Medicine, Chuncheon-si, Gangwon-do, Republic of Korea
| | - Ji-Hyeon Shin
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
| | - Soo Whan Kim
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Sung Won Kim
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Byung-Guk Kim
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jin-Hee Cho
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Yong-Jin Park
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Do Hyun Kim
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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2
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Kim KH, Kim H, Lim SY, Koh IC. Periantral fungal abscess after zygoma reduction: a case report. Arch Craniofac Surg 2023; 24:288-291. [PMID: 38176763 PMCID: PMC10766502 DOI: 10.7181/acfs.2023.00353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 09/04/2023] [Accepted: 12/18/2023] [Indexed: 01/06/2024] Open
Abstract
This case report describes our treatment of a persistent periantral abscess in a 35-year-old woman. The abscess developed following a zygoma-reduction surgery, during which a preexisting fungal ball had not been addressed. Our comprehensive treatment approach included functional endoscopic sinus surgery, fungal ball removal, abscess drainage, and debridement. Two weeks postoperatively, the patient's symptoms had resolved. A 6-month postoperative follow-up revealed no signs of recurrence or complications, and the patient reported satisfactory functional and aesthetic results. This case underscores the importance of thorough preoperative evaluations and raises awareness about the potential risks of untreated asymptomatic pathologies, which can potentially progress and lead to further complications.
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Affiliation(s)
- Keun Hyung Kim
- Department of Plastic and Reconstructive Surgery, Myunggok Medical Research Center, Konyang University Hospital, Konyang University College of Medicine, Daejeon, Korea
| | - Hoon Kim
- Department of Plastic and Reconstructive Surgery, Myunggok Medical Research Center, Konyang University Hospital, Konyang University College of Medicine, Daejeon, Korea
| | - Soo Yeon Lim
- Department of Plastic and Reconstructive Surgery, Myunggok Medical Research Center, Konyang University Hospital, Konyang University College of Medicine, Daejeon, Korea
| | - In Chang Koh
- Department of Plastic and Reconstructive Surgery, Myunggok Medical Research Center, Konyang University Hospital, Konyang University College of Medicine, Daejeon, Korea
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3
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Kim KS, Min HJ. Concurrent Monoclonal Gammopathy of Undetermined Significance in a Patient With Maxillary Sinus Fungus Ball. EAR, NOSE & THROAT JOURNAL 2022:1455613221125923. [PMID: 36053198 DOI: 10.1177/01455613221125923] [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: 11/16/2022] Open
Abstract
Fungus ball is a common disease encountered in rhinology departments. As it usually affects immunocompetent patients, other systemic diseases occurring concurrently with fungus ball have not been reported often. Recently, we encountered a patient who was diagnosed with fungus ball in the maxillary sinus and underwent endoscopic sinus surgery. During the surgery, fungus ball-like materials were sucked out and a maxillary sinus mucosal biopsy was performed. The post-operative pathologic report demonstrated that there were many plasma cells; the patient underwent several additional tests in our hematologic department. Finally, he was diagnosed with monoclonal gammopathy of undetermined significance (MGUS). In the present report, we summarize our experience with this patient and share the lessons that we have learned from this case.
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Affiliation(s)
- Kyung Soo Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Chung-Ang UniversityCollege of Medicine, Seoul, Korea
| | - Hyun Jin Min
- Department of Otorhinolaryngology-Head and Neck Surgery, Chung-Ang UniversityCollege of Medicine, Seoul, Korea
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4
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Doo JG, Min HK, Choi GW, Kim SW, Min JY. Analysis of predisposing factors in unilateral maxillary sinus fungal ball: the predictive role of odontogenic and anatomical factors. Rhinology 2022; 60:377-383. [PMID: 35856790 DOI: 10.4193/rhin22.175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND The pathogenesis of maxillary sinus fungal ball (MSFB) is explained by aerogenic and odontogenic factors. We evaluated the predisposing factors, including intranasal anatomical and dental factors for increased diagnostic accuracy. METHODOLOGY In this study, 117 patients who underwent endoscopic sinus surgery for unilateral MSFB were included. Preoperative computed tomography (CT) scans were used to analyze the presence of anatomical variations (anterior and posterior nasal septal deviation (NSD), concha bullosa (CB), infraorbital cell (haller cell), paradoxical middle turbinate, everted uncinate process and MS size). Dental factors including history of dental procedures and findings on CT scans were reviewed. RESULTS Anterior and posterior NSD toward non-affected side were significantly associated with the presence of FB. The presence of CB and infraorbital cell was higher in the non-affected side rather than in the lesion side. Compared to non-affected MS, FB-presence MS was shallower and had a larger height to depth ratio. The presence of dental history was significantly higher on FB-presence MS than non-affected MS. In multivariable analysis, posterior NSD toward non-affected side, dental history increased the aOR of MSFB, while the presence of CB and infraorbital cell decreased the aOR of MSFB. CONCLUSIONS The occurrence of MSFB seems to be associated with ipsilateral odontogenic factors, followed by anatomic variations including posterior NSD toward non-affected side and absence of CB and infraorbital cell.
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Affiliation(s)
- J G Doo
- Department of Otorhinolaryngology-Head and Neck Surgery, Nowon Eulji Medical Center, Eulji University School of Medicine, Seoul, Korea.,Department of Medicine, Graduate school, Kyung Hee University, Seoul, Korea
| | - H K Min
- Department of Otorhinolaryngology-Head and Neck Surgery, Kyung Hee University Medical Center, Seoul, Korea
| | - G W Choi
- Department of Otorhinolaryngology-Head and Neck Surgery, Kyung Hee University Medical Center, Seoul, Korea
| | - S W Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Kyung Hee University Medical Center, Seoul, Korea
| | - J-Y Min
- Department of Otorhinolaryngology-Head and Neck Surgery, Kyung Hee University Medical Center, Seoul, Korea
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Kikuta S, Han B, Yoshihara S, Nishijima H, Kondo K, Yamasoba T. High CT Attenuation Values Relative to the Brainstem Predict Fungal Hyphae Within the Sinus. Front Surg 2022; 9:876340. [PMID: 35784936 PMCID: PMC9243468 DOI: 10.3389/fsurg.2022.876340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 05/30/2022] [Indexed: 11/25/2022] Open
Abstract
Objectives There is currently no established objective diagnostic indicator for the differentiation of sinus fungal ball (SFB) from unilateral nonfungal chronic sinusitis (UCRS). This study evaluated whether computed tomography (CT) attenuation values relative to those of the brainstem (relative CT number) are useful for differentiating SFB from UCRS. Materials and Methods Consecutive patients who were pathologically diagnosed with SFB or UCRS between 2013 and 2021 were retrospectively identified. The relative CT numbers of region of interest (ROIs) within the sinuses were compared between the two patient groups. Factors with predictive power for differentiating SFBs from UCRSs were identified by uni/multivariable logistic regression analyses. Results One hundred and eighty-three patients with unilateral chronic sinusitis were finally analyzed (SFB, 86 cases; UCRS, 97 cases). Regardless of the presence or absence of calcified lesions, the relative CT numbers in SFB were significantly higher than those in UCRS. ROIs showing high relative CT numbers were those where fungal hyphae were present. In the uni/multivariable logistic regression analysis, age (p < 0.001), relative CT number (p < 0.001), and calcification (p = 0.002) had predictive value for distinguishing SFB from UCRS. Within those cases not showing calcification, age (p = 0.004) and relative CT number (p < 0.001) were predictive factors for differentiating SFB from UCRS. A relative CT number >1.5 was significantly associated with SFB (sensitivity, 70%; specificity, 91%), with a significantly larger area under the receiver operating characteristics curve than age. Conclusions High relative CT numbers within the sinus are strongly associated with the presence of fungal hyphae, and measurement of relative CT number is a powerful adjunctive diagnostic method for distinguishing between SFB and UCRS.
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6
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The Endonasal Endoscopic Approach to Different Sinonasal Fungal Balls. Int J Otolaryngol 2022; 2022:6721896. [PMID: 35360416 PMCID: PMC8964197 DOI: 10.1155/2022/6721896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Accepted: 02/25/2022] [Indexed: 11/18/2022] Open
Abstract
Background. Fungal ball sinusitis is a sinonasal fungus ball that usually affects immunocompetent adults with female predominance. The most affected sinus is the maxillary sinus. Aspergillus species is the most typically found fungus. Computed tomography (CT) scan is the gold standard tool in order to diagnose fungal ball sinusitis. The ultimate method for a fungal ball is functional endoscopic sinus surgery (FESS), which has a high success rate and a low morbidity rate. Objective. This study aims to demonstrate the various clinical presentations of fungal ball sinusitis including isolated maxillary sinus, sphenoid sinus, simultaneous occurrence of maxillary and sphenoid fungal ball, and post endonasal endoscopic pituitary surgery fungal ball with various age groups. Also, this study aims to emphasize the importance of early diagnosis and treatment in such cases. Patients and Methods. A retrospective study that was carried in the otorhinolaryngology department of two hospitals: King Fahad Specialist Hospital and Qatif Central Hospital, Eastern Region, Saudi Arabia. The study was conducted on a total of 16 patients who were diagnosed with paranasal sinuses fungal ball in an 11-year period from January 2008 and November 2019. Results. Out of 16 patients with paranasal sinuses fungal ball, 11 cases were female and 5 males, with age ranging between 16 and 46 years. Results showed eight isolated sphenoid (50%), six isolated maxillary fungal ball (38%), one simultaneous occurrence of the sphenoid and maxillary fungal ball (6%), and one post endonasal endoscopic pituitary surgery for pituitary adenoma (6%). CT scan was performed for all 16 cases which is the standard tool for the diagnosis of the fungal ball. Conclusion. Fungal ball may present with variety of symptoms but most commonly with postnasal discharge (PND), headache, and facial pain. CT sinuses is the diagnostic radiological modality to confirm the diagnosis. The FESS functional endoscopic sinus surgery is the gold safe approach for patients with fungal ball to manage their symptoms, confirm the diagnosis, and removal of disease with no morbidities.
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7
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Li E, Rodriguez A, Luong AU, Allen D, Knight JM, Kheradmand F, Corry DB. The immune response to airway mycosis. Curr Opin Microbiol 2021; 62:45-50. [PMID: 34052540 DOI: 10.1016/j.mib.2021.04.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 04/14/2021] [Accepted: 04/23/2021] [Indexed: 01/15/2023]
Abstract
The allergic airway diseases chronic rhinosinusitis (CRS), allergic fungal rhinosinusitis (AFRS), asthma, allergic bronchopulmonary mycosis/aspergillosis (ABPM/A), and cystic fibrosis (CF) share a common immunological signature marked by TH2 and TH17 cell predominant immune responses, the production of IgE antibody, and a typical inflammatory cell infiltrate that includes eosinophils and other innate immune effector cells. Severe forms of these disorders have long been recognized as being related to hypersensitivity reactions to environmental fungi. Increasingly however,environmental fungi are assuming a more primary role in the etiology of these disorders, with airway mycosis, a type of non-invasive airway fungal infection, recognized as an essential driving factor in at least severe subsets of allergic airway diseases. In this review, we consider recent progress made in understanding the immune mechanisms that drive airway mycosis-related diseases, improvements in immune-based diagnostic strategies, and therapeutic approaches that target key immune pathways.
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Affiliation(s)
- Evan Li
- Departments ofMedicine, Baylor College of Medicine, Texas, USA
| | | | - Amber U Luong
- Department of Otolaryngology, McGovern Medical School of the University of Texas Health Science Center at Houston, Houston, TX, USA
| | - David Allen
- Department of Otolaryngology, McGovern Medical School of the University of Texas Health Science Center at Houston, Houston, TX, USA
| | - John Morgan Knight
- Departments of Pathology & Immunology, Biology of Inflammation Center, Baylor College of Medicine, Texas, USA
| | - Farrah Kheradmand
- Departments ofMedicine, Baylor College of Medicine, Texas, USA; Departments of Pathology & Immunology, Biology of Inflammation Center, Baylor College of Medicine, Texas, USA; Michael E. Debakey Veterans Administration Center for Translational Research in Inflammatory Diseases, Houston, TX, USA
| | - David B Corry
- Departments ofMedicine, Baylor College of Medicine, Texas, USA; Departments of Pathology & Immunology, Biology of Inflammation Center, Baylor College of Medicine, Texas, USA; Michael E. Debakey Veterans Administration Center for Translational Research in Inflammatory Diseases, Houston, TX, USA.
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8
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Abstract
PURPOSE OF REVIEW Chronic rhinosinusitis (CRS) is a broad classification of airway inflammation that affects a significant portion of the population. The current model of delineating patients suffering from CRS is dated and is no longer as simple as the presence of polyps or no polyps. Continued advances in the endotype descriptions of CRS have allowed for new phenotypic descriptions that aid in driving management and research efforts. RECENT FINDINGS Geographic differences exist between patient presentations, which require a molecular evaluation of the driving forces. Increased understanding of these differences allows for patient-specific treatment decisions. SUMMARY New descriptions of CRS phenotypes allow for more targeted therapy for patients, particularly to those with difficult to control disease. The previously broad classification of CRS with or without nasal polyps is no longer sufficient at driving these treatment decisions.
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Abstract
Unilateral diseases of the maxillary sinus are among the most common rhinologic diagnoses. The diversity of these diseases can represent a challenge for the treating physician. The spectrum ranges from harmless maxillary sinus cysts that seldom require treatment, to highly aggressive malignant tumors. Special attention should be given to the management of inverted papilloma. These benign tumors are characterized by high recurrence rates and the potential for malignant transformation. The key to minimizing recurrence is precise surgical intervention. Other unilateral maxillary sinus diseases such as the antrochoanal polyp and the fungus ball (aspergilloma) are also discussed in depth.
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Affiliation(s)
- E Giotakis
- Erste HNO-Universitätsklinik Athen, Hippokrateio-Krankenhaus, Athen, Griechenland.
| | - S Knipping
- Klinik für Hals‑, Nasen- und Ohrenheilkunde, Kopf- und Halschirurgie, Plastische Operationen, Städtisches Klinikum Dessau und Martin-Luther-Universität Halle-Wittenberg, Dessau, Deutschland
| | - T Kühnel
- Klinik und Poliklinik für Hals-Nasen-Ohren-Heilkunde, Universität Regensburg, Regensburg, Deutschland
| | - R K Weber
- HNO-Klinik, Städtisches Klinikum Karlsruhe, Karlsruhe, Deutschland.,Sinus Academy, Karlsruhe, Deutschland
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McCormick JP, Thompson HM, Cho DY, Woodworth BA, Grayson JW. Phenotypes in Chronic Rhinosinusitis. Curr Allergy Asthma Rep 2020; 20:20. [PMID: 32430653 DOI: 10.1007/s11882-020-00916-6] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
PURPOSE OF REVIEW Chronic rhinosinusitis (CRS) is a heterogenous disease process affecting a significant proportion of the population and impacting quality of life and productivity. Historically, CRS has been classified broadly into CRS with nasal polyps (CRSwNP) and CRS without nasal polyps (CRSsNP). Increased understanding regarding unique presentations of CRS subsets and their underlying inflammatory profiles has led to a new system for classifying CRS phenotypes. RECENT FINDINGS Consideration of CRS phenotypes has traditionally been a key factor in determining treatment paradigms. Under a new phenotype classification system, physical findings will continue to drive treatment decisions, but with more precision. Recent rapidly accumulated knowledge indicates that the broad categorization of CRSwNP or CRSsNP is no longer clinically useful. Reorganization of CRS phenotypes and their underlying endotypes will lead to more targeted and efficacious therapy.
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Affiliation(s)
- Justin P McCormick
- Department of Otolaryngology - Head and Neck Surgery, University of Alabama at Birmingham, 1720 Second Avenue South, Birmingham, AL, 35294, USA
| | - Harrison M Thompson
- Department of Otolaryngology - Head and Neck Surgery, University of Alabama at Birmingham, 1720 Second Avenue South, Birmingham, AL, 35294, USA
| | - Do-Yeon Cho
- Department of Otolaryngology - Head and Neck Surgery, University of Alabama at Birmingham, 1720 Second Avenue South, Birmingham, AL, 35294, USA
| | - Bradford A Woodworth
- Department of Otolaryngology - Head and Neck Surgery, University of Alabama at Birmingham, 1720 Second Avenue South, Birmingham, AL, 35294, USA
| | - Jessica W Grayson
- Department of Otolaryngology - Head and Neck Surgery, University of Alabama at Birmingham, 1720 Second Avenue South, Birmingham, AL, 35294, USA.
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Kim SC, Ryoo I, Shin JM, Suh S, Jung HN, Shin SU. MR Findings of Fungus Ball: Significance of High Signal Intensity on T1-Weighted Images. J Korean Med Sci 2020; 35:e22. [PMID: 31950777 PMCID: PMC6970076 DOI: 10.3346/jkms.2020.35.e22] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Accepted: 12/02/2019] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Central dark-signal intensity with high-signal, hypertrophic mucosal wall of paranasal sinuses on T2-weighted images (T2WI) is a characteristic magnetic resonance imaging (MRI) feature of sinonasal fungus ball. However, this finding is usually interpreted as non-fungal chronic sinusitis with central normal sinus air. In addition, T1-weighted images (T1WI) and T2WI are basic sequences of all magnetic resonance (MR) examinations. Therefore, we evaluated the usefulness of T1WI for detecting fungus balls comparing with computed tomography (CT) findings and T2-weighted MRI findings. METHODS This retrospective study was approved by the Institutional Review Board of Korea University Guro Hospital. Two reviewers assessed preoperative CT and MR images of 55 patients with pathologically confirmed fungus balls. Reviewers evaluated the presence and patterns of calcifications on CT. Overall signals and the presence and extent of certain signals of fungus balls on MRI were also assessed. The relationship between calcifications and MRI signals was also evaluated. RESULTS Of the patients, 89.1% had calcifications on CT. All had dark signal portions with high signal, hypertrophic mucosal walls on T2WI. Most (92.7%) patients showed iso- to hyper-intense overall signals on T1WI and 89.1% had T1-weighted high signal portions on MRI. The presence, patterns, and location of calcifications had no significant correlation with T1-weighted high-signal intensity portion. CONCLUSION Fungus ball can be suggested by the presence of the hyper-signal intensity portions in the fungal mass on T1WI in conjunction with dark-signal lesions surrounded by high-signal, hypertrophic mucosal walls in paranasal sinuses on T2WI.
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Affiliation(s)
- Soo Chin Kim
- Department of Radiology, Seoul National University Hospital Healthcare System Gangnam Center, Seoul National University College of Medicine, Seoul, Korea
| | - Inseon Ryoo
- Department of Radiology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea.
| | - Jae Min Shin
- Department of Otorhinolaryngology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Sangil Suh
- Department of Radiology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Hye Na Jung
- Department of Radiology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Sung Ui Shin
- Department of Radiology, Seoul National University Hospital Healthcare System Gangnam Center, Seoul National University College of Medicine, Seoul, Korea
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Cha H, Song Y, Bae YJ, Won TB, Kim JW, Cho SW, Rhee CS. Clinical Characteristics Other Than Intralesional Hyperdensity May Increase the Preoperative Diagnostic Accuracy of Maxillary Sinus Fungal Ball. Clin Exp Otorhinolaryngol 2019; 13:157-163. [PMID: 31674170 PMCID: PMC7248610 DOI: 10.21053/ceo.2019.00836] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Accepted: 09/04/2019] [Indexed: 11/22/2022] Open
Abstract
Objectives This study aimed to evaluate the clinical characteristics of maxillary sinus fungus ball (MFB) to increase the preoperative diagnostic accuracy. Methods A retrospective review of 247 patients who underwent endoscopic sinus surgery for unilateral maxillary sinusitis from January 2015 to December 2017 at a single institution was performed. Patients with pathologically proven MFB were compared to those with unilateral chronic maxillary sinusitis (CMS). Patient demographics and computed tomography (CT) findings were evaluated. The CT features were categorized as intralesional hyperdensity (calcification), the irregular lobulated protruding lesion (fuzzy appearance), maxillary sinus full haziness without mass effect, maxillary sinus full haziness with mass effect, and others. A regression tree analysis was performed. Results In total, 247 patients were analyzed; among them, 179 (72.5%) had MFB and 68 (27.5%) had CMS. MFB showed predominance in older individuals. Among the radiological features, intralesional hyperdensity was most commonly associated with MFB. The presence of a fuzzy appearance or full opacity with mass effect was also associated with MFB. The highest area under the curve was noted with the regression tree analysis based on the model, which included the presence of intralesional hyperdensity, demographic data (age), and presence of fuzzy appearance or maxillary sinus full haziness with mass effect in case of absence of intralesional hyperdensity (0.904). Conclusion A simple algorithm to optimize the preoperative diagnosis of MFB was developed. Physicians should be aware of such findings in the management of patients presenting with unilateral CMS.
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Affiliation(s)
- Hyunkyung Cha
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea.,Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Yoonjae Song
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Yun Jung Bae
- Department of Radiology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Tae-Bin Won
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea.,Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Jeong-Whun Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Sung-Woo Cho
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Chae-Seo Rhee
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea.,Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
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13
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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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