1
|
Ghosh K, Das S, Sorongpong S, Das N, Pandey P. Emergence of Lasiodiplodia theobromae induced leaf necrosis in tea (Camellia sinensis [L.] O. Kuntze) from India. Arch Microbiol 2024; 206:284. [PMID: 38814366 DOI: 10.1007/s00203-024-04018-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Revised: 05/11/2024] [Accepted: 05/23/2024] [Indexed: 05/31/2024]
Abstract
The tea plant, Camellia sinensis [L.] O. Kuntze, is a vital global agricultural commodity, yet faces challenges from fungal infections, which affects its production. To reduce the loss in the tea production, the fungal infections must be removed which is managed with fungicides, which are harmful to the environment. Leaf necrosis, which decreases tea quality and quantity, was investigated across Assam, revealing Lasiodiplodia theobromae as the causative agent. Pathogenicity tests, alongside morphological and molecular analyses, confirmed its role in leaf necrosis. Genome and gene analysis of L. theobromae showed multiple genes related to its pathogenicity. The study also assessed the impact of chemical pesticides on this pathogen. Additionally, the findings in this study highlight the significance of re-assessing management approaches in considering the fungal infection in tea.
Collapse
Affiliation(s)
- Kheyali Ghosh
- Assam University Silchar, Cachar, 788011, Assam, India
| | - Sandeep Das
- Assam University Silchar, Cachar, 788011, Assam, India
| | | | - Nandita Das
- Assam University Silchar, Cachar, 788011, Assam, India
| | - Piyush Pandey
- Assam University Silchar, Cachar, 788011, Assam, India.
| |
Collapse
|
2
|
Menon NN, B BM, S S. Clinicomycological Profile of Fungal Rhinosinusitis in South India. Indian J Otolaryngol Head Neck Surg 2023; 75:2142-2148. [PMID: 37636625 PMCID: PMC10447791 DOI: 10.1007/s12070-023-03826-x] [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: 07/28/2022] [Accepted: 04/20/2023] [Indexed: 08/29/2023] Open
Abstract
Chronic rhinosinusitis (CRS) is widely prevalent globally. Fungal rhinosinusitis is a subtype which requires early detection by using appropriate tests and to make an accurate decision regarding the treatment modality. This study aims at determining the clinicomycological profile of fungal rhinosinusitis (FRS). A total of 105 patients with CRS were included in the study which was prospectively done during a time period of 18 months in a tertiary care hospital. All patients were subjected to CT scans and diagnostic nasal examinations (DNE) preoperatively. The sinonasal specimens were subjected to KOH mount, fungal culture and histopathological examination following functional endoscopic sinus surgery (FESS). 53% of the patients with fungal sinusitis belonged to the age group 41-60 years. The prevalence of FRS was found to be 38% with aspergillus species accounting for about 85% cases. FRS is a disease which can have a wide spectrum of clinical presentations requiring early detection and appropriate treatment which is essential to avoid both short term and long term sequalae.
Collapse
Affiliation(s)
- Nandini N Menon
- Department of Surgical Oncology, BLK- MAX Super Speciality Hospital, Pusa road, Rajendra Place, 110005 Delhi, India
| | - Bharathi M B
- ENT and Head and Neck Surgery Department, JSS Hospital, Mysore, Karnataka India
| | - Sandeep S
- ENT and Head and Neck Surgery Department, JSS Hospital, Mysore, Karnataka India
| |
Collapse
|
3
|
Park MJ, Han JY. Allergic Mucin in Allergic Fungal Rhinosinusitis. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2023; 11:2574-2575. [PMID: 37330712 DOI: 10.1016/j.jaip.2023.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 05/28/2023] [Accepted: 06/01/2023] [Indexed: 06/19/2023]
Affiliation(s)
- Marn Joon Park
- Department of Otorhinolaryngology-Head and Neck Surgery, Inha University Hospital, Inha University College of Medicine, Incheon, Korea.
| | - Jee-Young Han
- Department of Pathology, Inha University Hospital, Inha University College of Medicine, Incheon, Korea
| |
Collapse
|
4
|
Fong A, Ahmed S, Ramalingam S, Brown RM, Harper L, Mollan SP. Eosinophilic Granulomatosis with Polyangiitis Presenting as Unilateral Acute Anterior Ischaemic Optic Neuropathy. Neuroophthalmology 2020; 45:109-116. [PMID: 34108782 PMCID: PMC8158048 DOI: 10.1080/01658107.2020.1761402] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 04/18/2020] [Accepted: 04/23/2020] [Indexed: 10/24/2022] Open
Abstract
Eosinophilic granulomatosis with polyangiitis (eGPA) is a rare vasculitis of small-medium sized vessels that can cause both anterior and posterior ischaemic optic neuropathies. Herein, the authors present a rare case of eGPA presenting initially as an acute unilateral anterior ischaemic optic neuropathy from short posterior ciliary artery vasculitis. The diagnosis presented a challenge as clinical and histopathological evidence suggested allergic rhinosinusitis, and no invasive fungal sinusitis was found. The high serum eosinophilia, asthma, optic neuropathy and paranasal sinus abnormalities fulfilled the criteria for a diagnosis of eGPA. Furthermore serum was positive for myeloperoxidase antibodies. Subsequently the case was successfully treated with oral glucocorticoids and intravenous rituximab.
Collapse
Affiliation(s)
- Anthony Fong
- Birmingham Neuro-Ophthalmology, Queen Elizabeth Hospital, Birmingham, UK
- Associate Lecturer Medicine, The University of Queensland, Level 6 Oral Health Centre, Herston, QLD, Australia
| | - Shahzada Ahmed
- Department of Ear Nose and Throat, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital, Birmingham, UK
| | - Satheesh Ramalingam
- Department of Neuroradiology, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital, Birmingham, UK
| | - Rachel M. Brown
- Department of Histopathology, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital, Birmingham, UK
| | - Lorraine Harper
- Department of Renal Medicine, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital, Birmingham, UK
| | - Susan P. Mollan
- Birmingham Neuro-Ophthalmology, Queen Elizabeth Hospital, Birmingham, UK
| |
Collapse
|
5
|
Dar SA, Rai G, Ansari MA, Akhter N, Gupta N, Sharma S, Haque S, Ramachandran VG, Wahid M, Rudramurthy SM, Chakrabarti A, Das S. FcɛR1α gene polymorphism shows association with high IgE and anti‐FcɛR1α in Chronic Rhinosinusitis with Nasal Polyposis. J Cell Biochem 2018; 119:4142-4149. [DOI: 10.1002/jcb.26619] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Accepted: 12/12/2017] [Indexed: 01/09/2023]
Affiliation(s)
- Sajad A. Dar
- Department of MicrobiologyUniversity College of Medical Sciences (University of Delhi) & Guru Teg Bahadur HospitalDelhiIndia
- Research and Scientific Studies UnitCollege of Nursing & Allied Health SciencesUniversity of JazanJazanSaudi Arabia
| | - Gargi Rai
- Department of MicrobiologyUniversity College of Medical Sciences (University of Delhi) & Guru Teg Bahadur HospitalDelhiIndia
| | - Mohammad A. Ansari
- Department of MicrobiologyUniversity College of Medical Sciences (University of Delhi) & Guru Teg Bahadur HospitalDelhiIndia
| | - Naseem Akhter
- Department of Laboratory MedicineFaculty of Applied Medical SciencesAlbaha UniversityAlbahaSaudi Arabia
| | - Neelima Gupta
- Department of OtorhinolaryngologyUniversity College of Medical Sciences (University of Delhi) & Guru Teg Bahadur HospitalDelhiIndia
| | - Sonal Sharma
- Department of PathologyUniversity College of Medical Sciences (University of Delhi) & Guru Teg Bahadur HospitalDelhiIndia
| | - Shafiul Haque
- Research and Scientific Studies UnitCollege of Nursing & Allied Health SciencesUniversity of JazanJazanSaudi Arabia
- Department of BiosciencesFaculty of Natural SciencesJamia Millia Islamia (A Central University)New DelhiIndia
| | - Vishnampettai G. Ramachandran
- Department of MicrobiologyUniversity College of Medical Sciences (University of Delhi) & Guru Teg Bahadur HospitalDelhiIndia
| | - Mohd Wahid
- Research and Scientific Studies UnitCollege of Nursing & Allied Health SciencesUniversity of JazanJazanSaudi Arabia
- Department of BiosciencesFaculty of Natural SciencesJamia Millia Islamia (A Central University)New DelhiIndia
| | - Shivprakash M. Rudramurthy
- Department of Medical MicrobiologyPost Graduate Institute of Medical Education & ResearchChandigarhIndia
| | - Arunaloke Chakrabarti
- Department of Medical MicrobiologyPost Graduate Institute of Medical Education & ResearchChandigarhIndia
| | - Shukla Das
- Department of MicrobiologyUniversity College of Medical Sciences (University of Delhi) & Guru Teg Bahadur HospitalDelhiIndia
| |
Collapse
|
6
|
Abstract
Fungal rhinosinusitis (FRS) comprises a spectrum of disease processes that vary in clinical presentation, histologic appearances, and biological significance. FRS can be acute or chronic and is most commonly classified as non-invasive or invasive based on whether fungi have invaded into tissue. This manuscript will review the pathologic classification of FRS.
Collapse
|
7
|
Bachert C, Holtappels G. Pathophysiology of chronic rhinosinusitis, pharmaceutical therapy options. GMS CURRENT TOPICS IN OTORHINOLARYNGOLOGY, HEAD AND NECK SURGERY 2015; 14:Doc09. [PMID: 26770283 PMCID: PMC4702058 DOI: 10.3205/cto000124] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Research in immunology has brought great progress in knowledge of inflammatory processes in the last 2 decades, which also has an impact on the upper airways. Our understanding of the pathophysiology of chronic rhinosinusitis developed from a rather mechanistic point of view with a focus on narrow clefts and mucociliary clearance to the appreciation of a complex network of immunological pathways forming the basis of disease. We today differentiate various forms of inflammation, we start to understand complex immune-regulatory networks and the reasons for their failure, and have already developed innovative approaches for therapy for the most severely ill subjects. Due to this new knowledge in inflammation and remodeling processes within mucosal tissue, specifically on the key driving factors, new diagnostic tools and therapeutic approaches for chronic rhinosinusitis have developed; the differentiation of endotypes based on pathophysiological principles will be crucial for the use of innovative therapies, mostly humanized monoclonal antibodies. Several hundred of those antibodies are currently developed for various indications and will impact our specialty as well as pneumology to a great extent.
Collapse
Affiliation(s)
- Claus Bachert
- Department of Otolaryngology and Upper Airways Research Laboratory, University of Ghent, Belgium; Division of ENT Diseases, CLINTEC, Karolinska Institute, University of Stockholm, Sweden
| | - Gabriële Holtappels
- Department of Otolaryngology and Upper Airways Research Laboratory, University of Ghent, Belgium
| |
Collapse
|
8
|
Patro SK, Verma RK, Panda NK, Chakrabarti A. Understanding paediatric allergic fungal sinusitis: Is it more aggressive? Int J Pediatr Otorhinolaryngol 2015; 79:1876-80. [PMID: 26363894 DOI: 10.1016/j.ijporl.2015.08.032] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Revised: 08/20/2015] [Accepted: 08/21/2015] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To study and characterize the features of AFRS in children as compared to adults. METHODS 50 consecutive patients of AFRS attending our outpatient department were included in the study from July 2011 to December 2013. They were divided into two groups (A and B) according to age being ≤14 years and >14 years. Clinical history and examination included anterior rhinoscopy, SNOT 20 scores, CT of Nose and PNS (para nasal sinuses) (Lund Mackay scores), diagnostic nasal endoscopy (Kupferberg's grades), punch biopsy from nasal polyp, serum IgE, absolute eosinophil counts (AEC) and Aspergillus skin hypersensitivity test was done in all patients for conformation of AFRS. Bent and Kuhn's criteria were used for diagnosis. Sweat chloride levels were done in all patients of group A. RESULTS Group A had 12 patients and group B had 38. Mean duration of symptoms was significantly less in children as compared to adults (p<0.05). All patients of both groups had nasal polyposis at presentation. Unilateral disease and multisinus involvement was more common in children (6/12) as compared to adults. Proptosis (2/12) and telecanthus (4/12) was more common in children (group A) as compared to adults (group B). LM (Lund Mackay) scores and serum IgE were significantly high in children as compared to adults. Follow up CT scans showed early evidence of recurrence in children as compared to adults (p<0.05). CONCLUSION AFRS was seen to be more aggressive in children with increased fungal load when compared with adults. Typically, AFRS in children was less responsive to treatment with increased recurrence rates.
Collapse
Affiliation(s)
- Sourabha K Patro
- Department of Otolaryngology, Head and Neck Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Roshan K Verma
- Department of Otolaryngology, Head and Neck Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India.
| | - Naresh K Panda
- Department of Otolaryngology, Head and Neck Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Arunaloke Chakrabarti
- Department of Microbiology, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India
| |
Collapse
|
9
|
Nasal Immunity, Rhinitis, and Rhinosinusitis. Mucosal Immunol 2015. [DOI: 10.1016/b978-0-12-415847-4.00100-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
|
10
|
Abstract
A 42 year old male presents with worsening pain and an increase in thick chronic drainage of the left sinus. Image studies show complete opacification of the left frontal sinus, left sphenoid sinus, and the left maxillary sinus. The patient was taken to the operating room and tissue for microscopic evaluation was obtained. The microscopic findings were classic for allergic fungal sinusitis: areas of alternating mucinous material and inflammatory cell debris and abundant Charcot-Leyden crystals. Cultures were performed and the patient began steroid therapy and desensitization therapy.
Collapse
|
11
|
Montone KT. The molecular genetics of inflammatory, autoimmune, and infectious diseases of the sinonasal tract: a review. Arch Pathol Lab Med 2014; 138:745-53. [PMID: 24878014 DOI: 10.5858/arpa.2013-0038-ra] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
CONTEXT The sinonasal tract is frequently affected by a variety of nonneoplastic inflammatory disease processes that are often multifactorial in their etiology but commonly have a molecular genetic component. OBJECTIVE To review the molecular genetics of a variety of nonneoplastic inflammatory diseases of the sinonasal tract. DATA SOURCES Inflammatory lesions of the sinonasal tract can be divided into 3 main categories: (1) chronic rhinosinusitis, (2) infectious diseases, and (3) autoimmune diseases/vasculitides. The molecular diagnosis and pathways of a variety of these inflammatory lesions are currently being elucidated and will shed light on disease pathogenesis and treatment. CONCLUSIONS The sinonasal tract is frequently affected by inflammatory lesions that arise through complex interactions of environmental, infectious, and genetic factors. Because these lesions are all inflammatory in nature, the molecular pathology surrounding them is most commonly due to upregulation and down-regulation of genes that affect inflammatory responses and immune regulation.
Collapse
Affiliation(s)
- Kathleen T Montone
- From the Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| |
Collapse
|
12
|
Khan AA, Rahmani AH, Aldebasi YH, Aly SM. Biochemical and pathological studies on peroxidases -an updated review. Glob J Health Sci 2014; 6:87-98. [PMID: 25168993 PMCID: PMC4825458 DOI: 10.5539/gjhs.v6n5p87] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2014] [Accepted: 04/17/2014] [Indexed: 12/31/2022] Open
Abstract
Peroxidases represent a family of isoenzymes actively involved in oxidizing reactive oxygen species, innate immunity, hormone biosynthesis and pathogenesis of several diseases. Different types of peroxidases have organ, tissues, cellular and sub-cellular level of specificities in their function. Different diseases lead to varied expressions of peroxidases based on several mechanisms proposed. Several researches are going on to understand its deficiency, over-expression and malfunction in relation with different diseases. Some common diseases of mankind like cancer, cardiovascular diseases and diabetes directly or indirectly involve the role of peroxidases. So the status of peroxidase levels may also function as a marker of different diseases. Although many types of diseases in human beings have a strong correlation with tissue specific peroxidases, the clear role of these oxido-reductases is not yet fully understood. Here we are focusing on the role of peroxidases in relations with different diseases occurring due to oxidative stress.
Collapse
Affiliation(s)
- Amjad A Khan
- Dept. of Basic Health Sciences, College of Applied Medical Science, Qassim University, Saudi Arabia.
| | | | | | | |
Collapse
|
13
|
Romani L, Puccetti P. Controlling pathogenic inflammation to fungi. Expert Rev Anti Infect Ther 2014; 5:1007-17. [DOI: 10.1586/14787210.5.6.1007] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
14
|
Chang C, Gershwin ME, Thompson GR. Fungal disease of the nose and sinuses: an updated overview. Curr Allergy Asthma Rep 2013; 13:152-61. [PMID: 23135919 DOI: 10.1007/s11882-012-0320-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Fungal diseases of the nose and sinuses encompasses a diverse spectrum of disease. Clinical manifestations are largely dependent upon the immune status of the host, as, given the ubiquitous nature of these organisms, exposure is unavoidable. Asymptomatic colonization of the nasal passages by fungi warrants no treatment and is common, while allergic fungal rhinosinusitis is challenging and often requires a combined approach of surgical intervention, immunotherapy, and corticosteroid administration. A diagnosis requires a combination of IgE immune reactivity, eosinophilic infiltration, and fungi recovery. Similarly, invasive disease may present only after several months of slowly progressive disease, or in rapid and fulminant fashion in the appropriate host. A differentiation of these overlapping syndromes and the pathophysiologic processes at play, and recommended treatment algorithms, are the focus of this review.
Collapse
Affiliation(s)
- Christopher Chang
- Department of Pediatrics, Division of Allergy, Asthma, and Immunology, Nemours/A.I. Dupont Hospital for Children, Thomas Jefferson University, 1600 Rockland Road, Wilmington, DE, 19803, USA.
| | | | | |
Collapse
|
15
|
Abstract
PURPOSE OF REVIEW Allergic fungal sinusitis (AFS) results from an immunoglobulin E (IgE)-mediated, eosinophil-predominant hypersensitivity reaction to extramucosal fungi within the paranasal sinuses. Although the pathogenesis of this noninvasive process is still not fully understood, there is new information. Recently, the use of allergen immunotherapy with fungal antigens as an adjunct in treatment of AFS has been evaluated. In this review, we summarize the experience in the published literature on the topic. RECENT FINDINGS There is evidence to suggest that allergen immunotherapy to fungal allergens may be effective in the treatment of symptoms of AFS and may decrease the rate of postoperative exacerbations and further operations. There is no evidence that this therapy induces immune complex disease. These studies pave the way for controlled trials of immunotherapy in patients with AFS. SUMMARY Allergen immunotherapy to fungi shows promise as a treatment to decrease the recurrence of AFS and should be considered a part of the treatment regimen. However, because the number of patients treated has been small and one study suggested that fungal immunotherapy administered before removal of fungal contents from the sinuses could worsen sinusitis, controlled studies are essential to moving forward.
Collapse
|
16
|
Abstract
INTRODUCTION Allergic fungal sinusitis is thought to represent a chronic autoimmune reaction directed against fungal elements within the sinuses, and is commonly seen in individuals with a history of chronic sinusitis that is refractory to medical therapy. The authors present a case of allergic fungal sinusitis involving the lacrimal drainage system. CASE A 54-year-old woman initially presented with recurrent erythema and induration of the left nasolacrimal sac due to dacryocystitis, which was unresponsive to treatment with topical and systemic antibiotics. Radiological evaluation demonstrated the presence of multiple soft tissue masses along the medial canthi. During subsequent endoscopic dacryocystorhinostomy, significant amounts of allergic mucin were found within the sinuses and marked eosinophilia was present within tissue obtained from the lacrimal sac, findings highly suggestive of allergic fungal sinusitis. CONCLUSION A diagnosis of allergic fungal sinusitis should be considered in patients presenting with epiphora in the appropriate clinical context. However, involvement of the lacrimal drainage system is an exceedingly unusual presentation.
Collapse
Affiliation(s)
- Charles Kim
- Department of Ophthalmology, Weill Cornell Medical College, New York, NY 10021, USA
| | | | | | | |
Collapse
|
17
|
Carvalho A, Cunha C, Iannitti RG, De Luca A, Giovannini G, Bistoni F, Romani L. Inflammation in aspergillosis: the good, the bad, and the therapeutic. Ann N Y Acad Sci 2013; 1273:52-9. [PMID: 23230837 DOI: 10.1111/j.1749-6632.2012.06754.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Aspergillosis includes a spectrum of diseases caused by different Aspergillus spp. New insights into the cellular and molecular mechanisms of resistance and immune tolerance to the fungus in infection and allergy have been obtained in experimental settings. The fact that virulence factors, traditionally viewed as fungal attributes, are contingent upon microbial adaptation to various environmental stresses encountered in the human host implies that the host and fungus are jointly responsible for pathogenicity. Ultimately, despite the occurrence of severe aspergillosis in immunocompromised patients, clinical evidence indicates that aspergillosis also occurs in the setting of a heightened inflammatory response, in which immunity occurs at the expense of host damage and pathogen eradication. Thus, targeting pathogenicity rather than microbial growth, tolerance rather than resistance mechanisms of defense may pave the way to targeted anti-inflammatory strategies in difficult-to-treat patients. The challenge now is to translate promising results from experimental models to the clinic.
Collapse
Affiliation(s)
- Agostinho Carvalho
- Department of Experimental Medicine and Biochemical Sciences, University of Perugia, Perugia, Italy
| | | | | | | | | | | | | |
Collapse
|
18
|
The Pathogenesis of CRS: An Update. CURRENT OTORHINOLARYNGOLOGY REPORTS 2012. [DOI: 10.1007/s40136-012-0002-5] [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]
|
19
|
On chronic rhinosinusitis and the prevalence of fungal sinus disease: problems of diagnostic accuracy and a proposed classification of chronic rhinosinusitis. Am J Otolaryngol 2012; 33:543-8. [PMID: 22387127 DOI: 10.1016/j.amjoto.2012.01.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2012] [Accepted: 01/24/2012] [Indexed: 11/21/2022]
Abstract
There is considerable controversy in the diagnosis and classification of the type of inflammation that is attributed to various forms of chronic rhinosinusitis (CRS). Specimens obtained during surgical treatment of CRS have been invaluable resources for identifying the underlying inflammatory process. The classification of sinus inflammation is based on histopathologic examination of these surgical specimens. Accurate identification of the pathology and standardized reporting are invaluable for postsurgical treatment options and our understanding of CRS. In a large multispecialty referral hospital where multiple surgeons and pathologists are involved in clinical practice, the lack of standardization in specimen collection, specimen processing, and reporting introduce several variables that make it extremely difficult for retrospective analysis. This report focuses on consecutive endoscopic sinus surgical procedures performed by 4 different sinus surgeons over a period of 4 years in a Central Texas multispecialty hospital. This is an analysis of the reality of clinical practice without intervention. At the core of this analysis are pathology reporting practices for fungal sinus disease and the undesirable variables introduced by nonstandardized reporting. A practical classification of CRS based on pathology is proposed.
Collapse
|
20
|
Won EJ, Shin JH, Lim SC, Shin MG, Suh SP, Ryang DW. Molecular identification of Schizophyllum commune as a cause of allergic fungal sinusitis. Ann Lab Med 2012; 32:375-9. [PMID: 22950076 PMCID: PMC3427828 DOI: 10.3343/alm.2012.32.5.375] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2012] [Revised: 05/15/2012] [Accepted: 07/19/2012] [Indexed: 11/19/2022] Open
Abstract
Schizophyllum commune, a basidiomycetous fungus, rarely causes disease in humans. We report a rare case of allergic fungal sinusitis caused by S. commune in a 14-yr-old girl. The patient presented with nasal obstruction and a purulent nasal discharge. Materials obtained during endoscopic surgery of the frontal recess revealed allergic mucin and a few fungal hyphae. A potato dextrose agar (PDA) culture from the allergic mucin yielded a rapidly growing white woolly mold. Although no distinctive features including hyphae bearing spicules or a clamp connection were present, the case isolate disclosed compatible mycological features including growth at 37℃, susceptibility to cycloheximide, and production of a tart and disagreeable smell. S. commune was confirmed by sequence analysis of the internal transcribed spacer region and D1/D2 regions of the 26S ribosomal DNA. We believe this is the first report of allergic fungal sinusitis caused by S. commune in Korea. Moreover, this report highlights the value of gene sequencing as an identification tool for non-sporulating isolates of S. commune.
Collapse
Affiliation(s)
- Eun Jeong Won
- Department of Laboratory Medicine, Chonnam National University Medical School and Chonnam National University Hospital, Gwangju, Korea
| | | | | | | | | | | |
Collapse
|
21
|
Shockley R, Roy S. Allergic Fungal Rhinosinusitis in Children. EAR, NOSE & THROAT JOURNAL 2012. [DOI: 10.1177/014556131209100705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Ross Shockley
- Department of Otolaryngology, Vanderbilt University,
Nashville (Dr. Shockley), and the Department of Otolaryngology, University of Texas
Medical School at Houston, Houston, Texas. The case described in this article
occurred at the University of Texas Medical School at Houston
| | - Soham Roy
- Department of Otolaryngology, Vanderbilt University,
Nashville (Dr. Shockley), and the Department of Otolaryngology, University of Texas
Medical School at Houston, Houston, Texas. The case described in this article
occurred at the University of Texas Medical School at Houston
| |
Collapse
|
22
|
Carvalho A, Cunha C, Bozza S, Moretti S, Massi-Benedetti C, Bistoni F, Aversa F, Romani L. Immunity and tolerance to fungi in hematopoietic transplantation: principles and perspectives. Front Immunol 2012; 3:156. [PMID: 22707953 PMCID: PMC3374351 DOI: 10.3389/fimmu.2012.00156] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2012] [Accepted: 05/25/2012] [Indexed: 12/30/2022] Open
Abstract
Resistance and tolerance are two complementary host defense mechanisms that increase fitness in response to low-virulence fungi. Resistance is meant to reduce pathogen burden during infection through innate and adaptive immune mechanisms, whereas tolerance mitigates the substantial cost of resistance to host fitness through a multitude of anti-inflammatory mechanisms, including immunological tolerance. In experimental fungal infections, both defense mechanisms are activated through the delicate equilibrium between Th1/Th17 cells, which provide antifungal resistance, and regulatory T cells limiting the consequences of the ensuing inflammatory pathology. Indoleamine 2,3-dioxygenase (IDO), a rate-limiting enzyme in the tryptophan catabolism, plays a key role in induction of tolerance against fungi. Both hematopoietic and non-hematopoietic compartments contribute to the resistance/tolerance balance against Aspergillus fumigatus via the involvement of selected innate receptors converging on IDO. Several genetic polymorphisms in pattern recognition receptors influence resistance and tolerance to fungal infections in human hematopoietic transplantation. Thus, tolerance mechanisms may be exploited for novel diagnostics and therapeutics against fungal infections and diseases.
Collapse
Affiliation(s)
- Agostinho Carvalho
- Department of Experimental Medicine and Biochemical Sciences, University of Perugia Perugia, Italy
| | | | | | | | | | | | | | | |
Collapse
|
23
|
The development of a sensitive and specific ELISA for mouse eosinophil peroxidase: assessment of eosinophil degranulation ex vivo and in models of human disease. J Immunol Methods 2011; 375:138-47. [PMID: 22019643 DOI: 10.1016/j.jim.2011.10.002] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2011] [Revised: 10/03/2011] [Accepted: 10/05/2011] [Indexed: 12/11/2022]
Abstract
Mouse models of eosinophilic disorders are often part of preclinical studies investigating the underlying biological mechanisms of disease pathology. The presence of extracellular eosinophil granule proteins in affected tissues is a well established and specific marker of eosinophil activation in both patients and mouse models of human disease. Unfortunately, assessments of granule proteins in the mouse have been limited by the availability of specific antibodies and a reliance on assays of released enzymatic activities that are often neither sensitive nor eosinophil specific. The ability to detect immunologically and quantify the presence of a mouse eosinophil granule protein in biological fluids and/or tissue extracts was achieved by the generation of monoclonal antibodies specific for eosinophil peroxidase (EPX). This strategy identified unique pairs of antibodies with high avidity to the target protein and led to the development of a unique sandwich ELISA for the detection of EPX. Full factorial design was used to develop this ELISA, generating an assay that is eosinophil-specific and nearly 10 times more sensitive than traditional OPD-based detection methods of peroxidase activity. The added sensitivity afforded by this novel assay was used to detect and quantify eosinophil degranulation in several settings, including bronchoalveolar fluid from OVA sensitized/challenged mice (an animal model of asthma), serum samples derived from peripheral blood recovered from the tail vasculature, and from purified mouse eosinophils stimulated ex vivo with platelet activating factor (PAF) and PAF + ionomycin. This ability to assess mouse eosinophil degranulation represents a specific, sensitive, and reproducible assay that fulfills a critical need in studies of eosinophil-associated pathologies in mice.
Collapse
|
24
|
Intranasally delivered siRNA targeting PI3K/Akt/mTOR inflammatory pathways protects from aspergillosis. Mucosal Immunol 2010; 3:193-205. [PMID: 19924119 DOI: 10.1038/mi.2009.130] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Innate responses combine with adaptive immunity to generate the most effective form of anti-Aspergillus immune resistance. Although some degree of inflammation is required for protection, progressive inflammation may worsen disease and ultimately prevents pathogen eradication. To define molecular pathways leading to or diverting from pathogenic inflammation in infection, we resorted to dendritic cells (DCs), known to activate distinct signaling pathways in response to pathogens. We found that distinct intracellular pathways mediated the sensing of conidia and hyphae by lung DCs in vitro, which translate in vivo in the activation of protective Th1/Treg responses by conidia or inflammatory Th2/Th17 responses by hyphae. In vivo targeting inflammatory (PI3K/Akt/mTOR) or anti-inflammatory (STAT3/IDO) DC pathways by intranasally delivered small interfering RNA (siRNA) accordingly modified inflammation and immunity to infection. Thus, the screening of signaling pathways in DCs through a systems biology approach may be exploited for the development of siRNA therapeutics to attenuate inflammation in respiratory fungal infections and diseases.
Collapse
|
25
|
A 42-year-old woman with chronic rhinosinusitis and allergic mucin. Curr Allergy Asthma Rep 2009; 9:255; discussion 255-9. [PMID: 19656469 DOI: 10.1007/s11882-009-0047-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|
26
|
Shoenfeld Y, Gershwin ME. Whither autoimmunity: the lessons of anti-CCP and B cell depletion. Clin Rev Allergy Immunol 2009; 34:1-3. [PMID: 18270849 DOI: 10.1007/s12016-007-8014-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
The most difficult component to understand in autoimmune disease has been the issue of causation. In contrast, there have been enormous gains in improved diagnostics as well as improved therapy. Indeed, the use of biologics have changed the profile of numerous autoimmune diseases. In this issue, we discuss two such aspects. Firstly, we place in perspective the use of anti-citrullinated protein antibodies in rheumatoid arthritis. Second, we discuss the increasing use of B cell depletion in the treatment of autoimmunity. Clinical Reviews in Allergy and Immunology is a unique venue for these themes because it covers the spectrum of allergy through autoimmunity. Indeed, we also present a special paper on the relationships of the hepatitis B virus and autoimmunity. Although the Th1 to Th2 dichotomy is well known to both murine and human immunologists, it is really in the study of specific inflammatory responses that they are correctly placed in the perspective of the continuum of immunopathology.
Collapse
Affiliation(s)
- Yehuda Shoenfeld
- Department of Medicine B and Center for Autoimmune Diseases, Sheba Medical Center, Affiliated to Tel-Aviv University, Tel-Hashomer, 52621, Israel.
| | | |
Collapse
|
27
|
Abstract
Aspergillus can cause several forms of pulmonary disease ranging from colonization to invasive aspergillosis and largely depends on the underlying lung and immune function of the host. This article reviews the clinical presentation, diagnosis, pathogenesis, and treatment of noninvasive forms of Aspergillus infection, including allergic bronchopulmonary aspergillosis (ABPA), aspergilloma, and chronic pulmonary aspergillosis (CPA). ABPA is caused by a hypersensitivity reaction to Aspergillus species and is most commonly seen in patients who have asthma or cystic fibrosis. Aspergillomas, or fungus balls, can develop in previous areas of cavitary lung disease, most commonly from tuberculosis. CPA has also been termed semi-invasive aspergillosis and usually occurs in patients who have underlying lung disease or mild immunosuppression.
Collapse
Affiliation(s)
- Brent P Riscili
- Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, The Ohio State University Medical Center, Davis Heart and Lung Research Institute, Columbus, OH 43210, USA
| | | |
Collapse
|
28
|
Schubert MS. Allergic fungal sinusitis: pathophysiology, diagnosis and management. Med Mycol 2009; 47 Suppl 1:S324-30. [PMID: 19330659 DOI: 10.1080/13693780802314809] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Allergic fungal sinusitis (AFS) is a noninvasive form of fungal rhinosinusitis with an incidence of between 6 and 9% of all rhinosinusitis requiring surgery. Regional variation in incidence has been reported, with the southern and southwestern US particularly endemic. Patients with AFS commonly present with chronic rhinosinusitis with nasal polyps, inhalant atopy, elevated total serum immunoglobulin E (IgE), and sinus-obstructing inspissates of a characteristic extramucosal 'peanut buttery' visco-elastic eosinophil-rich material called 'allergic mucin' that contains sparse numbers of fungal hyphae. Sinus CT is always abnormal, showing findings of chronic rhinosinusitis that often include central areas of increased contrast ('hyperattenuation') within abnormal paranasal sinuses that represent the presence of fungal-containing allergic mucin. AFS has been found to be analogous in several ways to allergic bronchopulmonary aspergillosis (ABPA). Both are chronic inflammatory respiratory tract disorders that are driven by hypersensitivity responses to the presence of small numbers of extramucosal fungi found growing within airway-impacting allergic mucin. AFS allergic mucin typically cultures positive for either dematiaceous fungi such as Bipolaris spicifera or Curvularia lunata, or Aspergillus species such as A. fumigatus, A. flavus or A. niger. As with ABPA, patients have type I immediate hypersensitivity to the etiologic mold in AFS. Further, both AFS and ABPA have been found to have association with specific class II major histocompatibility alleles. Proper diagnosis of AFS and differentiation from the other forms of both noninvasive and invasive fungal rhinosinusitis requires strict adherence to published diagnostic criteria. Medical treatment of AFS has been modeled to an extent after treatment approaches for ABPA that includes the use of postoperative oral corticosteroids and aggressive antiallergic inflammation therapy. The use of follow-up measurements of total serum IgE during treatment of both AFS and ABPA patients can help to monitor disease activity. Future AFS research will lead to further insights into pathogenesis, improved treatments, and ultimately decreases in surgical recurrence rates for this highly recurrent hypertrophic rhinosinusitis disorder.
Collapse
|
29
|
Abstract
Moulds are responsible for diseases in humans through the three pathogenetic mechanisms of infection, allergy, and toxicity. Fungal infection is especially a risk factor for immunodeficient patients, but it occurs in immunocompetent patients as well. Fungal allergy is manifested as bronchial asthma, hypersensitivity pneumonitis, allergic bronchopulmonary aspergillosis, or allergic fungal sinusitis. Mycotoxicosis is almost exclusively the result of ingestion of mould-contaminated foodstuffs. In each case there is specificity for the etiologic mould. There is controversy regarding the ability of indoor airborne mould spores to cause human disease through non-specific toxicity via the inhalation route. Pulmonary mycotoxicosis is an established, although rare, occupational disease of farmers who inhale enormous quantities of mycotoxins, endotoxins, and other toxic chemicals from contaminated silage. Other conditions attributed to indoor airborne mycotoxin are unproven. These include infantile pulmonary hemosiderosis, epistaxis, 'toxic encephalopathy', immune dysregulation and a variety of subjective complaints without objective signs of pathology such as fatigue, headache, dyspnea, gastrointestinal distress, neuromuscular and skeletal complaints, etc. Non-specific irritation from moulds via the inhalation route is also a controversial subject that remains unproven. Published studies alleging an epidemiologic causal relationship are unconvincing.
Collapse
Affiliation(s)
- Abba I Terr
- UCSF Medical Center, San Francisco, California 94108, USA.
| |
Collapse
|
30
|
Abstract
Protective immunity against fungal pathogens is achieved by the integration of two distinct arms of the immune system, the innate and adaptive responses. Innate and adaptive immune responses are intimately linked and controlled by sets of molecules and receptors that act to generate the most effective form of immunity for protection against fungal pathogens. The decision of how to respond will still be primarily determined by interactions between pathogens and cells of the innate immune system, but the actions of T cells will feed back into this dynamic equilibrium to regulate the balance between tolerogenic and inflammatory responses. In the last two decades, the immunopathogenesis of fungal infections and fungal diseases was explained primarily in terms of Th1/Th2 balance. Although Th1 responses driven by the IL-12/IFN-gamma axis are central to protection against fungi, other cytokines and T cell-dependent pathways have come of age. The newly described Th17 developmental pathway may play an inflammatory role previously attributed to uncontrolled Th1 responses and serves to accommodate the seemingly paradoxical association of chronic inflammatory responses with fungal persistence in the face of an ongoing inflammation. Regulatory T cells in their capacity to inhibit aspects of innate and adaptive antifungal immunity have become an integral component of immune resistance to fungi, and provide the host with immune defense mechanisms adequate for protection, without necessarily eliminating fungal pathogens which would impair immune memory--or causing an unacceptable level of tissue damage. The enzyme indoleamine 2,3-dioxygenase and tryptophan metabolites contribute to immune homeostasis by inducing Tregs and taming overzealous or heightened inflammatory responses.
Collapse
Affiliation(s)
- Luigina Romani
- Microbiology Section, Department of Experimental Medicine and Biochemical Sciences, University of Perugia, Italy.
| |
Collapse
|
31
|
Romani L, Zelante T, De Luca A, Bozza S, Bonifazi P, Moretti S, D'Angelo C, Giovannini G, Bistoni F, Fallarino F, Puccetti P. Indoleamine 2,3-dioxygenase (IDO) in inflammation and allergy toAspergillus. Med Mycol 2009; 47 Suppl 1:S154-61. [DOI: 10.1080/13693780802139867] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
|
32
|
Crameri R, Zeller S, Glaser AG, Vilhelmsson M, Rhyner C. Cross-reactivity among fungal allergens: a clinically relevant phenomenon? Mycoses 2008; 52:99-106. [PMID: 18983424 DOI: 10.1111/j.1439-0507.2008.01644.x] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Atopic patients suffering from allergic asthma, allergic rhinitis, or atopic eczema often have detectable levels of serum IgE antibodies to fungi. Although the association between fungal sensitisation and different forms of allergic diseases, including allergic asthma and life-threatening allergic bronchopulmonary aspergillosis, is well established, the clinical relevance of cross-reactivity among different fungal species remains largely unknown. Recent progress in molecular cloning of fungal allergens and the availability of more than 40 completely sequenced fungal genomes facilitates characterisation, cloning, and production of highly pure recombinant allergens, identification of homologous and orthologous allergens widespread among the fungal kingdom, in silico prediction, and experimental in vitro and in vivo verification of cross-reactivity between homologous pan-allergens. These studies indicate that cross-reactivity is an important component of fungal sensitisation.
Collapse
Affiliation(s)
- Reto Crameri
- Swiss Institute of Allergy and Asthma Research (SIAF), Davos, Switzerland.
| | | | | | | | | |
Collapse
|
33
|
Vasculitis: Current Status and Future Directions. Clin Rev Allergy Immunol 2008; 35:1-4. [DOI: 10.1007/s12016-007-8061-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
|
34
|
Romani L, Zelante T, De Luca A, Fallarino F, Puccetti P. IL-17 and therapeutic kynurenines in pathogenic inflammation to fungi. THE JOURNAL OF IMMUNOLOGY 2008; 180:5157-62. [PMID: 18390695 DOI: 10.4049/jimmunol.180.8.5157] [Citation(s) in RCA: 96] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Largely viewed as proinflammatory, innate responses combine with adaptive immunity to generate the most effective form of antifungal resistance, and T cells exercise feedback control over diverse effects of inflammation on infection. Some degree of inflammation is required for protection, particularly in mucosal tissues, during the transitional response occurring between the rapid innate and slower adaptive response. However, progressive inflammation worsens disease and ultimately prevents pathogen eradication. IDO, tryptophan catabolites ("kynurenines"), and regulatory T cells help to tame overzealous and exaggerated inflammatory responses. In this context, IL-23 and the Th17 pathway, which down-regulate tryptophan catabolism, may instead favor pathology and serve to accommodate the seemingly paradoxical association of chronic inflammation with fungal persistence. Recent data support a view in which IL-23/IL-17 antagonistic strategies, including the administration of synthetic kynurenines, could represent a new means of harnessing progressive or potentially harmful inflammation.
Collapse
Affiliation(s)
- Luigina Romani
- Department of Experimental Medicine and Biochemical Sciences, University of Perugia, Perugia, Italy.
| | | | | | | | | |
Collapse
|
35
|
Sherer Y, Matthias T, Shoenfeld Y. Cutting Edge Issues in Autoimmunity. Clin Rev Allergy Immunol 2008; 34:275-8. [DOI: 10.1007/s12016-007-8047-9] [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]
|
36
|
Driemel O, Wagner C, Hurrass S, Müller-Richter U, Kühnel T, Reichert TE, Kosmehl H. [Allergic fungal sinusitis, fungus ball and invasive sinonasal mycosis - three fungal-related diseases]. ACTA ACUST UNITED AC 2008; 11:153-9. [PMID: 17505847 DOI: 10.1007/s10006-007-0058-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND Three different fungal-related clinical pictures have to be differentiated in the paranasal sinuses: allergic fungal sinusitis, fungus ball and invasive sinonasal mycosis. PURPOSE A morphological reevaluation of fungal-related diseases of the paranasal sinuses as well as a retrospective analysis of their clinical parameters was performed. PATIENTS AND METHODS 86 patients with patho-histological proven fungal-related disease of the nasal sinuses were enclosed in this study. Reevaluation and correlation of clinical and histological parameters were conducted on routine material (HE, PAS and Grocott) according to the modern morphological definitions. RESULTS Invasive sinonasal mycosis was seen in 22 cases, eleven male and eleven female, mean age 57 years (22 to 84 years). It was significantly related (nine out of 22 patients, 41%) to immunocompromising conditions: three patients had diabetes mellitus type II, five had have a radiation therapy due to carcinoma and one patient suffered from bacterial endocarditis. A fungus ball was diagnosed in 60 patients, 26 male, 34 female, mean age 54 years (22-88 years). An immunocompromising condition was seen in nine out of 60 patients (15%). Causes for immune impairment were diabetes mellitus (two patients), radiation therapy due to carcinoma (four patients), myocarditis (one patient) and chronic hepatitis (two patients). Allergic fungal sinusitis was recorded in four patients, three male, one female, mean age 43 years (17-63 years). No immunosuppression was diagnosed. CONCLUSIONS Despite the fact that allergic fungal sinusitis is the most common fungal disease of the paranasal sinuses, it is not well known among physicians and pathologists and therefore underrepresented within the diagnoses of paranasal infections. The term "aspergilloma" is imprecise and does not represent a clear diagnosis. A further differentiation in "fungus ball" (without invasion) and "invasive sinonasal mycosis" is required. The three groups of fungal-related sinusitis occur at different ages. Allergic fungal sinusitis is common among young adults. An immunocompromising condition is a prerequisite for an invasive sinonasal mycosis.
Collapse
Affiliation(s)
- Oliver Driemel
- Klinikum der Universität Regensburg, Klinik und Poliklinik für Mund-, Kiefer- und Gesichtschirurgie, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany.
| | | | | | | | | | | | | |
Collapse
|
37
|
Affiliation(s)
- Arturo Casadevall
- Albert Einstein College of Medicine, Department of Microbiology and Immunology, 1300 Morris Park Ave, Bronx, NY 10461, Phone 718-430-3665, E-mail
| |
Collapse
|
38
|
Bibliography. Current world literature. Nose and paranasal sinuses. Curr Opin Otolaryngol Head Neck Surg 2007; 15:48-55. [PMID: 17211184 DOI: 10.1097/moo.0b013e32802e6d9b] [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]
|