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Chen A, Pietris J, Bacchi S, Chan W, Psaltis AJ, Selva D, Lim W. Imaging Features of Invasive Fungal Rhinosinusitis: A Systematic Review. Can Assoc Radiol J 2024; 75:601-608. [PMID: 38344986 DOI: 10.1177/08465371241227424] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/02/2024] Open
Abstract
Fungal rhinosinusitis (FRS) includes non-invasive and invasive subtypes with the latter having significant morbidity and mortality. This systematic review aims to identify the imaging features most correlated with invasive fungal rhinosinusitis (IFRS) and present a checklist of these features to aid diagnosis. PubMed, Embase, CENTRAL, and Science Direct were searched from inception to May 2023, in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines. Primary research articles published in English describing the imaging features of IFRS were included. The systematic review was conducted in accordance with the PRISMA guidelines. Forty-eight articles were identified for inclusion. Six studies examined radiological features in acute invasive fungal rhinosinusitis (AIFRS), and 9 studies of chronic invasive fungal rhinosinusitis (CIFRS). A majority of studies did not specify whether IFRS cases were acute or chronic. On CT, bony erosion and mucosal thickening were the most common features. Other features include nasal soft tissue thickening, nasal cavity opacification, opacification of the affected sinus, and perisinus soft tissue infiltration. Extra-sinus extension was commonly observed on MRI, most often invading intraorbitally and intracranially. Other sites of extra-sinus extension included the cavernous sinus, pterygopalatine fossa, infratemporal fossa, masticator space, and facial soft tissue. IFRS is a condition with potential for high morbidity and mortality. Several radiological features are highly suggestive of IFRS. Early identification of high-risk radiological features using a checklist may aid prompt diagnosis and early treatment. Future research investigating the radiological differentiation between IFRS and other significant pathology including bacterial orbital cellulitis would be beneficial.
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Affiliation(s)
- Anni Chen
- Royal Adelaide Hospital, Adelaide, SA, Australia
- Department of Radiology, University of Adelaide, Adelaide, SA, Australia
| | - James Pietris
- Faculty of Medicine, University of Queensland, Herston, QLD, Australia
| | - Stephen Bacchi
- Royal Adelaide Hospital, Adelaide, SA, Australia
- College of Medicine and Public Health, Flinders University of South Australia, Bedford Park, SA, Australia
- Department of Neurology, University of Adelaide, Adelaide, SA, Australia
| | - WengOnn Chan
- Royal Adelaide Hospital, Adelaide, SA, Australia
- South Australian Institute of Ophthalmology, University of Adelaide, SA, Australia
- Department of Ophthalmology, University of Adelaide, Adelaide, SA, Australia
| | - Alkis J Psaltis
- Royal Adelaide Hospital, Adelaide, SA, Australia
- Department of Otolaryngology Head and Neck Surgery, University of Adelaide, Adelaide, SA, Australia
| | - Dinesh Selva
- Royal Adelaide Hospital, Adelaide, SA, Australia
- South Australian Institute of Ophthalmology, University of Adelaide, SA, Australia
- Department of Ophthalmology, University of Adelaide, Adelaide, SA, Australia
| | - WanYin Lim
- Royal Adelaide Hospital, Adelaide, SA, Australia
- Department of Radiology, University of Adelaide, Adelaide, SA, Australia
- Jones Radiology, Eastwood, SA, Australia
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Xun Z, Li T, Xue X. The application strategy of liposomes in organ targeting therapy. WILEY INTERDISCIPLINARY REVIEWS. NANOMEDICINE AND NANOBIOTECHNOLOGY 2024; 16:e1955. [PMID: 38613219 DOI: 10.1002/wnan.1955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Revised: 02/29/2024] [Accepted: 02/29/2024] [Indexed: 04/14/2024]
Abstract
Liposomes-microscopic phospholipid bubbles with bilayered membrane structure-have been a focal point in drug delivery research for the past 30 years. Current liposomes possess a blend of biocompatibility, drug loading efficiency, prolonged circulation and targeted delivery. Tailored liposomes, varying in size, charge, lipid composition, and ratio, have been developed to address diseases in specific organs, thereby enhancing drug circulation, accumulation at lesion sites, intracellular delivery, and treatment efficacy for various organ-specific diseases. For further successful development of this field, this review summarized liposomal strategies for targeting different organs in series of major human diseases, including widely studied cardiovascular diseases, liver and spleen immune diseases, chronic or acute kidney injury, neurodegenerative diseases, and organ-specific tumors. It highlights recent advances of liposome-mediated therapeutic agent delivery for disease intervention and organ rehabilitation, offering practical guidelines for designing organ-targeted liposomes. This article is categorized under: Therapeutic Approaches and Drug Discovery > Emerging Technologies Biology-Inspired Nanomaterials > Lipid-Based Structures.
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Affiliation(s)
- Zengyu Xun
- State Key Laboratory of Medicinal Chemical Biology, College of Life Science, Nankai University, Tianjin, People's Republic of China
| | - Tianqi Li
- State Key Laboratory of Medicinal Chemical Biology, College of Pharmacy, Nankai University, Tianjin, People's Republic of China
| | - Xue Xue
- State Key Laboratory of Medicinal Chemical Biology, College of Life Science, Nankai University, Tianjin, People's Republic of China
- State Key Laboratory of Medicinal Chemical Biology, College of Pharmacy, Nankai University, Tianjin, People's Republic of China
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Mohammadi K, Mohiyuddin SMA, Prasad KC, Rajan A, Indu Varsha G, Natrajan A, Sakalecha AK, Jose DA. Invasive Sinusitis Presenting with Orbital Complications in COVID Patients: Is Mucor the Only Cause? Indian J Otolaryngol Head Neck Surg 2024; 76:55-63. [PMID: 38440575 PMCID: PMC10908983 DOI: 10.1007/s12070-023-04077-6] [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: 06/14/2023] [Accepted: 07/11/2023] [Indexed: 03/06/2024] Open
Abstract
The second wave of COVID pandemic was associated with an outbreak of Mucormycosis. The mortality rate of Mucormycosis reaches 50-80% in cases with orbital and intracranial extension (Fadda in Acta Otorhinolaryngol Ital 41:43-50, 2021). In this outbreak we found that few of these patients had bacterial invasive sinusitis mimicking fungal sinusitis. Amphotericin the only effective drug against Mucormycosis is highly toxic and expensive and not indicated in bacterial sinusitis. Our aim was to determine the exact etiologic agent, predisposing factors and outcome of treatment of COVID associated invasive sinusitis presenting with orbital complications. It is a retrospective observational study done in 33 patients with orbital complications in COVID associated invasive sinusitis. Demographic details of the patients and clinical presentation were documented. Rhinological examination was done and a nasal swab was taken for KOH mount along with Gram`s stain and Culture and Sensitivity. All Patients underwent radiological evaluation by contrast enhanced computed tomography (CECT) or MRI. Liposomal Amphotericin B was started. Surgical debridement done. Amphotericin-B was stopped in cases reported negative for fungal elements and antibiotics administered for two weeks. Outcome of treatment was documented. A total of 33 patients were included in the study. 48.5% patients were found to have bacterial infection and 27.3% patient's fungal infections and 24.2% mixed infections.Eschar formation, necrotic tissue, erosion of the lamina papyracea was seen in both Klebsiella (33.3%) and Staphylococcal infections (16.6%) similar to Mucor and mixed infections. Persistent opthalmoplegia and deterioration of vision was associated with Mucor and mixed infections. However improvement in proptosis, ptosis, ophthalmoplegia, and vision was observed in cases associated with bacterial invasive sinusitis. Invasive bacterial sinusitis was under diagnosed during second wave of COVID. Identification of invasive bacterial sinusitis can help in de-escalation of treatment.
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Affiliation(s)
- Kouser Mohammadi
- Sri Devaraj Urs Academy of Higher Education and Research, Tamaka, Kolar, India
| | | | - K. C. Prasad
- Sri Devaraj Urs Academy of Higher Education and Research, Tamaka, Kolar, India
| | - Akshaya Rajan
- Sri Devaraj Urs Academy of Higher Education and Research, Tamaka, Kolar, India
| | | | - Arvind Natrajan
- Sri Devaraj Urs Academy of Higher Education and Research, Tamaka, Kolar, India
| | - Anil k. Sakalecha
- Sri Devaraj Urs Academy of Higher Education and Research, Tamaka, Kolar, India
| | - Diana Ann Jose
- Sri Devaraj Urs Academy of Higher Education and Research, Tamaka, Kolar, India
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Bahethi R, Talmor G, Choudhry H, Lemdani M, Singh P, Patel R, Hsueh W. Chronic invasive fungal rhinosinusitis and granulomatous invasive fungal sinusitis: A systematic review of symptomatology and outcomes. Am J Otolaryngol 2024; 45:104064. [PMID: 37769504 DOI: 10.1016/j.amjoto.2023.104064] [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: 05/24/2023] [Revised: 09/18/2023] [Accepted: 09/20/2023] [Indexed: 10/03/2023]
Abstract
INTRODUCTION Chronic invasive fungal rhinosinusitis (CIFRS) and granulomatous invasive fungal sinusitis are two uncommon diseases differentiated primarily by the pathologic finding of non-caseating granulomas in GIFRS. Both share many similarities in presentation. We aim to characterize the symptomatology and outcomes of these diseases. METHODS A comprehensive search strategy was designed to identify studies in the Cochrane, EMBASE and PubMed databases from database inception to January 2022. Inclusion criteria included all patients with a diagnosis of either CIFRS or GIFRS. All studies were screened by two reviewers. Chi-square analyses were used where appropriate. RESULTS 51 studies were included totaling 513 patients. The majority were diagnosed with CIFRS (389, 75.8 %) compared to GIFRS (124, 24.4 %). CIFRS was more common in immunocompromised or diabetic patients (p < 0.0001; p = 0.02). Patients with CIFRS were more likely to exhibit nasal symptoms including discharge (p = 0.0001), obstruction (p = 0.03) and congestion (p = 0.001) as well as systemic symptoms including fever, which no GIFRS patient exhibited, facial pain (p = 0.007), headache (p = 0.004). Aspergillus was the most common organism identified in both groups with a slight predominance among GIFRS patients (p = 0.01). GIFRS patients were also more likely to present with no identifiable organisms (p = 0.0006). CIFRS patients were more likely to die of disease (p = 0.0008). CONCLUSIONS CIFRS generally presents with more symptoms and is associated with poorer outcomes primarily occurring in an immunocompromised population. GIFRS likely follows a more insidious course in immunocompetent patients. Understanding the key differences in symptomatology and outcomes for these two populations is critical for appropriate diagnosis and prognostication.
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Affiliation(s)
- Rohini Bahethi
- Department of Otolaryngology-Head and Neck Surgery at Rutgers New, Jersey Medical School, Newark, NJ, United States.
| | - Guy Talmor
- Department of Otolaryngology-Head and Neck Surgery at Rutgers New, Jersey Medical School, Newark, NJ, United States
| | - Hannaan Choudhry
- Department of Otolaryngology-Head and Neck Surgery at Rutgers New, Jersey Medical School, Newark, NJ, United States
| | - Mehdi Lemdani
- Department of Otolaryngology-Head and Neck Surgery at Rutgers New, Jersey Medical School, Newark, NJ, United States
| | - Priyanka Singh
- Department of Otolaryngology-Head and Neck Surgery at Rutgers New, Jersey Medical School, Newark, NJ, United States
| | - Rushi Patel
- Department of Otolaryngology-Head and Neck Surgery at Rutgers New, Jersey Medical School, Newark, NJ, United States
| | - Wayne Hsueh
- Department of Otolaryngology-Head and Neck Surgery at Rutgers New, Jersey Medical School, Newark, NJ, United States
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Varghese L, Kurien R, Cherian LM, Rebekah G, Regi S, Selvaraj DSS, Abhilash KPP, Thomas M, Michael JS, Varghese GM, Rupa V. Optimizing Surgical Management of Acute Invasive Fungal Sinusitis. Turk Arch Otorhinolaryngol 2023; 61:175-182. [PMID: 38784956 PMCID: PMC11110089 DOI: 10.4274/tao.2024.2023-10-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 01/05/2024] [Indexed: 05/25/2024] Open
Abstract
Objective Early surgical debridement is vital for favorable outcomes in acute invasive fungal sinusitis (AIFS). Our study aimed to propose guidelines with tailored, conservative surgical procedures based on areas of involvement and evaluate their usefulness in avoiding repeated debridement. Methods This retrospective observational study was conducted on 150 AIFS patients operated on with the proposed surgical guidelines from May to June 2021 at a tertiary care hospital. Data including demography, comorbidities, surgical procedures, revision surgery, and outcome were collected and analyzed. Results All 150 patients underwent bilateral endoscopic sinonasal debridement. Among them, 108 patients (72%) had current or recent coronavirus disease (COVID) infection. Ninety-two patients (61.3%) required additional procedures based on disease extent. Twenty patients (15.4%) required revision debridement because of progressive or recurrent disease. Mean age of this group was 46.15 (standard deviation ±11.2) years with a strong male predominance (9:1). Seventeen had diabetes mellitus, 12 suffered from active COVID-19 infection and six had received corticosteroids. None of the 31 patients who had recovered from COVID-19 or had no comorbidities required revision surgery. Age, gender, and comorbidities were not significant predictors for revision surgery. Fourteen patients (70%) underwent second surgery within one month of primary surgery. Predominant disease locations were alveolus and palate (55% each), and in 80% the site was uninvolved at primary surgery. The most common revision procedure was inferior partial maxillectomy (60%). At follow-up, all were asymptomatic with no evidence of disease. Conclusion The proposed surgical guidelines for AIFS allow for adequate surgical debridement with preservation of optimum functional status. Low revision surgery rates and good outcomes with minimal morbidity validate its usefulness.
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Affiliation(s)
- Lalee Varghese
- Department of Otorhinolaryngology, Christian Medical College, Vellore, India
| | - Regi Kurien
- Department of Otorhinolaryngology, Christian Medical College, Vellore, India
| | - Lisa Mary Cherian
- Department of Otorhinolaryngology, Christian Medical College, Vellore, India
| | - Grace Rebekah
- Department of Biostatistics, Christian Medical College, Vellore, India
| | - Soumya Regi
- Department of Radiodiagnosis, Christian Medical College, Vellore, India
| | | | | | - Meera Thomas
- Department of Pathology, Christian Medical College, Vellore, India
| | | | - George M. Varghese
- Department of Infectious Diseases, Christian Medical College, Vellore, India
| | - Vedantam Rupa
- Department of Otorhinolaryngology, Christian Medical College, Vellore, India
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Sawhney A, Rajaratnam N, Finkel D. Progression of chronic rhinosinusitis to invasive cerebro-orbital aspergillosis following steroid treatment: A case of induced immunosuppression. IDCases 2023; 32:e01772. [PMID: 37207174 PMCID: PMC10189251 DOI: 10.1016/j.idcr.2023.e01772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Revised: 04/20/2023] [Accepted: 04/21/2023] [Indexed: 05/21/2023] Open
Abstract
Invasive aspergillosis is a classic fungal infection of immunocompromised hosts which rarely manifests in immunocompetent patients. In this report, we present a case of invasive aspergillosis which resulted from induced immunosuppression through corticosteroid treatment of chronic rhinosinusitis. Further investigation is necessary into the epidemiology of mixed fungal rhinosinusitis and providers should be wary of invasive disease in those receiving chronic steroids.
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Affiliation(s)
| | - Nishan Rajaratnam
- Rutgers New Jersey Medical School, Department of Medicine, Division of Infectious Diseases, United States
- Corresponding author.
| | - Diana Finkel
- Rutgers New Jersey Medical School, Department of Medicine, Division of Infectious Diseases, United States
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Tsuda T, Takeda K, Fujii S, Hayama M, Inohara H. Pseudo-malignant paranasal invasive aspergillosis showing bone destruction and FDG uptake on PET/CT: A case report. Medicine (Baltimore) 2022; 101:e31759. [PMID: 36397331 PMCID: PMC9666084 DOI: 10.1097/md.0000000000031759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
RATIONALE Aspergillosis is a rare disease that often occurs in patients with diabetes mellitus or compromised hosts. This study describes a 60-years-old woman with unusual pseudo-malignant paranasal invasive aspergillosis with 18F-fluorodeoxyglucose (18F-FDG) uptake treated by endoscopic sinus surgery. To the best of our knowledge, there are few reported cases of paranasal fungal infection with 18F-FDG uptake. PATIENTS CONCERNS A 60-years-old woman was presented with headache and nasal obstruction. DIAGNOSES Computed tomography (CT) showed a shadow with bone destruction in the sinus cavity and accumulation of 18F-FDG uptake. The patient was diagnosed with a malignant tumor or pseudo-malignant paranasal invasive aspergillosis. INTERVENTIONS The patient underwent endoscopic sinus surgery; no neoplastic lesions were detected in the areas with CT shadows. All the observed fungal mass reservoirs were removed. OUTCOMES The patient remained hospitalized for 1 week after the surgery with no significant postoperative abnormalities. There was no recurrence of the disease for 6 months, and the patient's symptoms resolved, indicating a good course of follow-up. LESSONS Invasive aspergillosis should be considered a differential disease when positron emission tomography (PET)/CT scans show FDG uptake, CT shows bone destruction, and T2-weighted MRI scans show a low signal.
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Affiliation(s)
- Takeshi Tsuda
- Department of Otorhinolaryngology–Head and Neck Surgery, Osaka University Graduate School of Medicine, Suita City, Osaka, Japan
| | - Kazuya Takeda
- Department of Otorhinolaryngology–Head and Neck Surgery, Osaka University Graduate School of Medicine, Suita City, Osaka, Japan
- * Correspondence: Kazuya Takeda, Department of Otorhinolaryngology–Head and Neck Surgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita City, Osaka 565-0871, Japan (e-mail: )
| | - Soichiro Fujii
- Department of Otorhinolaryngology–Head and Neck Surgery, Osaka University Graduate School of Medicine, Suita City, Osaka, Japan
| | - Masaki Hayama
- Department of Otorhinolaryngology–Head and Neck Surgery, Osaka University Graduate School of Medicine, Suita City, Osaka, Japan
- Department of Otorhinolaryngology, Hyogo Prefectural Nishinomiya Hospital, Nishinomiya City, Hyogo, Japan
| | - Hidenori Inohara
- Department of Otorhinolaryngology–Head and Neck Surgery, Osaka University Graduate School of Medicine, Suita City, Osaka, Japan
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Sulena S, Dhawan M, Singh N, Arora H, Singh G, Aggarwal V, Tapasvi C. Clinicoradiological profile and outcome of cavernous sinus syndrome with coronavirus disease-2019-associated rhino-orbito-cerebral mucormycosis. J Neurosci Rural Pract 2022; 13:730-739. [PMID: 36743739 PMCID: PMC9894018 DOI: 10.25259/jnrp-2022-2-29] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 09/20/2022] [Indexed: 12/04/2022] Open
Abstract
Objective With coronavirus disease 2019 (COVID-19) pandemic across the world, there had been an exponential increase in rhino-orbito-cerebral mucormycosis (ROCM). Extension of infection to cavernous sinus leads to cavernous sinus syndrome (CSS). This study aims to describe incidence, clinicoradiological profile, and outcome of CSS positive along with comparative analysis of CSS negative COVID-19-associated ROCM. Material and Method This was a prospective and observational study conducted from May 1, 2021, to July 31, 2021. Subjects included ROCM with active or recovered COVID-19 (past 6 weeks) and were categorized and staged. CSS was defined as involvement of two or more of third, fourth, fifth, or sixth cranial nerve with one each direct and indirect qualitative neuroradiological features. Clinicoradiological features of CSS-positive and negative COVID-19-associated ROCM groups were compared. Results Incidence of CSS with COVID-19-associated ROCM was 28%. Mean age of subjects was 44 ± 15 years with 60% being males and 73% were proven ROCM. Significant differences seen across the CSS-positive and negative groups were ocular, nasal, and cerebral findings including eyelid and periocular discoloration, ptosis, proptosis, ophthalmoplegia, nasal discharge, mucosal inflammation, and fever. Oculomotor, trochlear, and abducens nerves were significantly involved more in CSS-positive group. Significant radiological findings across two groups included indirect features in orbit, nose, and paranasal sinuses along with direct features in cavernous sinus. Surgical intervention was more common in CSS-positive group. Mortality in CSS-positive group at 8-24 weeks was 13 and 27%, respectively. Conclusion Extension of ROCM to CSS was more common in young males in advanced stages of proven ROCM with concurrent COVID-19. CSS-positive group had significant difference in clinicoradiological features involving orbit, nose, paranasal sinuses, and central nervous system as compared to CSS-negative group. This study highlights the need to develop an objective scoring system considering clinical and radiological features for diagnosis of CSS with COVID-19-associated ROCM.
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Affiliation(s)
- Sulena Sulena
- Department of Neurology, Guru Gobind Singh Medical College, Faridkot, India
| | - Munish Dhawan
- Department of Ophthalmology, Guru Gobind Singh Medical College, Faridkot, India
| | - Navchint Singh
- Department of Ophthalmology, Guru Gobind Singh Medical College, Faridkot, India
| | - Hobinder Arora
- Department of Community Medicine, Guru Gobind Singh Medical College, Faridkot, India
| | - Gurbax Singh
- Department of ENT, Guru Gobind Singh Medical College, Faridkot, India
| | - Varun Aggarwal
- Department of Neurosurgery, All India Institute of Medical Sciences, Bathinda, India
| | - Chaitanya Tapasvi
- Department of Radiodiagnosis, Guru Gobind Singh Medical College, Faridkot, Punjab, India
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Ray SK, Mukherjee S. COVID-19-Associated Mucormycosis, A New Incident in Recent Time: Is An Emerging Disease in The Near Future Impending? Avicenna J Med 2021; 11:210-216. [PMID: 34881204 PMCID: PMC8648408 DOI: 10.1055/s-0041-1735383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Mucormycosis (also known as black fungus) is caused by fungi of the Zygomycetes class and is the third most common invasive mycosis after candidiasis and aspergillosis. They colonize a large number of patients without invading them. Systemic glucocorticoids are currently used to treat severe Coronavirus disease 19 (COVID-19). In such patients, opportunistic fungal infections are a problem. Although COVID-19-related pulmonary aspergillosis is becoming more common, mucormycosis is still uncommon. Mucormycosis normally appears 10 to 14 days after being admitted to the hospital. Mucormycosis is a rare but dangerous infection that can make extreme COVID-19 worse. Mucormycosis is more likely to occur in people who have diabetes mellitus and other risk factors. Mucormycosis is most likely exacerbated by concurrent glucocorticoid treatment. To improve outcomes, a high index of suspicion and aggressive management is required. Excessive usage of steroids, monoclonal antibodies, and broad-spectrum antibiotics might cause the formation or worsen of a fungal infection. A high index of suspicion and aggressive management are needed. In patients with COVID-19 infection, physicians should be vigilant of the likelihood of subsequent invasive fungal infections. To enhance results in pulmonary mucormycosis, early diagnosis and treatment are critical. Confirmation of the clinical form necessitates a combination of symptoms that are consistent with tissue invasion histologically. Combining various clinical data and the isolation of the fungus from clinical samples in culture is needed for the probable diagnosis of mucormycosis. The organism that causes mucormycosis is identified using macroscopic and microscopic morphological criteria, carbohydrate assimilation, and the maximum temperature at which they can expand. Mucormycosis must be treated with antifungal medication prescribed by a doctor. It may necessitate surgery in some circumstances, and it can result in the loss of the upper jaw and, in some situations, an eye.
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Affiliation(s)
- Suman Kumar Ray
- Department of Applied Sciences, Indira Gandhi Technological and Medical Sciences University, Arunachal Pradesh, India
| | - Sukhes Mukherjee
- Department of Biochemistry, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
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Twu KH, Kuo YJ, Ho CY, Kuan EC, Wang WH, Lan MY. Invasive Fungal Rhinosinusitis with and without Orbital Complications: Clinical and Laboratory Differences. J Fungi (Basel) 2021; 7:jof7070573. [PMID: 34356952 PMCID: PMC8306043 DOI: 10.3390/jof7070573] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Revised: 07/15/2021] [Accepted: 07/16/2021] [Indexed: 12/24/2022] Open
Abstract
Background: Invasive fungal rhinosinusitis (IFS) is a rare but often fatal disease. There are limited studies regarding IFS with orbital complications (IFSwOC). The present study aimed to identify the clinical signs associated with IFSwOC and prognosticators of the disease. Methods: A retrospective case series was conducted of patients histopathologically confirmed IFS or fungal rhinosinusitis with clinically apparent neuro-orbital complications who underwent surgery between 2008 and 2018. Demographic data, presenting symptoms and signs, culture data, laboratory results, and patient outcomes were obtained from medical records. Results: A total of 38 patients were identified, including 9 patients with IFSwOC, and 29 patients with IFS without orbital complications (IFSsOC). The clinical signs associated with developing orbital complications include headache, fever, sphenoid sinus, or posterior ethmoid sinus involvement, CRP level ≥ 1.025 mg/dL, or ESR level ≥ 46.5 mm/h. In IFSwOC group, male, posterior ethmoid sinus involvement, WBC count ≥ 9000 μL, CRP level ≥ 6.91 mg/dL, or ESR level ≥ 69 mm/h were correlated with a significantly poorer prognosis. Conclusion: IFS patients with sphenoid or posterior ethmoid sinus involvement, headache or fever as presenting symptoms, elevated CRP, and ESR level were at risk of developing orbital complications. Timely surgical debridement followed by systemic antifungal treatment may improve treatment outcomes.
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Affiliation(s)
- Kuan-Hsiang Twu
- Department of Otolaryngology-Head and Neck Surgery, Taipei Veterans General Hospital, Taipei 11217, Taiwan;
- School of Medicine, National Yang Ming Chiao Tung University, Taipei 11221, Taiwan; (Y.-J.K.); (C.-Y.H.); (W.-H.W.)
| | - Ying-Ju Kuo
- School of Medicine, National Yang Ming Chiao Tung University, Taipei 11221, Taiwan; (Y.-J.K.); (C.-Y.H.); (W.-H.W.)
- Department of Pathology, Taipei Veterans General Hospital, Taipei 11217, Taiwan
| | - Ching-Yin Ho
- School of Medicine, National Yang Ming Chiao Tung University, Taipei 11221, Taiwan; (Y.-J.K.); (C.-Y.H.); (W.-H.W.)
- Department of Otolaryngology, Cheng Hsin General Hospital, Taipei 11220, Taiwan
| | - Edward C. Kuan
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, CA 92868, USA;
| | - Wei-Hsin Wang
- School of Medicine, National Yang Ming Chiao Tung University, Taipei 11221, Taiwan; (Y.-J.K.); (C.-Y.H.); (W.-H.W.)
- Department of Neurosurgery, Taipei Veterans General Hospital, Taipei 11217, Taiwan
| | - Ming-Ying Lan
- Department of Otolaryngology-Head and Neck Surgery, Taipei Veterans General Hospital, Taipei 11217, Taiwan;
- School of Medicine, National Yang Ming Chiao Tung University, Taipei 11221, Taiwan; (Y.-J.K.); (C.-Y.H.); (W.-H.W.)
- Correspondence: ; Tel.: +886-2-2875-7337
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