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Solé D, Kuschnir FC, Pastorino AC, Constantino CF, Galvão C, Chong E Silva DC, Baptistella E, Goudouris ES, Sakano E, Ejzenbaum F, Matsumoto FY, Mizoguchi FM, Aarestrup FM, Wandalsen GF, Chong Neto HJ, Brito de Oliveira JV, Faibes Lubianca Neto J, Rizzo MCV, Silva Chavarria MLF, Urrutia-Pereira M, Filho NAR, de Paula Motta Rubini N, Mion O, Piltcher OB, Ramos RT, Francesco RD, Roithmann R, Anselmo-Lima WT, Romano FR, de Mello Júnior JF. V Brazilian Consensus on Rhinitis - 2024. Braz J Otorhinolaryngol 2024; 91:101500. [PMID: 39388827 DOI: 10.1016/j.bjorl.2024.101500] [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: 08/14/2024] [Accepted: 08/17/2024] [Indexed: 10/12/2024] Open
Abstract
Since we published the "IV Brazilian Consensus on Rhinitis", in2017, several advances have been achieved and have enabled a further understanding of the different aspects of "Rhinitis". This new guideline, developed jointly by ASBAI, SBP and SBORL, represents a relevant milestone in the updated and integrated management of the different forms of the disease, and it aims to unify evidence-based approaches to improve the diagnosis and treatment of this common and often underestimated condition. The document covers a wide range of topics, including clear definitions of the different phenotypes and endotypes of rhinitis, risk factors, updated diagnostic criteria, and recommended methods for clinical and laboratory investigation. We stress the importance of detailed clinical history and objective assessment, as well as tools for control and assessing severity tools an accurate diagnostic approach to the disease. Regarding treatment, it emphasizes the treatment customization, considering the severity of symptoms, the presence of comorbidities and the impact on the patient's quality of life. We discuss different drug treatment, in addition to non-pharmacological measures, such as environmental control and specific immunotherapy; and the possible role of immunobiological agents. Furthermore, the consensus addresses issues related to patient education, prevention and management of special situations, such as rhinitis in children, in pregnant women and in the elderly. In short, the "V Brazilian Consensus on Rhinitis" represents a comprehensive and updated guide for healthcare professionals involved in the diagnosis and management of rhinitis, aiming to improve patients' quality of life through an integrated and evidence-based approach.
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Affiliation(s)
- Dirceu Solé
- Universidade Federal de São Paulo, Escola Paulista de Medicina, São Paulo, SP, Brazil; Sociedade Brasileira de Pediatria, Rio de Janeiro, RJ, Brazil
| | - Fábio Chigres Kuschnir
- Associação Brasileira de Alergia e Imunologia, São Paulo, SP, Brazil; Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Antônio Carlos Pastorino
- Sociedade Brasileira de Pediatria, Rio de Janeiro, RJ, Brazil; Universidade de São Paulo, São Paulo, SP, Brazil
| | - Clóvis F Constantino
- Sociedade Brasileira de Pediatria, Rio de Janeiro, RJ, Brazil; Universidade de Santo Amaro, São Paulo, SP, Brazil
| | - Clóvis Galvão
- Associação Brasileira de Alergia e Imunologia, São Paulo, SP, Brazil; Universidade de São Paulo, São Paulo, SP, Brazil
| | - Débora Carla Chong E Silva
- Sociedade Brasileira de Pediatria, Rio de Janeiro, RJ, Brazil; Universidade Federal do Paraná́, Curitiba, PR, Brazil
| | - Eduardo Baptistella
- Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial, São Paulo, SP, Brazil
| | - Ekaterini Simões Goudouris
- Sociedade Brasileira de Pediatria, Rio de Janeiro, RJ, Brazil; Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Eulália Sakano
- Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial, São Paulo, SP, Brazil; Universidade Estadual de Campinas, Campinas, SP, Brazil
| | - Fábio Ejzenbaum
- Sociedade Brasileira de Pediatria, Rio de Janeiro, RJ, Brazil; Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, SP, Brazil
| | - Fausto Yoshio Matsumoto
- Universidade Federal de São Paulo, Escola Paulista de Medicina, São Paulo, SP, Brazil; Sociedade Brasileira de Pediatria, Rio de Janeiro, RJ, Brazil
| | - Flavio Massao Mizoguchi
- Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial, São Paulo, SP, Brazil
| | - Fernando Monteiro Aarestrup
- Associação Brasileira de Alergia e Imunologia, São Paulo, SP, Brazil; Universidade Federal de Juiz de Fora, Juiz de Fora, MG, Brazil
| | - Gustavo F Wandalsen
- Universidade Federal de São Paulo, Escola Paulista de Medicina, São Paulo, SP, Brazil; Sociedade Brasileira de Pediatria, Rio de Janeiro, RJ, Brazil
| | - Herberto José Chong Neto
- Sociedade Brasileira de Pediatria, Rio de Janeiro, RJ, Brazil; Universidade Federal do Paraná́, Curitiba, PR, Brazil
| | | | - José Faibes Lubianca Neto
- Sociedade Brasileira de Pediatria, Rio de Janeiro, RJ, Brazil; Fundação Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, RS, Brazil
| | | | | | - Marilyn Urrutia-Pereira
- Associação Brasileira de Alergia e Imunologia, São Paulo, SP, Brazil; Universidade Federal do Pampa, Uruguaiana, RS, Brazil
| | - Nelson Augusto Rosário Filho
- Associação Brasileira de Alergia e Imunologia, São Paulo, SP, Brazil; Universidade Federal do Paraná́, Curitiba, PR, Brazil
| | - Norma de Paula Motta Rubini
- Associação Brasileira de Alergia e Imunologia, São Paulo, SP, Brazil; Universidade Federal do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Olavo Mion
- Universidade de São Paulo, São Paulo, SP, Brazil; Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial, São Paulo, SP, Brazil
| | - Otávio Bejzman Piltcher
- Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial, São Paulo, SP, Brazil; Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazi
| | - Regina Terse Ramos
- Sociedade Brasileira de Pediatria, Rio de Janeiro, RJ, Brazil; Universidade Federal da Bahia, Salvador, BA, Brazil
| | - Renata Di Francesco
- Sociedade Brasileira de Pediatria, Rio de Janeiro, RJ, Brazil; Universidade de São Paulo, São Paulo, SP, Brazil
| | - Renato Roithmann
- Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial, São Paulo, SP, Brazil; Universidade Luterana do Brasil, Canos, RS, Brazil
| | - Wilma Terezinha Anselmo-Lima
- Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial, São Paulo, SP, Brazil; Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Ribeirão Preto, SP, Brazil
| | - Fabrizio Ricci Romano
- Universidade de São Paulo, São Paulo, SP, Brazil; Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial, São Paulo, SP, Brazil
| | - João Ferreira de Mello Júnior
- Universidade de São Paulo, São Paulo, SP, Brazil; Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial, São Paulo, SP, Brazil.
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Kwiatkowska MA, Craig JR. Unilateral Sinus Disease: What Is, and Is Not Odontogenic Sinusitis? Otolaryngol Clin North Am 2024:S0030-6665(24)00090-2. [PMID: 39147657 DOI: 10.1016/j.otc.2024.06.005] [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: 08/17/2024]
Abstract
The differential diagnosis of unilateral sinus disease (USD) is broad, and while concerning etiologies like sinonasal neoplasia, invasive fungal sinusitis, and cerebrospinal fluid rhinorrhea should always be considered, most cases are due to noninvasive inflammatory or infectious conditions. To diagnose USD appropriately, clinicians must integrate the clinical history and examination, nasal endoscopy, computed tomography (CT), and possibly MRI. Odontogenic sinusitis (ODS) is the most common cause of unilateral maxillary sinus opacification on CT, with 45% to 75% of such cases being odontogenic in nature. This study provides USD diagnostic considerations and reinforces the diagnostic approach to ODS.
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Affiliation(s)
- Marta A Kwiatkowska
- Department of Otolaryngology and Oncological Laryngology, Military Institute of Medicine, National Research Institute, Warsaw, Poland. https://twitter.com/MartaKwiat_ska
| | - John R Craig
- Division Head of Rhinology, Department of Otolaryngology-Head and Neck Surgery, Henry Ford Health-Michigan State University College of Human Medicine, Henry Ford Hospital, 2799 West Grand Boulevard, Detroit, MI 48202, USA.
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3
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Cameron BH, Gong SW, Corry DB, Luong AU. Update on the Role of Fungus in Allergy, Asthma, and the Unified Airway. Otolaryngol Clin North Am 2024; 57:279-292. [PMID: 37867110 DOI: 10.1016/j.otc.2023.09.005] [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] [Indexed: 10/24/2023]
Abstract
The united airway refers to the combined upper and lower airways and their interconnected pathophysiologic relationships. Inflammatory airway diseases (chronic rhinosinusitis, asthma, and so forth) have been linked to fungal species through type 2 immune responses. These type 2 immune responses involve the cytokines interleukin (IL)-4, IL-5, IL-13, and a myriad of other inflammatory processes that lead to a spectrum of diseases from allergic bronchopulmonary mycosis to chronic rhinosinusitis. Historically, these diseases have been managed primarily with corticosteroids but recent revelations in the molecular pathophysiology provide opportunities for more diverse treatment options for patients with uncontrolled disease.
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Affiliation(s)
- Brian H Cameron
- Department of Otorhinolaryngology - Head and Neck Surgery, McGovern Medical School at the University of Texas Health Science Center, 6431 Fannin Street, MSB 5.036, Houston, TX, USA
| | - Shaina W Gong
- Department of Otorhinolaryngology - Head and Neck Surgery, McGovern Medical School at the University of Texas Health Science Center, 6431 Fannin Street, MSB 5.036, Houston, TX, USA
| | - David B Corry
- Department of Medicine, Biology of Inflammation Center, Baylor College of Medicine, One Baylor Plaza, Houston, 77030 TX, USA
| | - Amber U Luong
- Department of Otorhinolaryngology - Head and Neck Surgery, McGovern Medical School at the University of Texas Health Science Center, 6431 Fannin Street, MSB 5.036, Houston, TX, USA; Center for Immunology and Autoimmune Diseases, Institute of Molecular Medicine, 1835 Pressler, Houston, TX, 77030 USA.
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Han SA, Kim S, Seo Y, Yang SK, Rhee CS, Han DH. Dental implant as a potential risk factor for maxillary sinus fungus ball. Sci Rep 2024; 14:2483. [PMID: 38291074 PMCID: PMC10827791 DOI: 10.1038/s41598-024-52661-9] [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: 08/24/2023] [Accepted: 01/22/2024] [Indexed: 02/01/2024] Open
Abstract
Fungus ball is the most common form of non-invasive fungal sinusitis, and maxillary sinus is the most commonly involved site. Maxillary sinus fungus ball (MFB) accounts for a considerable proportion of unilateral maxillary sinusitis. The prevalence of MFB has recently increased; however, its contributing factors are unclear. This study analyzed the association between MFB and dental implants. One hundred one patients who underwent unilateral maxillary sinus surgery were divided into two groups based on surgical biopsy results: unilateral bacterial sinusitis (UBS, n = 45) and MFB (n = 56). Stratified random sampling of 30 patients from each group was performed to adjust for age. The number of dental implants on maxillary teeth and degree of penetration into the maxillary sinus was radiologically evaluated. The number of patients with dental implants was greater (P = 0.085) and the number of implants was significantly higher (P = 0.031) in the MFB group. Dental implant can be a potential risk factor for MFB development. Therefore, dental implant surgeons should take caution in penetrating the maxillary sinus floor during implant insertion and otolaryngologists should consider the possibility of fungus ball when assessing patients with sinusitis who have dental implants.
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Affiliation(s)
- Sun A Han
- Department of Otorhinolaryngology-Head and Neck Surgery, Hallym University Dongtan Sacred Heart Hospital, Hwaseong-si, Republic of Korea
| | - Sungtae Kim
- Department of Periodontology, Dental Research Institute, Seoul National University School of Dentistry, Seoul, Republic of Korea
| | - Yuju Seo
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University College of Medicine, Daehakro 101, Jongno-gu, Seoul, Republic of Korea
| | - Seung Koo Yang
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University College of Medicine, Daehakro 101, Jongno-gu, Seoul, Republic of Korea
| | - Chae-Seo Rhee
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University College of Medicine, Daehakro 101, Jongno-gu, Seoul, Republic of Korea
- Graduate School of Immunology, Seoul National University College of Medicine, Seoul, Republic of Korea
- Institute of Allergy and Clinical Immunology and Sensory Organ Research Institute, Seoul National University Biomedical Research Center, Seoul, Republic of Korea
- Sensory Organ Research Institute, Seoul National University Biomedical Research Center, Seoul, Republic of Korea
| | - Doo Hee Han
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University College of Medicine, Daehakro 101, Jongno-gu, Seoul, Republic of Korea.
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Mohammadi R, Taghian E, Abtahi S, Mohammadi A, Hashemi S, Ahmadikia K, Dolatabadi S. A study on the fungal rhinosinusitis: Causative agents, symptoms, and predisposing factors. JOURNAL OF RESEARCH IN MEDICAL SCIENCES 2023; 28:12. [PMID: 37064793 PMCID: PMC10098138 DOI: 10.4103/jrms.jrms_270_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Revised: 09/01/2022] [Accepted: 09/26/2022] [Indexed: 03/18/2023]
Abstract
Background In natural conditions, inhaled fungi are considered a part of the microflora of nasal cavities and sinuses. However, subsequent to the protracted use of corticosteroids and antibacterial agents, suppression of the immune system by chemotherapy, and poor ventilation, these fungi can become pathogens. Fungal colonization in the nose and paranasal sinuses is a prevalent medical issue in immunocompetent and immunosuppressed patients. In this study, we aimed to categorize fungal rhinosinusitis (FRS) among immunocompetent and immunosuppressed patients and identified the etiologic agents of disease by molecular methods. Materials and Methods A total of 74 cases were evaluated for FRS. Functional endoscopic sinus surgery was performed for sampling. The clinical samples were examined by direct microscopy with potassium hydroxide 20% and subcultured on Sabouraud Dextrose Agar with chloramphenicol. Polymerase chain reaction sequencing was applied to identify causative agents. Results Thirty-three patients (44.6%) had FRS. Principal predisposing factors were antibiotic consumption (n = 31, 93.9%), corticosteroid therapy (n = 22, 66.6%), and diabetes mellitus (n = 21, 63.6%). Eyesore (n = 22, 66.6%), proptosis (n = 16, 48.5%), and headache (n = 15, 45.4%) were the most common clinical manifestations among patients. Rhizopus oryzae (n = 15, 45.4%) and Aspergillus flavus (n = 10, 30.3%) were the most prevalent fungal species. Conclusion Diagnosis and classification of FRS are crucial, and a lack of early precise diagnosis can lead to a delay in any surgical or medical management. Since there are a variety of treatments for FRS, accurate identification of etiologic agents should be performed based on phenotypic and molecular methods.
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Saravanam PK, Thattarakkal VR, Arun A. Rhino-Orbito-Cerebral Mucormycosis: An Audit. Indian J Otolaryngol Head Neck Surg 2022; 74:2686-2692. [PMID: 36452555 PMCID: PMC9702400 DOI: 10.1007/s12070-020-02033-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Accepted: 08/03/2020] [Indexed: 10/23/2022] Open
Abstract
This study aims at identifying the predisposing factors, clinical and radiological features that dictated the treatment outcome of Rhino-orbito-cerebral mucormycosis (ROCM). This is a retrospective observational study. Medical records of 39 patients with ROCM proven by fungal smear or histopathology (HPE), admitted in Sri Ramachandra Institute of Higher Education and Research from Jan 2015 to Dec 2019 were reviewed and audited. The mean age of the patients was 52.6 years and they were predominantly men (76.9%). There is a statistically significant association between uncontrolled diabetes and increasing severity of the disease in this study and an important cause of mortality. Fungal smear and HPE plays a crucial role in diagnosis. Radiological evaluation helps in identifying the extent of spread and in this study 31% of patients had intraorbital and 20% had intracranial extension. In-hospital mortality was 13%. Our results showed better outcome when combined medical and surgical intervention was undertaken. Rhino-orbito-cerebral Mucormycosis is a rapidly spreading invasive fungal infection with significant mortality and morbidity. Early diagnosis and proactive surgical and medical intervention is crucial for better outcome. Hence the clinician should be highly alert to certain subtle clinical signs and radiological features in a diabetic patients for improving the treatment outcomes and avoiding potentially fatal complications.
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Affiliation(s)
- Prasanna Kumar Saravanam
- Department of ENT, Head and Neck Surgery, Sri Ramachandra Institute of Higher Education and Research, Porur, Chennai, Tamil Nadu 600116 India
| | - Vinay Raj Thattarakkal
- Department of ENT, Head and Neck Surgery, Sri Ramachandra Institute of Higher Education and Research, Porur, Chennai, Tamil Nadu 600116 India
| | - Arthi Arun
- Department of ENT, Head and Neck Surgery, Sri Ramachandra Institute of Higher Education and Research, Porur, Chennai, Tamil Nadu 600116 India
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Kurokawa M, Kurokawa R, Baba A, Kim J, Tournade C, Mchugh J, Trobe JD, Srinivasan A, Bapuraj JR, Moritani T. Deadly Fungi: Invasive Fungal Rhinosinusitis in the Head and Neck. Radiographics 2022; 42:2075-2094. [PMID: 36178803 DOI: 10.1148/rg.220059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Invasive fungal rhinosinusitis (IFRS) is a serious infection that is associated with high morbidity and mortality rates. The incidence of IFRS has been increasing, mainly because of the increased use of antibiotics and immunosuppressive drugs. Rhino-orbital cerebral mucormycosis has recently reemerged among patients affected by COVID-19 and has become a global concern. The detection of extrasinus involvement in its early stage contributes to improved outcomes; therefore, imaging studies are essential in establishing the degree of involvement and managing the treatment properly, especially in immunocompromised patients. The common sites of extrasinus fungal invasion are the intraorbital, cavernous sinus, and intracranial regions. Fungi spread directly to these regions along the blood vessels or nerves, causing devastating complications such as optic nerve ischemia or compression, optic neuritis or perineuritis, orbital cellulitis, cavernous sinus thrombosis, mycotic aneurysm, vasculitis, internal carotid arterial occlusion, cerebral infarction, cerebritis, and brain abscess. IFRS has a broad imaging spectrum, and familiarity with intra- and extrasinonasal imaging features, such as loss of contrast enhancement of the affected region, which indicates tissue ischemia due to angioinvasion of fungi, and the surrounding anatomy is essential for prompt diagnosis and management. The authors summarize the epidemiology, etiology, risk factors, and complications of IFRS and review the anatomy and key diagnostic imaging features of IFRS beyond the sinonasal regions. ©RSNA, 2022.
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Affiliation(s)
- Mariko Kurokawa
- From the Division of Neuroradiology, Department of Radiology (M.K., R.K., A.B., J.K., C.T., A.S., J.R.B., T.M.), Department of Pathology, Michigan Medicine (J.M.), and Kellogg Eye Center, Department of Ophthalmology and Visual Sciences and Department of Neurology (J.D.T.), University of Michigan, 1500 E Medical Center Dr, UH B2, Ann Arbor, MI 48109; and Department of Radiology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan (R.K.)
| | - Ryo Kurokawa
- From the Division of Neuroradiology, Department of Radiology (M.K., R.K., A.B., J.K., C.T., A.S., J.R.B., T.M.), Department of Pathology, Michigan Medicine (J.M.), and Kellogg Eye Center, Department of Ophthalmology and Visual Sciences and Department of Neurology (J.D.T.), University of Michigan, 1500 E Medical Center Dr, UH B2, Ann Arbor, MI 48109; and Department of Radiology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan (R.K.)
| | - Akira Baba
- From the Division of Neuroradiology, Department of Radiology (M.K., R.K., A.B., J.K., C.T., A.S., J.R.B., T.M.), Department of Pathology, Michigan Medicine (J.M.), and Kellogg Eye Center, Department of Ophthalmology and Visual Sciences and Department of Neurology (J.D.T.), University of Michigan, 1500 E Medical Center Dr, UH B2, Ann Arbor, MI 48109; and Department of Radiology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan (R.K.)
| | - John Kim
- From the Division of Neuroradiology, Department of Radiology (M.K., R.K., A.B., J.K., C.T., A.S., J.R.B., T.M.), Department of Pathology, Michigan Medicine (J.M.), and Kellogg Eye Center, Department of Ophthalmology and Visual Sciences and Department of Neurology (J.D.T.), University of Michigan, 1500 E Medical Center Dr, UH B2, Ann Arbor, MI 48109; and Department of Radiology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan (R.K.)
| | - Christopher Tournade
- From the Division of Neuroradiology, Department of Radiology (M.K., R.K., A.B., J.K., C.T., A.S., J.R.B., T.M.), Department of Pathology, Michigan Medicine (J.M.), and Kellogg Eye Center, Department of Ophthalmology and Visual Sciences and Department of Neurology (J.D.T.), University of Michigan, 1500 E Medical Center Dr, UH B2, Ann Arbor, MI 48109; and Department of Radiology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan (R.K.)
| | - Jonathan Mchugh
- From the Division of Neuroradiology, Department of Radiology (M.K., R.K., A.B., J.K., C.T., A.S., J.R.B., T.M.), Department of Pathology, Michigan Medicine (J.M.), and Kellogg Eye Center, Department of Ophthalmology and Visual Sciences and Department of Neurology (J.D.T.), University of Michigan, 1500 E Medical Center Dr, UH B2, Ann Arbor, MI 48109; and Department of Radiology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan (R.K.)
| | - Jonathan D Trobe
- From the Division of Neuroradiology, Department of Radiology (M.K., R.K., A.B., J.K., C.T., A.S., J.R.B., T.M.), Department of Pathology, Michigan Medicine (J.M.), and Kellogg Eye Center, Department of Ophthalmology and Visual Sciences and Department of Neurology (J.D.T.), University of Michigan, 1500 E Medical Center Dr, UH B2, Ann Arbor, MI 48109; and Department of Radiology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan (R.K.)
| | - Ashok Srinivasan
- From the Division of Neuroradiology, Department of Radiology (M.K., R.K., A.B., J.K., C.T., A.S., J.R.B., T.M.), Department of Pathology, Michigan Medicine (J.M.), and Kellogg Eye Center, Department of Ophthalmology and Visual Sciences and Department of Neurology (J.D.T.), University of Michigan, 1500 E Medical Center Dr, UH B2, Ann Arbor, MI 48109; and Department of Radiology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan (R.K.)
| | - Jayapalli Rajiv Bapuraj
- From the Division of Neuroradiology, Department of Radiology (M.K., R.K., A.B., J.K., C.T., A.S., J.R.B., T.M.), Department of Pathology, Michigan Medicine (J.M.), and Kellogg Eye Center, Department of Ophthalmology and Visual Sciences and Department of Neurology (J.D.T.), University of Michigan, 1500 E Medical Center Dr, UH B2, Ann Arbor, MI 48109; and Department of Radiology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan (R.K.)
| | - Toshio Moritani
- From the Division of Neuroradiology, Department of Radiology (M.K., R.K., A.B., J.K., C.T., A.S., J.R.B., T.M.), Department of Pathology, Michigan Medicine (J.M.), and Kellogg Eye Center, Department of Ophthalmology and Visual Sciences and Department of Neurology (J.D.T.), University of Michigan, 1500 E Medical Center Dr, UH B2, Ann Arbor, MI 48109; and Department of Radiology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan (R.K.)
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Masmoudi M, Chelli J, Ben Mabrouk A, Chebil E, Thabet W, Hasnaoui M, Mighri K. Noninvasive fungal rhinosinusitis: a case series. F1000Res 2022; 10:869. [PMID: 36225239 PMCID: PMC9525990 DOI: 10.12688/f1000research.67204.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/06/2022] [Indexed: 11/20/2022] Open
Abstract
Introduction: Fungal rhinosinusitis (FRS) remains a rare disease. The noninvasive forms are hard to diagnose. The management protocols remain controversial. We aim to describe the clinical, radiological and pathological features of noninvasive FRS and present our management protocol and follow-up results. Patients and methods: This descriptive study was conducted in the ear-nose-throat department of the university hospital, Taher Sfar in Mahdia, Tunisia. All patients who responded to the definition of noninvasive FRS (fungal balls and allergic fungal sinusitis) were included. The study was conducted over a three year period (May 2017 – April 2021). Results: Eleven patients were included in this study: four cases of fungal balls and seven cases of allergic fungal sinusitis. Patients presented with symptoms of chronic recurrent rhinosinusitis with no response to conventional treatments. Computed tomodensitometry scan showed opacification of the paranasal sinuses in all patients. Other signs were heterogeneous opacities, local calcifications and thinning of the bony walls of the sinuses. Histopathological findings were inflammatory polyps in all cases of allergic FRS with the presence of fungal hyphae in 42.8% of the cases. All patients underwent surgery after a median delay of 12 [6–24] months of the symptom’s onset. The used procedures were endoscopic middle meatal antrostomy for all patients, ethmoidectomy (81.8%) and sphenoidotomy (36.4%). None received systemic antifungals or corticosteroids with a favorable outcome in all cases. Conclusion: Symptoms of noninvasive FRS are nonspecific. The scan images contribute to the diagnosis, but the perioperative findings and the histopathological results remain crucial. The management is mainly surgical.
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Affiliation(s)
- Mohamed Masmoudi
- Department of Otolaryngology - Head and Neck Surgery, Faculty of Medicine of Monastir, Tahar Sfar Hospital, Mahdia, 5100, Tunisia
| | - Jihene Chelli
- Department of Endocrinology and Internal Medicine, Faculty of Medicine of Monastir, Tahar Sfar Hospital, Mahdia, 5100, Tunisia
| | - Asma Ben Mabrouk
- Department of Endocrinology and Internal Medicine, Faculty of Medicine of Monastir, Tahar Sfar Hospital, Mahdia, 5100, Tunisia
| | - Ezer Chebil
- Department of Otolaryngology - Head and Neck Surgery, Faculty of Medicine of Monastir, Tahar Sfar Hospital, Mahdia, 5100, Tunisia
| | - Wadii Thabet
- Department of Otolaryngology - Head and Neck Surgery, Faculty of Medicine of Monastir, Tahar Sfar Hospital, Mahdia, 5100, Tunisia
| | - Mehdi Hasnaoui
- Department of Otolaryngology - Head and Neck Surgery, Faculty of Medicine of Monastir, Tahar Sfar Hospital, Mahdia, 5100, Tunisia
| | - Khalifa Mighri
- Department of Otolaryngology - Head and Neck Surgery, Faculty of Medicine of Monastir, Tahar Sfar Hospital, Mahdia, 5100, Tunisia
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Monga S, Malik JN, Sharma A, Agarwal D, Priya R, Naseeruddin K. Management of Fungal Rhinosinusitis: Experience From a Tertiary Care Centre in North India. Cureus 2022; 14:e23826. [PMID: 35530915 PMCID: PMC9068350 DOI: 10.7759/cureus.23826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/04/2022] [Indexed: 11/28/2022] Open
Abstract
Introduction Fungal rhinosinusitis (FRS) has increased over the past few decades due to the rampant use of antibiotics, steroids, immunosuppressive drugs, increased incidence of HIV and uncontrolled diabetes. The current study reviews the types, clinical presentation, microbiology, histopathology and outcomes related to FRS in a tertiary care center in North India. Methods We retrospectively reviewed the clinical and follow-up records of patients diagnosed with FRS over three years. The data reviewed included clinical workup, ophthalmological profile, comorbidities, immunological status, radiological investigations, intraoperative and histopathological findings, treatment and follow-up records. In addition, we performed a descriptive analysis of the reviewed data. Results The study consisted of 30 FRS patients (16 male, 14 female). In that, 77% of cases were of allergic FRS, while fungal ball, chronic invasive, chronic granulomatous and acute invasive FRS represented 3%, 10%, 3% and 7% cases, respectively. The most common presentation in non-invasive forms was nasal obstruction, nasal discharge, hyposmia and polyposis, while it was facial pain and headache in the invasive varieties. After appropriate medical and surgical management through endoscopic sinus surgery, the recurrence rate in non-invasive and invasive fungal sinusitis was 16.6% and 20.8%, respectively. There was nil mortality at a minimum of one year of follow-up. Conclusion The non-invasive forms of FRS are common and have a relatively mild course. Early medical and surgical intervention and management of the underlying comorbidities are the key factors in managing invasive FRS. Close follow-up after surgery is also necessary for the timely detection and management of recurrences.
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Mahajan A, Padashetty S, Shukla S, Agarwal U, Patil V, Noronha V, Menon N, Prabhash K. The masquerader. CANCER RESEARCH, STATISTICS, AND TREATMENT 2022. [DOI: 10.4103/crst.crst_64_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023] Open
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Zainea V, Ionita I, Pituru S, Pietroșanu C, Rusescu A, Stefanescu C, Gherghiceanu F, Anghelina F, Palade D, Hainarosie R. Endoscopic assessment of sinonasal mucormycosis with SPIES: The ‘battlefield’ sign. Exp Ther Med 2021; 23:77. [DOI: 10.3892/etm.2021.11000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 08/17/2021] [Indexed: 11/06/2022] Open
Affiliation(s)
- Viorel Zainea
- Department of ENT, ‘Carol Davila’ University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | - Irina Ionita
- Allergy Department, ‘Carol Davila’ University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | - Silviu Pituru
- Department of ENT, ‘Carol Davila’ University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | - Cătălina Pietroșanu
- Department of ENT, ‘Carol Davila’ University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | - Andreea Rusescu
- Department of ENT, ‘Carol Davila’ University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | - Cristian Stefanescu
- Department of ENT, ‘Carol Davila’ University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | - Florentina Gherghiceanu
- Department of ENT, ‘Carol Davila’ University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | - Florin Anghelina
- Department of ENT, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
| | - Dragos Palade
- Department of ENT, ‘Grigore T. Popa’ University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Razvan Hainarosie
- Department of ENT, ‘Carol Davila’ University of Medicine and Pharmacy, 050474 Bucharest, Romania
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RADIOLOGICAL EVALUATION OF ALLERGIC FUNGAL SINUSITIS: NOVEL FINDINGS. JOURNAL OF CONTEMPORARY MEDICINE 2021. [DOI: 10.16899/jcm.1020505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Prevalence of Positive Fungal Cultures in Patients with Chronic Sinusitis undergoing Functional Endoscopic Sinus Surgery in Yasuj, Iran. JOURNAL OF CLINICAL CARE AND SKILLS 2021. [DOI: 10.52547/jccs.2.3.151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Shipman P, Highland J, Witt B, Alt J. Non-invasive Fungal Sinusitis as a Complication of a Steroid-Eluting Stent Following Endoscopic Sinus Surgery: A Case Report. Ann Otol Rhinol Laryngol 2021; 131:678-682. [PMID: 34350789 DOI: 10.1177/00034894211036844] [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] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Steroid eluting stents have proven to be a highly useful adjunctive therapy for chronic rhinosinusitis (CRS) and play an important role in the treatment of many inflammatory diseases of the sinuses. Few reports of adverse events were reported in clinical trials and are described in the literature. However, we describe the first known case of an immunocompetent patient developing non-invasive fungal tissue infection as a sequelae of stent-related tissue necrosis requiring surgical debridement. METHODS A 69-year-old immunocompetent male with CRS had Propel™ stents placed in the bilateral frontal sinus outflow tracts during revision endoscopic sinus surgery. He presented 2 weeks post-operatively with severe facial pain without vision changes, fevers, mental status changes, or evidence of cranial neuropathies. On rigid nasal endoscopy, necrotic tissue and gross fungal elements were visualized in the left frontal sinus outflow tract at the area of previous steroid stent position. RESULTS The patient was taken for urgent endoscopic sinus surgery and debridement given significant symptoms and concern for invasive fungal infection. A revision left maxillectomy, ethmoidectomy, and draf 2b frontal sinus drillout were performed, with healthy bleeding tissue encountered beneath necrotic tissue. Pathology revealed tissue necrosis, exudative lumenal debris, and extensive fungal elements with no evidence of tissue invasion, and cultures yielded growth of aspergillus niger. The patient's symptoms improved significantly on post-operative day 1, he had normal post-operative changes at 2 weeks following debridement, and had no recurrence of fungal infection with complete healing at 4 months. CONCLUSION While likely rare, steroid-eluting stents may pose a risk of saprophytic tissue infection as a result of tissue necrosis and local immunosuppression. Caution should be taken in using these devices in immunocompromised patients.
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Affiliation(s)
- Paige Shipman
- Division of Otolaryngology, Department of Surgery, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Julie Highland
- Division of Otolaryngology, Department of Surgery, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Benjamin Witt
- Department of Pathology, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Jeremiah Alt
- Division of Otolaryngology, Department of Surgery, University of Utah School of Medicine, Salt Lake City, UT, USA
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Clinical features in maxillary sinus fungus ball in patients with malignant hematological disease. Eur Arch Otorhinolaryngol 2021; 279:1919-1927. [PMID: 34216265 DOI: 10.1007/s00405-021-06973-5] [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: 02/25/2021] [Accepted: 06/27/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE Previous studies on fungus balls have primarily focused on immunocompetent patients, and only a few studies have described the clinical characteristics of fungus balls in malignant hematological disease (MHD) patients. Therefore, we compared the clinical features of maxillary sinus fungus ball (MSFB) between immunosuppressive patients with MHD and immunocompetent patients. METHODS Twenty patients with MHD and 40 randomly selected immunocompetent patients were enrolled and divided into MHD and non-MHD groups. All patients were diagnosed with MSFB and their clinical features were retrospectively analyzed. RESULTS Patients in the MHD group had non-specific clinical symptoms and endoscopic manifestations of MSFB, similar to those in the non-MHD group. On computed tomography (CT), the MHD group showed higher Lund-Mackay scores, lesser single sinus opacifications, more multiple sinus opacifications on the affected side, and more bilateral opacifications compared to the non-MHD group. The MHD group had a lower frequency of central hyper-density and heterogeneous opacifications than the non-MHD group. There were no significant differences between the two groups in terms of the fungal-infected side, lateral sinus wall ratio, sclerosis of the lateral sinus wall, erosion of the inner sinus wall, and nasal septum deviation. CONCLUSION The clinical symptoms and endoscopic manifestations of MSFB in patients with MHD were similar to those of immunocompetent patients. However, more atypical signs and wider mucosal inflammation were found on CT scans of MSFB patients with MHD. These results indicate that caution should be executed when excluding the possibility of fungus balls in immunosuppressive patients.
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Gonzalez ML, Chen S, Mazaheri P, Schneider J, Chernock R. Acute Invasive Fungal Sinusitis: A 30-Year Review of Pathology Practice and Possible Utility of the DiffQuik® Stain. Head Neck Pathol 2021; 15:852-858. [PMID: 33544380 PMCID: PMC8385081 DOI: 10.1007/s12105-021-01295-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 01/15/2021] [Indexed: 11/29/2022]
Abstract
Acute invasive fungal rhinosinusitis (AIFRS) is a fulminant disease with a high mortality rate. Here, we review the clinical and pathologic features of AIFRS over a 30-year period at a tertiary-care academic center focusing on diagnostic practice, especially the use of intra-operative consultation (IOC). A 1-year trial of intraoperative staining with DiffQuik® (DQ) was also assessed. There were 202 cases from 104 patients with AIFRS. The incidence of AIFRS increased over time (6.8 per year in the past decade versus 1.9 before 2009) as did the number of IOCs per case (2.4 per case in the past decade versus 0.6 before 2009). Disagreement between final diagnosis and IOC was seen in 8.3 % of patients, and the block-by-block error rate was 14.9 %. Fusarium was the most common fungus identified. An attempt to categorize the fungal organism based on histopathology was performed in 85.6 % of patients, with 91 % agreement with microbial cultures or PCR. Fungal hyphae were subjectively easier to identify on DQ stained cryostat sections compared to on routine hematoxylin and eosin stained sections and hyphae were identified in all 5 blocks in which organisms were present. The increasing incidence of AIFRS and expanding use of IOC indicate a need to improve and standardize the diagnostic protocol. The use of DQ as visual aid in IOC for AIFRS may be useful.
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Affiliation(s)
- Manuel Lora Gonzalez
- Department of Pathology & Immunology, Washington University School of Medicine-Barnes Jewish Hospital, St. Louis, MO USA ,Present Address: Department of Pathology, University of Alabama at Birmingham, Birmingham, AL USA
| | - Stephanie Chen
- Department of Otolaryngology, Washington University School of Medicine-Barnes Jewish Hospital, St. Louis, MO USA
| | - Parisa Mazaheri
- Department of Radiology, Washington University School of Medicine-Barnes Jewish Hospital, St. Louis, MO USA
| | - John Schneider
- Department of Otolaryngology, Washington University School of Medicine-Barnes Jewish Hospital, St. Louis, MO USA
| | - Rebecca Chernock
- Department of Pathology & Immunology, Washington University School of Medicine-Barnes Jewish Hospital, St. Louis, MO USA
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Postextraction Mucormycosis in Immunocompromised-Patient Management and Review of Literature. J Oral Maxillofac Surg 2021; 79:1482-1491. [PMID: 33617788 DOI: 10.1016/j.joms.2021.01.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 01/16/2021] [Accepted: 01/16/2021] [Indexed: 11/23/2022]
Abstract
PURPOSE Mucormycosis is an uncommon aggressive, opportunistic infection that can produce widespread orofacial tissue necrosis. This primarily affects immunocompromised individuals. It is the deadliest and most rapidly progressing type of human-affecting fungal infection. The aim of the study is to investigate the diagnostic criteria and treatment approach in 10 cases of mucormycosis in the author's institute from 2008 to 2019. Moreover, a review of the English literature presents all cases of mucormycosis after tooth extraction. MATERIALS AND METHODS Ten patients at our institute have been treated. They were evaluated and discussed as per their diagnostic criteria, surgical treatment, and mortality rates. RESULTS All 10 immunocompromised patients had a primary hematologic malignancy. The criteria for a positive diagnosis were clinical symptoms and a biopsy for microbiological culture and histologic analysis. Each patient was subjected to vigorous surgical resection and underwent antifungal treatment. Seven patients died because of their main disease. Owing to the unregulated spread of mucormycosis, 2 patients died. Four cases were diagnosed after maxillary tooth extraction. CONCLUSIONS The most important factor for patient survival tends to be the management of the underlying disease with early detection and active surgical and antifungal action. Four of 10 cases diagnosed with mucormycosis appeared after tooth extraction, a relatively high number compared with the literature. Therefore, it is the dental profession's obligation to be familiar with the possibility of the potentially severe and possibly fatal complication.
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Alotaibi NH, Omar OA, Altahan M, Alsheikh H, Al Mana F, Mahasin Z, Othman E. Chronic Invasive Fungal Rhinosinusitis in Immunocompetent Patients: A Retrospective Chart Review. Front Surg 2020; 7:608342. [PMID: 33392248 PMCID: PMC7772145 DOI: 10.3389/fsurg.2020.608342] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Accepted: 11/16/2020] [Indexed: 11/13/2022] Open
Abstract
Objective: We report cases of Chronic Invasive Fungal Sinusitis (CIFS) in patients considered as immunocompetent at tertiary care center (King Faisal Specialist Hospital), to analyze their clinical, biological, radiological features, and management. Material and methods: A retrospective chart review of CIFS in immunocompetent patients. The inclusion criteria as the following: immunocompetent patients of any age with histopathological findings of CIFS. Immunocompromised patients, acute Invasive Fungal Sinusitis (IFS), non-invasive fungal rhinosinusitis, and no positive histological findings were excluded. Results: Seventeen (17) patients were included. The species isolated included: Aspergillus (most frequent) & Mucor. Surgical treatment approaches were described. Complications reported include CSF leak, blindness, recurrence, and death. Conclusions: Early diagnosis and management of CIFS improve clinical outcomes.
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Affiliation(s)
- Naif H Alotaibi
- Department of Otolaryngology, Head and Neck Surgery and Communication Sciences, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia.,College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Omar Abu Omar
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Mays Altahan
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Haifa Alsheikh
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Fawziah Al Mana
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Zeyad Mahasin
- Department of Otolaryngology, Head and Neck Surgery and Communication Sciences, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia
| | - Eyas Othman
- Department of Otolaryngology, Head and Neck Surgery and Communication Sciences, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia.,College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
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Yin LX, Spillinger A, Lees KA, Bailey KR, Choby G, O'Brien EK, Stokken JK. An internally validated diagnostic tool for acute invasive fungal sinusitis. Int Forum Allergy Rhinol 2020; 11:65-74. [PMID: 32668099 DOI: 10.1002/alr.22635] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 04/29/2020] [Accepted: 05/30/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND Acute invasive fungal sinusitis (AIFS) is a potentially life-threatening diagnosis in immunocompromised patients. Identifying patients who could benefit from evaluation and intervention can be challenging for referring providers and otolaryngologists alike. We aimed to develop and validate an accessible diagnostic tool to estimate the probability of AIFS. METHODS Retrospective chart review from 1999 to 2017 identified all patients evaluated for possible AIFS at a tertiary care center. AIFS was diagnosed by pathologic confirmation of fungal tissue angioinvasion. Stepwise selection and univariate logistic regression were used to screen risk factors for a multivariable predictive model. Model performance was assessed using Tukey's goodness-of-fit test and the area under the receiver operator characteristic curve (AUC). Model coefficients were internally validated using bootstrapping with 1000 iterations. RESULTS A total of 283 patients (244 negative controls, 39 with AIFS) were included. Risk factors in our final diagnostic model included: fever ≥38°C (log-odds ratio [LOR] 1.72; 95% CI, 0.53 to 2.90), unilateral facial swelling, pain, or erythema (LOR 2.84; 95% CI, 1.46 to 4.23), involvement of the orbit or pterygopalatine fossa on imaging (LOR 3.02; 95% CI, 1.78 to 4.26), and mucosal necrosis seen on endoscopy (LOR 5.52; 95% CI, 3.81 to 7.24), with p < 0.01 for all factors. The model had adequate goodness of fit (p > 0.05) and discrimination (AUC = 0.96). CONCLUSION We present an internally validated diagnostic tool to stratify the risk for AIFS. The estimated risk may help determine which patients can be observed with serial nasal endoscopy, which ones could be biopsied, and which ones would benefit from immediate surgical intervention.
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Affiliation(s)
- Linda X Yin
- Department of Otorhinolaryngology, Mayo Clinic, Rochester, MN
| | - Aviv Spillinger
- Department of Otorhinolaryngology, Mayo Clinic, Rochester, MN
| | - Katherine A Lees
- Department of Otolaryngology-Head and Neck Surgery, University of Utah, Salt Lake City, UT
| | - Kent R Bailey
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN
| | - Garret Choby
- Department of Otorhinolaryngology, Mayo Clinic, Rochester, MN
| | - Erin K O'Brien
- Department of Otorhinolaryngology, Mayo Clinic, Rochester, MN
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Goyal VK, Ahmad A, Turfe Z, Peterson EI, Craig JR. Predicting Odontogenic Sinusitis in Unilateral Sinus Disease: A Prospective, Multivariate Analysis. Am J Rhinol Allergy 2020; 35:164-171. [PMID: 32646233 DOI: 10.1177/1945892420941702] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Odontogenic sinusitis (ODS) is a common cause of unilateral sinus disease (USD), but can be challenging to diagnose due to nonspecific clinical presentations, potentially subtle to absent dental pathology on sinus computed tomography (CT), and underrepresentation in the sinusitis literature. OBJECTIVE Identify sinonasal clinical variables predictive of ODS in patients presenting with unilateral maxillary sinus opacification on sinus CT. METHODS A prospective cohort study was conducted on 131 consecutive patients with USD and at least partial or complete maxillary sinus opacification on sinus CT. Patients' demographics, sinonasal symptoms (anterior and posterior drainage, nasal obstruction, facial pressure, smell loss, and foul smell), 22-item sinonasal outcome test, nasal endoscopy findings, CT findings, and histopathology were collected. Patients' diagnoses included ODS, chronic rhinosinusitis with or without nasal polyps, and inverted papilloma. Demographic and clinical data were compared between patients with unilateral ODS and non-odontogenic disease using univariate and multivariate analyses. RESULTS Of the 131 USD patients, 65 had ODS and 66 had non-odontogenic disease. The following variables were significantly associated with unilateral ODS on multivariate analysis: middle meatal pus on endoscopy (OR= 17.67, 95% CI-5.69, 54.87; p = 0.001), foul smell (OR= 6.11, 95% CI-1.64, 22.82; p=.007), facial pressure (OR= 3.55, 95% CI-1.25, 10.12; p = 0.018), and any frontal opacification on CT (OR= 5.19, 95% CI-1.68, 16.06; p = 0.004). Any sphenoid opacification on CT was inversely related to ODS (OR = 0.14, 95% CI-0.03, 0.69; p = 0.016). The study was adequately powered. CONCLUSION With unilateral maxillary sinus disease, the following features were significantly associated with ODS: foul smell, ipsilateral facial pressure, middle meatal pus on endoscopy, and any frontal sinus opacification on sinus CT. Additionally, any sphenoid sinus opacification on CT was inversely related to ODS. Presence or absence of these clinical variables can be used to increase or decrease one's suspicion of an odontogenic source of sinusitis.
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Affiliation(s)
- Vinay K Goyal
- Department of Otolaryngology, Henry Ford Health System, Detroit, Michigan
| | - Abid Ahmad
- Wayne State Medical University, Detroit, Michigan
| | - Zaahir Turfe
- Department of Otolaryngology, Henry Ford Health System, Detroit, Michigan
| | - Edward I Peterson
- Department of Public Health Services, Henry Ford Health System, Detroit, Michigan
| | - John R Craig
- Department of Otolaryngology, Henry Ford Health System, Detroit, Michigan
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[Guideline for "rhinosinusitis"-long version : S2k guideline of the German College of General Practitioners and Family Physicians and the German Society for Oto-Rhino-Laryngology, Head and Neck Surgery]. HNO 2019; 66:38-74. [PMID: 28861645 DOI: 10.1007/s00106-017-0401-5] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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Abstract
Fungal rhinosinusitis (FRS), once considered a rare disease, has seen a steep rise in incidence in recent times. This global rise in the burden of fungal disease is a consequence of an increment in the population with weakened immune systems. Increased life expectancy with rise in conditions like diabetes mellitus, medical advancements with invasive interventions, use of immunosuppressive drugs and chemo-radiotherapy all lead to unique risk situations. The situation becomes more alarming with the fact that there has been a significant rise in cases in immune-competent hosts with no predisposing factors. FRS represents a wide spectrum of disease ranging from the mild form of superficial colonization, allergic manifestations to life threatening extensive invasive disease. The categorization of disease into acute and chronic and invasive or noninvasive is important factor with implications in disease management and prognosis and this has been emphasized greatly in recent years. Diagnosis of FRS has been a challenge as the presenting clinical signs and symptoms and radiographic manifestations are often nonspecific. Definitive diagnosis requires direct fungi identification and hence culture and microscopic examination remain the gold standard. Availability of advanced and rapid diagnostic techniques is rare in majority of developing nations. Therapeutic dilemmas are another aspect of the management of FRS as in spite of the availability of new antifungal drugs, treatment is often empirical due to non-availability of early diagnosis, rapid disease progression and high costs of antifungal drugs. A description of the different types of FRS, their diagnosis and management has been presented in this review.
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Affiliation(s)
- Virendra Singh
- Department of Oral and maxillofacial Surgery, PGIDS, Pt. BD Sharma University of Health Sciences, Rohtak, Haryana 124001 India
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Pestana J, Carmo A, Ribeiro JC, Tomé R. Chronic invasive rhinosinusitis by Conidiobolus coronatus, an emerging microorganism. J Mycol Med 2019; 29:67-70. [PMID: 30638827 DOI: 10.1016/j.mycmed.2018.12.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2018] [Revised: 12/02/2018] [Accepted: 12/19/2018] [Indexed: 10/27/2022]
Abstract
Fungi from the Conidiobolus genus have been implicated in the development of chronic invasive fungal rhinosinusitis, mainly in tropical countries. The mycosis associated to these fungi may cause irreversible facial deformities and is potentially fatal. The authors present the first case of a chronic invasive fungal rhinosinusitis due to Conidiobolus coronatus diagnosed in a 66-year-old Caucasian male patient, living in Portugal without any travels abroad and complaining of progressive refractory nasal obstruction, facial pain and anosmia. Upon the culture of samples collected during sinus endoscopic surgery, colonies that presented a macroscopic aspect remembering wax were detected. The microscopic evaluation allowed the observation of simple conidiophores forming spherical conidia, and of conidiophores that presented hair-like appendages. Together, these characteristics allowed the identification of the fungi as a Conidiobolus, which was confirmed upon the DNA sequencing. The authors emphasised the role of this fungi as an emergent microorganism as well as the difficulties associated to the diagnosis and treatment.
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Affiliation(s)
- J Pestana
- Faculty of Medicine, University of Coimbra, 3000 Coimbra, Portugal
| | - A Carmo
- Department of Clinical Pathology, Centro Hospitalar e Universitário de Coimbra, 3000 Coimbra, Portugal
| | - J C Ribeiro
- Faculty of Medicine, University of Coimbra, 3000 Coimbra, Portugal; Department of Otorhinolaryngology, Centro Hospitalar e Universitário de Coimbra, 3000 Coimbra, Portugal
| | - R Tomé
- Department of Clinical Pathology, Centro Hospitalar e Universitário de Coimbra, 3000 Coimbra, Portugal.
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Craig PG, Zhan X, Aly N, Policeni B. Nontraumatic emergencies of inflammatory paranasal sinus disease. Semin Ultrasound CT MR 2018; 40:125-138. [PMID: 31030736 DOI: 10.1053/j.sult.2018.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Inflammatory disease of the paranasal sinuses is extremely common and the course is often innocuous. However, when extrasinus spread of disease occurs life-threatening complications can arise. Intraorbital and intracranial involvement can progress rapidly either by hematogenous spread or in the case of fungal sinusitis via angioinvasion. An understanding of anatomy and appropriate imaging protocols is critical when these complications arise. The knowledge of imaging features of the different disease processes and prompt diagnosis is essential to improve patient outcomes and positively impact patient care.
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Affiliation(s)
- Patrick G Craig
- Department of Radiology, University of Iowa Hospitals and Clinics, Iowa City, IA.
| | - Xin Zhan
- Department of Radiology, University of Iowa Hospitals and Clinics, Iowa City, IA
| | - Nour Aly
- Department of Radiology, University of Iowa Hospitals and Clinics, Iowa City, IA
| | - Bruno Policeni
- Department of Radiology, University of Iowa Hospitals and Clinics, Iowa City, IA
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Małek M, Bogusz B, Mrowiec P, Szuta M, Opach M, Skiba-Kurek I, Nowak P, Klesiewicz K, Budak A, Karczewska E. Nested PCR for the detection of Aspergillus species in maxillary sinus samples of patients with chronic sinusitis. Rev Iberoam Micol 2018; 35:140-146. [PMID: 30274951 DOI: 10.1016/j.riam.2018.04.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Revised: 03/27/2018] [Accepted: 04/05/2018] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Fungal rhinosinusitis has become an increasingly recognized disease, being Aspergillus species responsible for most of the cases. Its diagnosis is quite difficult because of the non-specific symptoms and low sensitivity of the current diagnostic methods. AIMS An Aspergillus-specific nested polymerase chain reaction (PCR) assay using biopsy specimens taken from the maxillary sinuses was performed in order to assess its usefulness. Conventional diagnostic methods (histology and culture) were also carried out. METHODS A case-control study was performed in the Institute of Stomatology, Jagiellonian University in Kraków, between 2011 and 2014. The case group consisted of 21 patients with suspected rhinosinusal mycetoma while the control group included 46 patients with no suspicion of fungal rhinosinusitis. The two-step PCR assay amplified an Aspergillus specific portion of the 18S rRNA gene. Interval estimation of sensitivity, specificity, positive (PPV) and negative (NPV) predictive values were calculated to assess the diagnostic test performance. The agreement between the PCR and the other tests was evaluated using the Kappa coefficient (k). RESULTS Ninety percent of the samples obtained from patients diagnosed with mycetoma yielded positive PCR results. The PCR showed almost perfect concordance with histology (k=0.88). Sensitivity, specificity, PPV and NPV estimates were 90%; 95% CI: (55.5-99.7%), 98.3%; 95% CI: (90.9-100%), 90%; 95% CI: (55.5-99.7%) and 98.3%; 95% CI: (90.9-100%), respectively. One clinical sample showed growth of Aspergillus fumigatus and positive PCR despite the negative histological examination. CONCLUSIONS Nested PCR assay is a promising diagnostic tool to evaluate the presence of Aspergillus in the tissue of maxillary sinus from patients with suspicion of sinus aspergillosis.
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Affiliation(s)
- Marianna Małek
- Department of Pharmaceutical Microbiology, Faculty of Pharmacy, Jagiellonian University Medical College, Kraków, Poland
| | - Bożena Bogusz
- Microbiological Laboratory, Department of Laboratory Diagnostics, Ludwik Rydygier Memorial Hospital, Kraków, Poland
| | - Paulina Mrowiec
- Department of Pharmaceutical Microbiology, Faculty of Pharmacy, Jagiellonian University Medical College, Kraków, Poland.
| | - Mariusz Szuta
- Department of Cranio-Maxillofacial, Oncological and Reconstructive Surgery, Institute of Stomatology, Jagiellonian University Medical College, Kraków, Poland
| | - Maciej Opach
- Department of Cranio-Maxillofacial, Oncological and Reconstructive Surgery, Institute of Stomatology, Jagiellonian University Medical College, Kraków, Poland
| | - Iwona Skiba-Kurek
- Department of Pharmaceutical Microbiology, Faculty of Pharmacy, Jagiellonian University Medical College, Kraków, Poland
| | - Paweł Nowak
- Department of Pharmaceutical Microbiology, Faculty of Pharmacy, Jagiellonian University Medical College, Kraków, Poland
| | - Karolina Klesiewicz
- Department of Pharmaceutical Microbiology, Faculty of Pharmacy, Jagiellonian University Medical College, Kraków, Poland
| | - Alicja Budak
- Department of Pharmaceutical Microbiology, Faculty of Pharmacy, Jagiellonian University Medical College, Kraków, Poland
| | - Elżbieta Karczewska
- Department of Pharmaceutical Microbiology, Faculty of Pharmacy, Jagiellonian University Medical College, Kraków, Poland
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Fernandez IJ, Crocetta FM, Demattè M, Farneti P, Stanzani M, Lewis RE, Fornaciari M, Pasquini E, Sciarretta V. Acute Invasive Fungal Rhinosinusitis in Immunocompromised Patients: Role of an Early Diagnosis. Otolaryngol Head Neck Surg 2018; 159:386-393. [DOI: 10.1177/0194599818765744] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Objective The aims of the present study were to evaluate the clinical significance of the delay for surgical treatment and the prognostic value of other clinical, pathologic, and microbiological variables among hematologic patients affected by acute invasive fungal rhinosinusitis (AIFRS). Furthermore, we propose our early diagnosis and treatment protocol, reporting its 10-year results. Study Design Monocentric retrospective analysis. Setting The study was conducted from 2001 to 2017 at the University Hospital of Bologna, Italy. Subjects and Methods The impact of time to treatment and clinical, pathologic, and microbiological variables were analyzed among patients with histologically and microbiologically proven AIFRS. The outcomes of patients treated before the introduction of the early diagnosis protocol were compared with those treated afterward. Results Nineteen patients affected by AIFRS were eligible for the study. Treatment delay >4 days ( P = .002), infection caused by Mucorales ( P = .015), and extension of the disease were negative prognostic variables ( P = .017). The application of our protocol significantly reduced the delay for diagnosis and appropriate treatment by an average of 7.3 days ( P = .02). Conclusion The promptness of the diagnosis and surgical treatment may play a significant role in the management of AIFRS, as it appears to be significantly associated with the disease outcome. Our protocol may help to reduce the time required for diagnosis of high-risk hematologic patients.
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Affiliation(s)
- Ignacio Javier Fernandez
- Otorhinolaryngology Head and Neck Surgery Unit, Head and Neck and Sensory Organs Department, Sant’Orsola–Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Francesco Maria Crocetta
- Otorhinolaryngology Head and Neck Surgery Unit, Head and Neck and Sensory Organs Department, Sant’Orsola–Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Marco Demattè
- Otorhinolaryngology Head and Neck Surgery Unit, Head and Neck and Sensory Organs Department, Sant’Orsola–Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Paolo Farneti
- Otorhinolaryngology Head and Neck Surgery Unit, Head and Neck and Sensory Organs Department, Sant’Orsola–Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Marta Stanzani
- Haematology Unit “Istituto Seràgnoli,” Specialist Diagnostic and Experimental Medicine, Sant’Orsola–Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Russel E. Lewis
- Infectious Disease Unit, Department of Medical and Surgical Sciences, Sant’Orsola–Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Martina Fornaciari
- Otorhinolaryngology Head and Neck Surgery Unit, Head and Neck and Sensory Organs Department, Sant’Orsola–Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Ernesto Pasquini
- Otorhinolaryngology Head and Neck Surgery Unit, Head and Neck and Sensory Organs Department, Sant’Orsola–Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Vittorio Sciarretta
- Otorhinolaryngology Head and Neck Surgery Unit, Head and Neck and Sensory Organs Department, Sant’Orsola–Malpighi Hospital, University of Bologna, Bologna, Italy
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Morrison DA, Wise SK, DelGaudio JM, Chowdhury NI, Levy JM. Intranasal tissue necrosis associated with opioid abuse: Case report and systematic review. Laryngoscope 2017; 128:1767-1771. [PMID: 29280484 DOI: 10.1002/lary.27069] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/27/2017] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Opioid abuse is a common disorder affecting over 2 million Americans. Intranasal tissue necrosis is a previously described sequela of nasal opioid inhalation, with a similar presentation to invasive fungal rhinosinusitis (IFRS). The goal of this case report and systematic review is to evaluate the evidence supporting this uncommon disease, with qualitative analysis of the presentation, management and treatment outcomes. DATA SOURCES MEDLINE, EMBASE, Google Scholar, Scopus, and Web of Science. REVIEW METHODS Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines were utilized to identify English-language studies reporting intranasal mucosal injury associated with prescription opioid abuse. Primary outcomes included clinical presentation, treatment strategies, and outcomes. RESULTS Systematic review identified 61 patients for qualitative analysis. Common clinical features include facial pain without a history of chronic sinusitis or known immunodeficiency. Diagnostic nasal endoscopy revealed superficial debris with underlying tissue necrosis, consistent with a preliminary diagnosis of IFRS. Characteristic pathologic findings include mucosal ulceration with an overlying acellular substrate, often with polarizable material. Fungal colonization is often reported, with several accounts of angiocentric invasion in immunocompetent patients. Complete symptom resolution is expected following surgical debridement with cessation of intranasal opioid inhalation, with 89% of identified patients experiencing a complete resolution of disease. CONCLUSION Intranasal opioid abuse is a prevalent condition associated with chronic pain and tissue necrosis that is clinically concerning for invasive fungal disease. Whereas IFRS must be excluded, even in patients without known immunodeficiency, complete resolution of symptoms can be expected following surgical debridement with cessation of opioid abuse. Laryngoscope, 1767-1771, 2018.
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Affiliation(s)
| | - Sarah K Wise
- Department of Otolaryngology-Head and Neck Surgery, Emory University School of Medicine, Atlanta, Georgia
| | - John M DelGaudio
- Department of Otolaryngology-Head and Neck Surgery, Emory University School of Medicine, Atlanta, Georgia
| | - Naweed I Chowdhury
- Department of Otolaryngology and Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, U.S.A
| | - Joshua M Levy
- Department of Otolaryngology-Head and Neck Surgery, Emory University School of Medicine, Atlanta, Georgia
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A Case of Fungus Ball-Type Maxillary Sinusitis Due to Penicillium Roqueforti. Mycopathologia 2017; 183:439-443. [PMID: 29075960 DOI: 10.1007/s11046-017-0217-6] [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: 08/02/2017] [Accepted: 10/19/2017] [Indexed: 10/18/2022]
Abstract
The Penicillium genera, encompassing about 225 different species of fungi, are naturally present in the environment. These genera are poorly linked to human disease, except for Penicillium marneffei causing septicemia in immunocompromised hosts. Thus, Penicillium species recovered from respiratory tract samples are often considered as inhaled contaminants in the clinical laboratory. However, we report here a case of fungal maxillary sinusitis due to Penicillium roqueforti diagnosed in a 40-year-old female, a teacher, complaining of moderate pain for months in the maxillary sinus and chronic posterior rhinorrhea. CT scanner and MRI enabled a preliminary diagnosis of left maxillary fungus ball-type sinusitis with calcified material seen on CT and marked very low signal in T2 weighted images seen on MRI. Anatomopathological and mycological examination of sinusal content showed septate hyphae. Direct sequencing of the sinusal content revealed P. roqueforti. P. roqueforti has been traditionally used in France for more than 200 years for cheese ripening. However, to our knowledge, this ascomycetous fungus has very rarely been associated in the literature with human disease. P. roqueforti is associated only with cheese worker's lung, a hypersensitivity pneumonitis affecting employees in blue cheese factories. Other species in the Penicillium genus are reported to cause various disorders such as invasive infection, superficial infection or allergic diseases. P. roqueforti has never previously been reported as a cause of human infection. Thus, we report the first case of fungus ball due to P. roqueforti in an immunocompetent patient.
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Chronic Rhinosinusitis and the Evolving Understanding of Microbial Ecology in Chronic Inflammatory Mucosal Disease. Clin Microbiol Rev 2017; 30:321-348. [PMID: 27903594 DOI: 10.1128/cmr.00060-16] [Citation(s) in RCA: 65] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Chronic rhinosinusitis (CRS) encompasses a heterogeneous group of debilitating chronic inflammatory sinonasal diseases. Despite considerable research, the etiology of CRS remains poorly understood, and debate on potential roles of microbial communities is unresolved. Modern culture-independent (molecular) techniques have vastly improved our understanding of the microbiology of the human body. Recent studies that better capture the full complexity of the microbial communities associated with CRS reintroduce the possible importance of the microbiota either as a direct driver of disease or as being potentially involved in its exacerbation. This review presents a comprehensive discussion of the current understanding of bacterial, fungal, and viral associations with CRS, with a specific focus on the transition to the new perspective offered in recent years by modern technology in microbiological research. Clinical implications of this new perspective, including the role of antimicrobials, are discussed in depth. While principally framed within the context of CRS, this discussion also provides an analogue for reframing our understanding of many similarly complex and poorly understood chronic inflammatory diseases for which roles of microbes have been suggested but specific mechanisms of disease remain unclear. Finally, further technological advancements on the horizon, and current pressing questions for CRS microbiological research, are considered.
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Sasso M, Barrot A, Carles MJ, Griffiths K, Rispail P, Crampette L, Lallemant B, Lachaud L. Direct identification of molds by sequence analysis in fungal chronic rhinosinusitis. J Mycol Med 2017; 27:514-518. [PMID: 28827018 DOI: 10.1016/j.mycmed.2017.07.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Revised: 06/20/2017] [Accepted: 07/17/2017] [Indexed: 11/30/2022]
Abstract
Fungi are widely implicated in chronic rhinosinusitis. Direct microscopic examination (DME) is used to confirm the biological diagnosis of fungal rhinosinusitis (FRS). Diagnostic sensitivity of DME is better than culture, however DME does not allow fungal species identification. In this study, we included 54 sinus samples demonstrating hyphae on DME. Direct sequencing was compared to culture for the identification of the fungal species. Sequence analysis identified fungi in 81.5% of cases while culture was positive in only 31.5%. The most common genus was Aspergillus and the identified species belonged to section Fumigati or to section Flavi. Among other fungi identified by sequence analysis, Schizophyllum commune was present in three samples attesting to the importance of this Basidiomycetes in FRS. Our results clearly demonstrate the superiority of sequencing compared to culture when performed on specimens with hyphal elements at DME, and contributes to the epidemiological knowledge of fungi involved in FRS.
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Affiliation(s)
- M Sasso
- Laboratoire de parasitologie-mycologie, CHU de Nîmes, place du Pr-Debré, 30029 Nîmes cedex 9, France; Faculté de médecine de Montpellier-Nîmes, université de Montpellier, Montpellier, France
| | - A Barrot
- Laboratoire de parasitologie-mycologie, CHU de Nîmes, place du Pr-Debré, 30029 Nîmes cedex 9, France; Faculté de médecine de Montpellier-Nîmes, université de Montpellier, Montpellier, France
| | - M-J Carles
- Laboratoire de virologie, CHU de Nîmes, Nîmes, France
| | - K Griffiths
- Service biostatistique et technologies de l'information et de la communication, AP-HM, hôpital de la Timone, Marseille, France
| | - P Rispail
- Département de parasitologie-mycologie, CHU de Montpellier, Marseille, France
| | - L Crampette
- Faculté de médecine de Montpellier-Nîmes, université de Montpellier, Montpellier, France; Service d'otorhinolaryngologie, CHU de Montpellier, Marseille, France
| | - B Lallemant
- Faculté de médecine de Montpellier-Nîmes, université de Montpellier, Montpellier, France; Service d'otorhinolaryngologie, CHU de Nîmes, Nîmes, France
| | - L Lachaud
- Laboratoire de parasitologie-mycologie, CHU de Nîmes, place du Pr-Debré, 30029 Nîmes cedex 9, France; Faculté de médecine de Montpellier-Nîmes, université de Montpellier, Montpellier, France.
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Singh AK, Gupta P, Verma N, Khare V, Ahamad A, Verma V, Agarwal SP. Fungal Rhinosinusitis: Microbiological and Histopathological Perspective. J Clin Diagn Res 2017; 11:DC10-DC12. [PMID: 28892889 DOI: 10.7860/jcdr/2017/25842.10167] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Accepted: 04/20/2017] [Indexed: 11/24/2022]
Abstract
INTRODUCTION On the basis of histopathology Fungal Rhinosinusitis (FRS) is categorized into non-invasive (allergic fungal rhinosinusitis, fungal ball) and invasive (acute invasive, chronic invasive and granulomatous invasive fungal sinusitis). This differentiation helps to decide the treatment. Role of latest molecular methods such as PCR and conventional methods such as KOH microscopy and culture also needs to be evaluated. Therefore, in this study we planned to categorise fungal rhinosinusitis on the basis of histopathology and compare it with other methods such as PCR, culture and KOH microscopy. AIM To analyse fungal rhinosinusitis cases by both histopathologically and microbiologically. MATERIALS AND METHODS A total of 76 clinically suspected fungal rhinosinusitis cases were included in the study. The tissue of suspected cases were processed and examined by KOH microscopy, histopathologically, culture and PCR. Histopathological examination was done by PAS, GMS and H&E stain. RESULTS FRS was diagnosed in 37 (48.68%) cases out of 76 clinically suspected cases of FRS. In which 17 (22.3%) cases were positive by direct microscopy, 21 (27.6%) by culture, 27 (35.5%) by PCR and 14 (18.42%) by histopathology. Approximately 14 cases of FRS were classified according to histopathology; 10 (71.3%) as non-invasive FRS. Out of these 10, 9 (64.2%) were classified as AFRS and 1 (7.14%) as fungal ball. Only 4 cases (28.5%) were diagnosed with invasive FRS. Out of these 4 cases, 2 (14.2%) were of chronic invasive fungal rhinosinusitis, 1 (7.14%) was of granulomatous invasive fungal rhinosinusitis and 1 (7.14%) was of acute fulminant invasive fungal rhinosinusitis. Allergic Fungal Rhinosinusitis (AFRS) is the most common type of FRS. Aspergillus flavus was found to be the most common fungi causing FRS. CONCLUSION Diagnosis should not be based on the single method. It should be done by both histopathological and microbiological methods, especially for those cases which are difficult to diagnose.
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Affiliation(s)
- Ajay Kumar Singh
- Associate Professor, Department of Pathology, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Prashant Gupta
- Associate Professor, Department of Microbiology, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Nitya Verma
- Ph. D Scholar, Department of Microbiology, Santosh Medical University, Ghajiabad, Uttar Pradesh, India
| | - Vineeta Khare
- Associate Professor, Department of Microbiology, Era's Lucknow Medical College, Lucknow, Uttar Pradesh, India
| | - Abrar Ahamad
- Ph. D Scholar, Department of Microbiology, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Virendra Verma
- Professor, Department of Ear, Nose and Throat, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - S P Agarwal
- Professor, Department of Ear, Nose and Throat, King George's Medical University, Lucknow, Uttar Pradesh, India
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Ni Mhurchu E, Ospina J, Janjua AS, Shewchuk JR, Vertinsky AT. Fungal Rhinosinusitis: A Radiological Review with Intraoperative Correlation. Can Assoc Radiol J 2017; 68:178-186. [DOI: 10.1016/j.carj.2016.12.009] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Accepted: 12/30/2016] [Indexed: 10/19/2022] Open
Abstract
The interaction between fungi and the sinonasal tract results in a range of clinical presentations with a broad spectrum of clinical severity. The most commonly accepted classification system divides fungal rhinosinusitis into invasive and noninvasive subtypes based on histopathological evidence of tissue invasion by fungi. Invasive fungal rhinosinusitis is subdivided into acute invasive and chronic invasive categories. The chronic invasive category includes a subcategory of chronic granulomatous disease. Noninvasive fungal disease includes localized fungal colonization, fungal ball, and allergic fungal rhinosinusitis. Noninvasive disease is simply fungal material (or the products of the inflammatory reaction of the sinus mucosa) that fills the sinuses but does not invade tissue. Bone loss is related to expansion of the sinus(es). Invasive disease causes tissue destruction, such that it expands past the bony confines of the sinuses. It can rapidly spread, causing acute necrosis. Alternatively, there may be slow tissue invasion characterized by symptoms confused with normal sinusitis, but destruction of normal nasal and paranasal structures.
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Affiliation(s)
- Elaine Ni Mhurchu
- Neuroradiology, University of British Columbia, Vancouver General Hospital, Vancouver, British Columbia, Canada
| | - Javier Ospina
- Otolaryngology - Head & Neck Surgery, University of British Columbia, Vancouver General Hospital and St Paul's Hospital, Vancouver, British Columbia, Canada
| | - Arif S. Janjua
- Otolaryngology - Head & Neck Surgery, University of British Columbia, Vancouver General Hospital and St Paul's Hospital, Vancouver, British Columbia, Canada
| | - Jason R. Shewchuk
- Neuroradiology, University of British Columbia, Vancouver General Hospital, Vancouver, British Columbia, Canada
| | - Alexandra T. Vertinsky
- Neuroradiology, University of British Columbia, Vancouver General Hospital, Vancouver, British Columbia, Canada
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Paknezhad H, Borchard NA, Charville GW, Ayoub NF, Choby GW, Thamboo A, Nayak JV. Evidence for a 'preinvasive' variant of fungal sinusitis: Tissue invasion without angioinvasion. World J Otorhinolaryngol Head Neck Surg 2017; 3:37-43. [PMID: 29204577 PMCID: PMC5683596 DOI: 10.1016/j.wjorl.2017.01.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Accepted: 01/28/2017] [Indexed: 11/26/2022] Open
Abstract
Clinical experience has suggested the existence of an intermediate form of fungal sinusitis between the categories of non-invasive fungal sinusitis (non-IFS) and invasive fungal sinusitis (IFS). This fungal sinusitis variant demonstrates unhealthy mucosa by endoscopy with fungal invasion, but lacks angioinvasion microscopically, representing what clinically behaves as a 'pre-invasive' subtype of fungal sinusitis. Unlike non-IFS disease, patients with pre-invasive fungal sinusitis were still felt to require anti-fungal medications due to histologic presence of invasive fungus. While sharing some clinical features of IFS, these 'intermediate' patients were successfully spared extended and repeated surgical debridements given the microscopic findings, and have been successfully treated with shorter courses of antifungal therapy. These select patients have had favorable outcomes when managed in a judicious and semi-aggressive manner, in an undefined zone between the treatments for routine fungal ball and aggressive IFS.
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Affiliation(s)
- Hassan Paknezhad
- Division of Rhinology, Department of Otolaryngology - Head and Neck Surgery, Stanford University School of Medicine, USA
| | - Nicole A Borchard
- Division of Rhinology, Department of Otolaryngology - Head and Neck Surgery, Stanford University School of Medicine, USA
| | - Greg W Charville
- Division of Rhinology, Department of Otolaryngology - Head and Neck Surgery, Stanford University School of Medicine, USA
| | - Noel F Ayoub
- Division of Rhinology, Department of Otolaryngology - Head and Neck Surgery, Stanford University School of Medicine, USA
| | - Garret W Choby
- Division of Rhinology, Department of Otolaryngology - Head and Neck Surgery, Stanford University School of Medicine, USA
| | - Andrew Thamboo
- Division of Rhinology, Department of Otolaryngology - Head and Neck Surgery, Stanford University School of Medicine, USA
| | - Jayakar V Nayak
- Division of Rhinology, Department of Otolaryngology - Head and Neck Surgery, Stanford University School of Medicine, USA
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Tostes VS, de Oliveira Schiavon JL, Lederman HM. Fungal Sinusitis: Magnetic Resonance Image Findings on Immunocompromised Patients. CURRENT RADIOLOGY REPORTS 2017. [DOI: 10.1007/s40134-017-0202-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Expression of maspin in invasive fungal rhinosinusitis. The Journal of Laryngology & Otology 2016; 131:150-154. [PMID: 28031066 DOI: 10.1017/s0022215116009890] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE This study aimed to test the expression of maspin in invasive fungal rhinosinusitis and explore its value in diagnosing invasive fungal rhinosinusitis. METHODS Forty-two fungal rhinosinusitis cases (12 invasive and 30 non-invasive) were selected as the experimental group, and 30 chronic rhinosinusitis cases comprised the control group. Maspin expression was assessed in nasal mucous membrane specimens by immunohistochemical staining. RESULTS Compared with the control group, maspin expression was down-regulated in the fungal rhinosinusitis group (p < 0.05). Furthermore, the staining score for maspin was lowest in the invasive fungal rhinosinusitis group, as compared with both the non-invasive fungal rhinosinusitis group and the control group (p < 0.05). A maspin staining score of 5.70 was the critical value for diagnosis of invasive fungal rhinosinusitis, with sensitivity and specificity of 91.7 per cent and 88.3 per cent, respectively. CONCLUSION The results of this study suggest that the maspin staining score may be a biomarker for effective and rapid diagnosis of invasive fungal rhinosinusitis.
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Masterson L, Egro FM, Bewick J, Erskine SE, Clark A, Javer AR, Philpott CM. Quality-of-life outcomes after sinus surgery in allergic fungal rhinosinusitis versus nonfungal chronic rhinosinusitis. Am J Rhinol Allergy 2016; 30:e30-5. [PMID: 26980383 DOI: 10.2500/ajra.2016.30.4280] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Given the differences in pathophysiology between allergic fungal rhinosinusitis (AFRS) and other chronic rhinosinusitis (CRS) subgroups, it remains unclear about whether these patients respond differently to a combination of surgical and medical treatments. OBJECTIVE To evaluate differences in quality-of-life (QoL) outcomes for a cohort of patients who underwent endoscopic sinus surgery (ESS) for CRS. METHODS This retrospective review included patients with CRS who underwent ESS between 2010 and 2013. QoL was measured by using the 22-item Sino-Nasal Outcome Test (SNOT-22). Variables collected included baseline demographics, SNOT-22 scores before ESS and at 1, 3, 6, 9, and 12 months after ESS. Groups tested were CRS with nasal polyposis, CRS without nasal polyposis (CRSsNP), and patients with AFRS. A linear mixed- effects regression model was used to calculate the adjusted mean QoL differences. RESULTS Among the 250 patients included, 61.6% had CRS with nasal polyposis (n = 154), 28.8% had CRSsNP (n = 72), and 9.6% had AFRS (n = 24). Significant differences were seen in SNOT-22 scores between pre- and postoperative visits and between the etiologic subgroups (p < 0.001). Multivariate analysis revealed significantly greater improvement in QoL for patients with AFRS in comparison with those with CRSsNP at the 9-month follow-up (change in SNOT-22 score, 22.6 [95% confidence interval, 1.2-44.1]; p < 0.0) and the 12-month follow-up (change in SNOT-22 score, 20.2 [95% confidence interval, 0.5-39.9]; p < 0.04). CONCLUSIONS Patients with AFRS experienced a more-prolonged QoL benefit from surgical and targeted medical intervention compared with those with CRSsNP, which may reflect the severity of inflammation that they presented with compared with other CRS subtypes.
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Affiliation(s)
- Liam Masterson
- Department of Ear Nose and Throat, James Paget University Hospital, Lowestoft Road, Gorleston-on-Sea, UK
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Lee RJ, Workman AD, Carey RM, Chen B, Rosen PL, Doghramji L, Adappa ND, Palmer JN, Kennedy DW, Cohen NA. Fungal Aflatoxins Reduce Respiratory Mucosal Ciliary Function. Sci Rep 2016; 6:33221. [PMID: 27623953 PMCID: PMC5021939 DOI: 10.1038/srep33221] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Accepted: 08/23/2016] [Indexed: 11/29/2022] Open
Abstract
Aflatoxins are mycotoxins secreted by Aspergillus flavus, which can colonize the respiratory tract and cause fungal rhinosinusitis or bronchopulmonary aspergillosis. A. flavus is the second leading cause of invasive aspergillosis worldwide. Because many respiratory pathogens secrete toxins to impair mucociliary immunity, we examined the effects of acute exposure to aflatoxins on airway cell physiology. Using air-liquid interface cultures of primary human sinonasal and bronchial cells, we imaged ciliary beat frequency (CBF), intracellular calcium, and nitric oxide (NO). Exposure to aflatoxins (0.1 to 10 μM; 5 to 10 minutes) reduced baseline (~6-12%) and agonist-stimulated CBF. Conditioned media (CM) from A. fumigatus, A. niger, and A. flavus cultures also reduced CBF by ~10% after 60 min exposure, but effects were blocked by an anti-aflatoxin antibody only with A. flavus CM. CBF reduction required protein kinase C but was not associated with changes in calcium or NO. However, AFB2 reduced NO production by ~50% during stimulation of the ciliary-localized T2R38 receptor. Using a fluorescent reporter construct expressed in A549 cells, we directly observed activation of PKC activity by AFB2. Aflatoxins secreted by respiratory A. flavus may impair motile and chemosensory functions of airway cilia, contributing to pathogenesis of fungal airway diseases.
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Affiliation(s)
- Robert J. Lee
- Department of Otorhinolaryngology – Head and Neck Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
- Department of Physiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Alan D. Workman
- Department of Otorhinolaryngology – Head and Neck Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Ryan M. Carey
- Department of Otorhinolaryngology – Head and Neck Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Bei Chen
- Department of Otorhinolaryngology – Head and Neck Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Phillip L. Rosen
- Department of Otorhinolaryngology – Head and Neck Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Laurel Doghramji
- Department of Otorhinolaryngology – Head and Neck Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Nithin D. Adappa
- Department of Otorhinolaryngology – Head and Neck Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - James N. Palmer
- Department of Otorhinolaryngology – Head and Neck Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - David W. Kennedy
- Department of Otorhinolaryngology – Head and Neck Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Noam A. Cohen
- Department of Otorhinolaryngology – Head and Neck Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
- Philadelphia VA Medical Center Surgical Services, Philadelphia, Pennsylvania, USA
- Monell Chemical Senses Center, Philadelphia, Pennsylvania, USA
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D'Anza B, Stokken J, Greene JS, Kennedy T, Woodard TD, Sindwani R. Chronic invasive fungal sinusitis: characterization and shift in management of a rare disease. Int Forum Allergy Rhinol 2016; 6:1294-1300. [DOI: 10.1002/alr.21828] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Revised: 06/04/2016] [Accepted: 06/28/2016] [Indexed: 11/11/2022]
Affiliation(s)
- Brian D'Anza
- Head and Neck Institute; Cleveland Clinic Foundation; Cleveland OH
| | - Janalee Stokken
- Department of Otolaryngology-Head and Neck Surgery; Mayo Clinic; Rochester MN
| | - J. Scott Greene
- Department of Otolaryngology-Head and Neck Surgery, Facial Plastic Surgery; Geisinger Medical Center; Danville PA
| | - Thomas Kennedy
- Department of Otolaryngology-Head and Neck Surgery, Facial Plastic Surgery; Geisinger Medical Center; Danville PA
| | - Troy D. Woodard
- Head and Neck Institute; Cleveland Clinic Foundation; Cleveland OH
| | - Raj Sindwani
- Head and Neck Institute; Cleveland Clinic Foundation; Cleveland OH
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Gavito-Higuera J, Mullins CB, Ramos-Duran L, Sandoval H, Akle N, Figueroa R. Sinonasal Fungal Infections and Complications: A Pictorial Review. J Clin Imaging Sci 2016; 6:23. [PMID: 27403401 PMCID: PMC4926542 DOI: 10.4103/2156-7514.184010] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Accepted: 05/20/2016] [Indexed: 11/04/2022] Open
Abstract
Fungal infections of the nose and paranasal sinuses can be categorized into invasive and non-invasive forms. The clinical presentation and course of the disease is primarily determined by the immune status of the host and can range from harmless or subtle presentations to life threatening complications. Invasive fungal infections are categorized into acute, chronic or chronic granulomatous entities. Immunocompromised patients with poorly controlled diabetes mellitus, HIV and patients receiving chemotherapy or chronic oral corticosteroids are mostly affected. Mycetoma and Allergic Fungal Rhinosinusitis are considered non-invasive forms. Computer tomography is the gold-standard in sinonasal imaging and is complimented by Magnetic resonance imaging (MRI) as it is superior in the evaluation of intraorbital and intracranial extensions. The knowledge and identification of the characteristic imaging patterns in invasive - and non- invasive fungal rhinosinusitis is crucial and the radiologist plays an important role in refining the diagnosis to prevent a possible fatal outcome.
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Affiliation(s)
- Jose Gavito-Higuera
- Department of Radiology, Texas Tech University Health Sciences Center, El Paso, TX 79905, USA
| | - Carola Birgit Mullins
- Department of Radiology, Texas Tech University Health Sciences Center, El Paso, TX 79905, USA
| | - Luis Ramos-Duran
- Department of Radiology, Texas Tech University Health Sciences Center, El Paso, TX 79905, USA
| | - Hugo Sandoval
- Department of Radiology, Texas Tech University Health Sciences Center, El Paso, TX 79905, USA
| | - Nassim Akle
- Department of Radiology, Texas Tech University Health Sciences Center, El Paso, TX 79905, USA
| | - Ramon Figueroa
- Department of Radiology and Imaging, Medical College of Georgia, Augusta University, Augusta, GA 30912, USA
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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.
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Lawrence LA, Mulligan JK, Roach C, Pasquini WN, Soler ZM, Banglawala SM, Karnezis TT, Gudis DA, Schlosser RJ. Superoxide dismutase reduces the inflammatory response to Aspergillus and Alternaria in human sinonasal epithelial cells derived from patients with chronic rhinosinusitis. Am J Rhinol Allergy 2016; 29:89-93. [PMID: 25785747 DOI: 10.2500/ajra.2015.29.4155] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Aspergillus fumigatus and Alternaria alternata are ubiquitous environmental fungal allergens that can exacerbate airway inflammation and contribute to the disease process in patients with chronic rhinosinusitis (CRS). These antigens have been shown to induce human sinonasal epithelial cells (HSNECs) to promote a proinflammatory response, but what is unclear is a means by which to reduce these effects. Inhaled pathogens can induce HSNECs to produce reactive oxygen species (ROS) that trigger cytokine production. OBJECTIVE This study aimed to determine whether the free radical scavenger superoxide dismutase (SOD) could reduce HSNEC-derived inflammation, as measured by interleukin (IL)-6 and IL-8 production, in response to Aspergillus or Alternaria exposure. METHODS Sinus tissue explants were collected at the time of surgery from control patients (n = 7) and patients with CRS with nasal polyps (CRSwNP) (n = 9). HSNECs were cultured from the explants and treated with Aspergillus, Alternaria, and SOD for 24 hours. Cell supernatants and lysates were collected, and IL-6 and IL-8 concentrations were measured using enzyme-linked immunosorbent assay. RESULTS In control and CRSwNP HSNECs, Aspergillus and Alternaria both increased cytokine production (p < 0.05), as measured by IL-6 and IL-8 concentration. SOD treatment reduced the inflammatory response to fungal antigen exposure from CRSwNP HSNECs but not control HSNECs. In CRSwNP patients, SOD significantly decreased IL-6 and IL-8 production after Alternaria exposure and IL-8 after Aspergillus exposure (p < 0.05). CONCLUSIONS When HSNECs from CRSwNP patients are treated with SOD concurrently with Aspergillus or Alternaria, SOD treatment decreases the fungal antigen-induced inflammatory response. The ability to attenuate inflammation induced by common fungal allergens with SOD treatment could provide a novel therapeutic or preventative approach for patients with CRS or other allergic inflammatory airway diseases.
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Affiliation(s)
- Lauren A Lawrence
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
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A Case of Fungus Ball-Type Pansinusitis Due to Fusarium proliferatum. Mycopathologia 2015; 180:251-5. [PMID: 26025662 DOI: 10.1007/s11046-015-9906-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2015] [Accepted: 05/20/2015] [Indexed: 10/23/2022]
Abstract
Incidence of fungal sinusitis due to the genus Fusarium has increased during the last two decades. We report a case of fungus ball sinusitis with multiple sinuses involvement in an Iranian 21-year-old woman. The patient was diagnosed as having a fungus ball-type sinusitis in computed tomography scan. The sinus biopsy revealed fungal structures on histopathological and direct microscopic examinations and a Fusarium species arose in culture. Partial sequencing of the translation elongation factor 1-alpha identified the isolate as F. proliferatum. Removal of all lesions by endoscopic surgery resulted in a favorable outcome. To the best of our knowledge, this is the first case of F. proliferatum-associated fungus ball which involved multi-sinus and highlights the efficiency of molecular methods for discrimination of fungal agents involved.
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Burke MC, Taheri R, Bhojwani R, Singh A. A practical approach to the imaging interpretation of sphenoid sinus pathology. Curr Probl Diagn Radiol 2015; 44:360-70. [PMID: 25792244 DOI: 10.1067/j.cpradiol.2015.02.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2014] [Revised: 02/04/2015] [Accepted: 02/05/2015] [Indexed: 11/22/2022]
Abstract
The goal of this article is to provide a practical approach to the imaging interpretation of sphenoid sinus pathology. Basic anatomy and physiology is reviewed first. This is followed by a discussion of the imaging modalities used to evaluate the sphenoid sinuses and how to differentiate a benign from an aggressive lesion. Finally, disease entities are discussed, with attention to clinical presentation, expected imaging appearance, and treatment. Although the focus is on sphenoid sinus pathology, the concepts presented can be applied to interpretation of disease in any paranasal sinus.
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Affiliation(s)
| | - Reza Taheri
- Neuroradiology, George Washington University Hospital, Washington, DC; Radiology, George Washington University Hospital, Washington, DC
| | - Roger Bhojwani
- Radiology, George Washington University Hospital, Washington, DC
| | - Ameet Singh
- Rhinology & Skull Base Surgery, George Washington University Hospital, Washington, DC; Endoscopic Pituitary and Anterior Skull Base Surgery, George Washington University Hospital, Washington, DC; Surgery and Neurologic Surgery, George Washington University Hospital, Washington, DC
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Gawlik R, Czecior E, Jarząb J, Grzanka A, Cichecka E, Sowa P, Ścierski W. Frequency of IgE-dependent hypersensitivity to moulds in patients with chronic rhinosinusitis with polyps. Postepy Dermatol Alergol 2014; 31:159-63. [PMID: 25097487 PMCID: PMC4112265 DOI: 10.5114/pdia.2014.40976] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2013] [Revised: 01/07/2014] [Accepted: 01/14/2014] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION The complicated etiology of chronic sinusitis with polyps and frequent allergy to mould is established. AIM We aimed to investigate the frequency of the IgE-dependent hypersensitivity in this group of patients and prove the need of surgery in allergic chronic rhinosinusitis patients. MATERIAL AND METHODS Forty-two patients (19 females, 23 males) aged 34-73 years (55 ±12.6 years), with chronic sinusitis with polyps were included into the study. Functional endoscopic sinus surgery, laryngological examination, sinus computed tomography scans, and smear from maxillary sinus for microbiological examination were done in all patients. Skin prick tests with common perennial and seasonal inhalant allergens, tIgE and sIgE against moulds were required. RESULTS Thirty-two of 42 patients (71.4%) were allergic to at least one inhalant allergen. A mean concentration of total IgE was 241.2 ±186.3 kU/l (35.0-708.0 kU/l) and was lower in patients with fungal culture found in sinus mucin than in patients without fungal presence 75.1 ±54.6 kU/l vs. 284.3 ±204.1 kU/l. We found no difference in the number of positive skin prick tests in a group with and without fungal culture. None of patients with fungal culture found in sinuses presented a detectable level of mold sIgE. All patients with fungal vegetation in sinuses required at least two polypectomy procedures. CONCLUSIONS The total IgE concentration was significantly lower in patients with fungal presence in sinuses. Nasal polyps occurred more frequently in patients with fungal presence in sinuses.
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Affiliation(s)
- Radosław Gawlik
- Chair and Clinical Department of Internal Diseases, Allergology and Clinical Immunology, Medical University of Silesia, Katowice, Poland. Head of Department: Prof. Barbara Rogala MD, PhD
| | - Eugeniusz Czecior
- Chair and Clinical Department of Otolaryngology in Zabrze, Medical University of Silesia in Katowice, Poland. Head of Department: Prof. Grzegorz Namysłowski MD, PhD
| | - Jerzy Jarząb
- Clinical Department of Internal Diseases, Dermatology and Allergology in Zabrze, Medical University of Silesia in Katowice, Poland. Head of Department: Prof. Jerzy Jarząb MD, PhD
| | - Alicja Grzanka
- Clinical Department of Internal Diseases, Dermatology and Allergology in Zabrze, Medical University of Silesia in Katowice, Poland. Head of Department: Prof. Jerzy Jarząb MD, PhD
| | | | - Paweł Sowa
- Chair and Clinical Department of Otolaryngology in Zabrze, Medical University of Silesia in Katowice, Poland. Head of Department: Prof. Grzegorz Namysłowski MD, PhD
| | - Wojciech Ścierski
- Chair and Clinical Department of Otolaryngology in Zabrze, Medical University of Silesia in Katowice, Poland. Head of Department: Prof. Grzegorz Namysłowski MD, PhD
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Gupta A, Xess I, Sharma SC, Mallick S. Invasive rhinosinusitis by Exserohilum rostratum in an immunocompetent child. BMJ Case Rep 2014; 2014:bcr-2013-202380. [PMID: 24711469 DOI: 10.1136/bcr-2013-202380] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Exserohilum is a saprophytic fungal pathogen responsible for a wide spectrum of infections in humans. It causes life-threatening acute invasive infections in the immunocompromised individuals, particularly those having haematological disorders. We report a proven case of chronic invasive rhinosinusitis with orbital involvement by Exserohilum rostratum in an immunocompetent child. The patient responded well to endoscopic sinus surgery followed by oral itraconazole. An aggressive surgical approach is required for improving the outcome of patients with invasive infections. A microbiological diagnosis may help in deciding the systemic antifungal agent in fungal rhinosinusitis.
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Affiliation(s)
- Ayush Gupta
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India
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Zhang F, An Y, Li Z, Zhao C. A Novel Model of Invasive Fungal Rhinosinusitis in Rats. Am J Rhinol Allergy 2013; 27:361-6. [PMID: 23816783 DOI: 10.2500/ajra.2013.27.3953] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Background Invasive fungal rhinosinusitis (IFRS) is a life-threatening inflammatory disease that affects immunocompromised patients, but animal models of the disease are scarce. This study aimed to develop an IFRS model in neutropenic rats. Methods The model was established in three consecutive steps: unilateral nasal obstruction with Merocel sponges, followed by administration of cyclophosphamide (CPA), and, finally, nasal inoculation with Aspergillus fumigatus. Fifty healthy Wistar rats were randomly divided into five groups, with group I as the controls, group II undergoing unilateral nasal obstruction alone, group III undergoing nasal obstruction with fungal inoculation, group IV undergoing nasal obstruction with administration of CPA, and group V undergoing nasal obstruction with administration of CPA and fungal inoculation. Hematology, histology, and mycology investigations were performed. Results The changes in the rat absolute neutrophil counts (ANCs) were statistically different across the groups. The administration of CPA decreased the ANCs, whereas nasal obstruction with fungal inoculation increased the ANCs, and nasal obstruction did not change them. Histological examination of the rats in group V revealed the hyphal invasion of sinus mucosa and bone, thrombosis, and tissue infarction. No pathology indicative of IFRS was observed in the remaining groups. Positive rates of fungal culture in tissue homogenates from the maxillary sinus (62.5%) and lung (25%) were found in group V, whereas groups I, II, III, and IV showed no fungal culture in the homogenates. Conclusion A rat IFRS model was successfully developed through nasal obstruction, CPA-induced neutropenia, and fungal inoculation. The disease model closely mimics the pathophysiology of anthropic IFRS.
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Affiliation(s)
- Fang Zhang
- Department of Otorhinolaryngology–Head and Neck Surgery, Second Hospital of Shanxi Medical University, Taiyuan, China
| | - Yunfang An
- Department of Otorhinolaryngology–Head and Neck Surgery, Second Hospital of Shanxi Medical University, Taiyuan, China
| | - Zeqing Li
- Department of Otolaryngology, Affiliated Hospital of Nanjing University of Traditional Chinese Medicine, Nanjing, China
| | - Changqing Zhao
- Department of Otorhinolaryngology–Head and Neck Surgery, Second Hospital of Shanxi Medical University, Taiyuan, China
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