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Blennow O, Hellgren U, Asgeirsson H. A slowly growing facial tumour in a southern African migrant. J Travel Med 2023; 30:taad018. [PMID: 36744722 PMCID: PMC10755164 DOI: 10.1093/jtm/taad018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 01/28/2023] [Accepted: 02/03/2023] [Indexed: 02/07/2023]
Affiliation(s)
- Ola Blennow
- Department of Infectious Diseases, Karolinska University Hospital, 14186 Stockholm, Sweden
- Unit of Infectious Diseases and Dermatology, Department of Medicine Huddinge, Karolinska Institutet, 14186 Stockholm, Sweden
| | - Urban Hellgren
- Department of Infectious Diseases, Karolinska University Hospital, 14186 Stockholm, Sweden
- Unit of Infectious Diseases and Dermatology, Department of Medicine Huddinge, Karolinska Institutet, 14186 Stockholm, Sweden
| | - Hilmir Asgeirsson
- Department of Infectious Diseases, Karolinska University Hospital, 14186 Stockholm, Sweden
- Unit of Infectious Diseases and Dermatology, Department of Medicine Huddinge, Karolinska Institutet, 14186 Stockholm, Sweden
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2
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Jiang T, Zhang Q, Li C, Li T, Sun S, Chen A, Ji H, Wan Y, Shi L, Yu L. Clinical Characteristics of Sphenoid Sinus Fungus Ball: A Nine-year Retrospective Study of 77 Cases. Laryngoscope 2023; 133:3292-3298. [PMID: 37022141 DOI: 10.1002/lary.30683] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Revised: 03/02/2023] [Accepted: 03/10/2023] [Indexed: 04/07/2023]
Abstract
OBJECTIVE This study aimed to investigate the clinical characteristics of sphenoid sinus fungus ball (SSFB) to help increase the accuracy of diagnosis and efficiency of treatment. METHODS We retrospectively analyzed the data of 77 patients who were histopathologically diagnosed with SSFB. RESULTS The mean age of SSFB patients was 52.4 years (range 25-84), and 47 patients (61.0%) were female. Compared to age-matched and sex-matched chronic rhinosinusitis (CRS) patients, headache was more common in SSFB patients (79.2%; p < 0.0001). SSFB patients also had higher prevalence of diabetes than CRS (p = 0.0420). The features of computed tomography (CT) were sphenoid sinus opacification (100%), sclerosis (93.5%), calcification (76.6%), and bone erosion (41.6%). Functional endoscopic sinus surgery (FESS) was the best treatment option, and the trans-ethmoid (n = 64, 83.1%) was the most commonly used approach. No one experienced a recurrence of SSFB in 44 successfully contacted patients. Six months after FESS, 91.0% of patients (40/44) established proper drainage in the sphenoid sinus. The recovery rates for headache and nasal symptoms were 91.7% (33/36) and 77.8% (7/9) respectively. CONCLUSION SSFB is more prevalent in older women and usually presents as unilateral headache. Diabetes is a potential risk factor for SSFB. CT findings provide evidence for diagnosis and suggestions for surgical approaches. FESS is the optimal treatment for SSFB. After FESS, most patients had good prognosis with no recurrence of SSFB. However, regular endoscopic follow-up is required due to the possibility of the postoperative closure of sphenoid ostium. LEVEL OF EVIDENCE 3 Laryngoscope, 133:3292-3298, 2023.
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Affiliation(s)
- Tianjiao Jiang
- Department of Otorhinolaryngology-Head and Neck Surgery, Shandong Provincial ENT Hospital, Shandong University, Jinan, China
| | - Qian Zhang
- Department of Otorhinolaryngology-Head and Neck Surgery, Shandong Provincial ENT Hospital, Shandong University, Jinan, China
| | - Chunhao Li
- Department of Otorhinolaryngology-Head and Neck Surgery, Shandong Provincial ENT Hospital, Shandong University, Jinan, China
| | - Tong Li
- Department of Radiology, Shandong Provincial ENT Hospital, Shandong University, Jinan, China
| | - Shujuan Sun
- Department of Otorhinolaryngology-Head and Neck Surgery, Shandong Provincial ENT Hospital, Shandong University, Jinan, China
| | - Aiping Chen
- Department of Otorhinolaryngology-Head and Neck Surgery, Shandong Provincial ENT Hospital, Shandong University, Jinan, China
| | - Hongzhi Ji
- Department of Otorhinolaryngology-Head and Neck Surgery, Shandong Provincial ENT Hospital, Shandong University, Jinan, China
| | - Yuzhu Wan
- Department of Otorhinolaryngology-Head and Neck Surgery, Shandong Provincial ENT Hospital, Shandong University, Jinan, China
| | - Li Shi
- Department of Otorhinolaryngology-Head and Neck Surgery, Shandong Provincial ENT Hospital, Shandong University, Jinan, China
| | - Liang Yu
- Department of Otorhinolaryngology-Head and Neck Surgery, Shandong Provincial ENT Hospital, Shandong University, Jinan, China
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Rupa V, Peter J, Michael JS, Thomas M, Irodi A, Rajshekhar V. Chronic Granulomatous Invasive Fungal Sinusitis in Patients With Immunocompetence: A Review. Otolaryngol Head Neck Surg 2023; 168:669-680. [PMID: 35503655 DOI: 10.1177/01945998221097006] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Accepted: 04/05/2022] [Indexed: 11/16/2022]
Abstract
OBJECTIVE We aimed to study the literature on chronic granulomatous invasive fungal sinusitis to elucidate the changing trends in the management of the disease. DATA SOURCES Using specific keywords, we searched the PubMed, PubMed Central, and Scopus databases over the past 50 years, which yielded 938 articles in the English language. REVIEW METHODS Scrutiny of 147 relevant articles revealed 15 homogenous case series (255 cases of histologically proven chronic granulomatous fungal sinusitis alone) and 8 heterogeneous case series (patients with other types of fungal sinusitis included), which were analyzed in detail (all with >5 cases each). CONCLUSIONS The disease typically affected middle-aged adults with immunocompetence. Most reports were from Sudan, India, and Saudi Arabia. A slowly progressive orbital, cheek, or palatal mass with proptosis (88.2%) or sinonasal symptoms (39.2%) was typical. Ethmoid (57.2%) and maxillary (51.4%) sinuses were chiefly affected with intracranial extension in 35.1%. Aspergillus flavus (64%) was the most frequent isolate reported. Endoscopic excision (78.8%) followed by azole therapy was the preferred treatment in recent reports. Orbital exenteration and craniotomy were infrequently performed. Complete resolution or improvement was reported in 91.3% of patients. Mortality ranged from 5.9% to 22.2%. There is a trend in the literature toward less radical and disfiguring surgery and preferential use of azoles, with good outcomes even in advanced cases. IMPLICATIONS FOR PRACTICE Chronic granulomatous fungal sinusitis should be diagnosed on the basis of well-defined histopathologic features. A combination of endoscopic sinus surgery and azole therapy usually yields good outcomes.
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Affiliation(s)
- Vedantam Rupa
- Department of Otorhinolaryngology, Christian Medical College Hospital, Vellore, India
| | - Jayanthi Peter
- Department of Ophthalmology, Christian Medical College Hospital, Vellore, India
| | | | - Meera Thomas
- Department of Pathology, Christian Medical College Hospital, Vellore, India
| | - Aparna Irodi
- Department of Radiology, Christian Medical College Hospital, Vellore, India
| | - Vedantam Rajshekhar
- Department of Neurological Sciences, Christian Medical College Hospital, Vellore, India
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4
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Alharbi A, Reville N, Molinier S, Bastier PL, de Gabory L. Characterization of fungus ball CT-hyperdensities within maxillary and sphenoid sinuses. Dentomaxillofac Radiol 2022; 51:20180384. [PMID: 35762348 PMCID: PMC10043618 DOI: 10.1259/dmfr.20180384] [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: 10/17/2018] [Revised: 05/10/2022] [Accepted: 06/03/2022] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES CT-scan hyperdensities (HD) are described in more than 60% of all paranasal sinus fungus ball (FB) cases. Two types can be distinguished according to their density: calcium and metal types. We aimed to establish the prevalence and density of the HD observed in sphenoid and maxillary sinus FB and their relation to dental factors. METHODS This retrospective study included 64 patients operated in a tertiary referral center for unilateral maxillary or sphenoid FB diagnosed by histology or mycology. Pre-operative CT scans were analyzed by three independent observers (two ENT and one radiologist). RESULTS There were 45 maxillary FB and 19 sphenoid FB. 63 FB showed HD. Metal-type HD were observed in 28 maxillary FB but not in sphenoid sinuses. Among maxillary FB, the prevalence of endodontic treatment was significantly more significant on the FB side than on the healthy side (p = 0.02). The prevalence of endodontic treatment on the pathological side was more significant in the metal-type group than in the group without metal-type HD (p = 0.01). Isolated calcium-type HD were evidenced in 17 maxillary FB and 18 sphenoid FB (p = 0.019). CONCLUSION This study highlights the existence of two different types of HD in FBs of the paranasal sinuses with an association between metal-type HD and endodontic treatments.
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Affiliation(s)
| | - Nicolas Reville
- Department of Otorhinolaryngology-Head and Neck Surgery, University Hospital of Bordeaux, Bordeaux, France
| | - Sandrine Molinier
- Radiology and Medical Imaging Department, University Hospital of Bordeaux, Bordeaux, France
| | - Pierre-Louis Bastier
- Department of Otorhinolaryngology-Head and Neck Surgery, University Hospital of Bordeaux, Bordeaux, France
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5
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Luizeti BO, Lima LARD, Spies JW, Sella GCP. Rare Presentations of Frontal Sinus Fungus Ball: A Systematic Review. Int Arch Otorhinolaryngol 2022; 26:e738-e743. [DOI: 10.1055/s-0041-1740598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 09/23/2021] [Indexed: 10/19/2022] Open
Abstract
Abstract
Introduction The sinus fungus ball is an agglomeration of debris and hyphae, mainly caused by Aspergillus fumigatus, within the paranasal sinus, commonly affecting a single sinus, and it only rarely affects the frontal sinus.
Objective To identify the state of the art of fungus ball in paranasal sinuses, especially related to the epidemiology of the disease in the frontal sinus. Additionally, this article reports a rare case of fungus ball in the frontal sinus in an adult male, and discusses the variables of this condition related to the patient.
Data Synthesis All of the 8 cases of fungus ball in the frontal sinus reported in this study affected male patients: 40% had unilateral disease, and 60%, bilateral disease, contrary to the incidence data of fungus ball in the other paranasal sinuses, which reports unilateral prevalence. However, in the present study, this index changes, with 50% of unilateral and 50% of bilateral incidence regarding frontal sinus involvement. The average age of the patients was 65.36 years (range: 60-74 years). The etiologic agent was Aspergillus spp., and the endonasal endoscopic therapeutic approach corresponded to 80% of cases, while frontal osteoplasty accounted for 20% of cases, reaffirming the prevalence data from other studies.
Conclusion Despite being a low-incidence entity, frontal sinus fungus ball should be considered in patients with pain in the frontal region refractory to the usual clinical treatments.
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Affiliation(s)
| | - Lesley Ane Roks de Lima
- Department of Medicine, Faculdade de Medicina, Universidade Cesumar, Maringá, Paraná, Brazil
| | - Jonas Willian Spies
- Department of Ophthalmology, Otorhinolaryngology, and Head and Neck Surgery, Faculdade de Medicina de Ribeirão Preto, Universidade de of São Paulo (FMRP-USP), Ribeirão Preto, São Paulo, Brazil
- Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial (ABORL-CCF), São Paulo, São Paulo, Brazil
| | - Guilherme Constante Preis Sella
- Department of Medicine, Faculdade de Medicina, Universidade Cesumar, Maringá, Paraná, Brazil
- Department of Ophthalmology, Otorhinolaryngology, and Head and Neck Surgery, Faculdade de Medicina de Ribeirão Preto, Universidade de of São Paulo (FMRP-USP), Ribeirão Preto, São Paulo, Brazil
- Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial (ABORL-CCF), São Paulo, São Paulo, Brazil
- Academia Brasileira de Cirurgia Plástica da Face (ABCPF), São Paulo, São Paulo, Brazil
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Kudukkil Thazhathuveettil S, Mehta H, Vinay K. Multiple Painless Subcutaneous Nodules on the Cheek of an Immunocompetent Man. JAMA Dermatol 2021; 157:1500-1501. [PMID: 34757379 DOI: 10.1001/jamadermatol.2021.4579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
| | - Hitaishi Mehta
- Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Keshavamurthy Vinay
- Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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7
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Promsopa C, Polwiang P, Chinpairoj S, Kirtsreesakul V. Complications of Isolated Fungal Sphenoiditis: Patient Clinical Characteristics. ORL J Otorhinolaryngol Relat Spec 2019; 82:15-24. [PMID: 31743915 DOI: 10.1159/000503902] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2019] [Accepted: 09/24/2019] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To evaluate the clinical characteristics of patients with complications of isolated fungal sphenoiditis. MATERIALS AND METHODS The records of patients diagnosed with isolated fungal sphenoiditis at Songklanagarind Hospital from January 2004 to December 2017 were retrospectively reviewed. Data related to demographics, clinical presentation, underlying disease, type of complication, surgical procedure, and clinical outcome were collected. RESULTS Among the 35 participating patients, complications were found at a rate of 40%. The most common complication was visual loss (71.43%). We also compared the clinical characteristics between patients with and without complications via univariate analysis. The enrolled patients consisted of 12 men and 23 women (1:2). The mean age was older in the complications group 64 (41-84) vs. 57.43 (36-81) years, respectively. Underlying diabetes mellitus and complete opacity of the sphenoid sinus were factors that related significantly to the occurrence of complications. After treatment, 35.72% of the participants made a complete recovery; underlying diabetes mellitus was associated with a poor prognosis. CONCLUSION This report indicates that practitioners must be careful of complications arising in elderly and female patients with isolated fungal sphenoiditis, who have a complete opacity of the sphenoid sinus and underlying diabetes mellitus.
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Affiliation(s)
- Chakapan Promsopa
- Department of Otolaryngology and Head and Neck Surgery, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand,
| | - Pittaya Polwiang
- Department of Otolaryngology and Head and Neck Surgery, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
| | - Suchet Chinpairoj
- Department of Otolaryngology and Head and Neck Surgery, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
| | - Virat Kirtsreesakul
- Department of Otolaryngology and Head and Neck Surgery, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
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Salah H, Lackner M, Houbraken J, Theelen B, Lass-Flörl C, Boekhout T, Almaslamani M, Taj-Aldeen SJ. The Emergence of Rare Clinical Aspergillus Species in Qatar: Molecular Characterization and Antifungal Susceptibility Profiles. Front Microbiol 2019; 10:1677. [PMID: 31447794 PMCID: PMC6697061 DOI: 10.3389/fmicb.2019.01677] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Accepted: 07/08/2019] [Indexed: 12/31/2022] Open
Abstract
Aspergillus are ubiquitous mold species that infect immunocompetent and immunocompromised patients. The symptoms are diverse and range from allergic reactions, bronchopulmonary infection, and bronchitis, to invasive aspergillosis. The aim of this study was to characterize 70 Aspergillus isolates recovered from clinical specimens of patients with various clinical conditions presented at Hamad general hospital in Doha, Qatar, by using molecular methods and to determine their in vitro antifungal susceptibility patterns using the Clinical and Laboratory Standards Institute (CLSI) M38-A2 reference method. Fourteen Aspergillus species were identified by sequencing β-tubulin and calmodulin genes, including 10 rare and cryptic species not commonly recovered from human clinical specimens. Aspergillus welwitschiae is reported in this study for the first time in patients with fungal rhinosinusitis (n = 6) and one patient with a lower respiratory infection. Moreover, Aspergillus pseudonomius is reported in a patient with fungal rhinosinusitis which is considered as the first report ever from clinical specimens. In addition, Aspergillus sublatus is reported for the first time in a patient with cystic fibrosis. In general, our Aspergillus strains exhibited low MIC values for most of the antifungal drugs tested. One strain of Aspergillus fumigatus showed high MECs for echinocandins and low MICs for the rest of the drugs tested. Another strain of A. fumigatus exhibited high MIC for itraconazole and categorized as non-wild type. These findings require further analysis of their molecular basis of resistance. In conclusion, reliable identification of Aspergillus species is achieved by using molecular sequencing, especially for the emerging rare and cryptic species. They are mostly indistinguishable by conventional methods and might exhibit variable antifungal susceptibility profiles. Moreover, investigation of the antifungal susceptibility patterns is necessary for improved antifungal therapy against aspergillosis.
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Affiliation(s)
- Husam Salah
- Division of Microbiology, Department of Laboratory Medicine and Pathology, Hamad Medical Corporation, Doha, Qatar.,Yeast Research, Westerdijk Fungal Biodiversity Institute, Utrecht, Netherlands
| | - Michaela Lackner
- Division of Hygiene and Medical Microbiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Jos Houbraken
- Applied and Industrial Mycology, Westerdijk Fungal Biodiversity Institute, Utrecht, Netherlands
| | - Bart Theelen
- Yeast Research, Westerdijk Fungal Biodiversity Institute, Utrecht, Netherlands
| | - Cornelia Lass-Flörl
- Division of Hygiene and Medical Microbiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Teun Boekhout
- Yeast Research, Westerdijk Fungal Biodiversity Institute, Utrecht, Netherlands.,Institute of Biodiversity and Ecosystem Dynamics (IBED), University of Amsterdam, Netherlands
| | - Muna Almaslamani
- Institute of Biodiversity and Ecosystem Dynamics (IBED), University of Amsterdam, Netherlands
| | - Saad J Taj-Aldeen
- Division of Microbiology, Department of Laboratory Medicine and Pathology, Hamad Medical Corporation, Doha, Qatar
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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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10
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Basilar Occlusion and Rupture Secondary to Rare Fungal Sinusitis. World Neurosurg 2019; 125:217-221. [PMID: 30772526 DOI: 10.1016/j.wneu.2019.01.179] [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: 12/07/2018] [Revised: 01/17/2019] [Accepted: 01/19/2019] [Indexed: 11/22/2022]
Abstract
BACKGROUND Intracranial vascular infections of fungal etiology are extremely rare. Most cases occur in immunocompromised patients with invasive fungal disease, most commonly originating in the paranasal sinuses or the lungs. Granulomatous invasive rhinosinusitis, which is extremely rare in North America, has been reported to affect immunocompetent patients in most cases, and its causative strain has potential to invade the intracranial arteries. We present a rare case of basilar artery rupture and infarction secondary to granulomatous invasive rhinosinusitis. CASE DESCRIPTION A 50-year-old man in Florida presented with ischemic symptoms and a 6-month history of headache, dizziness, and falls. After biopsy, the patient developed subarachnoid hemorrhage and thrombosis. Several thrombectomy attempts were performed, resulting in persistent occlusion of the basilar artery and subsequent comatous state. After discussion with the patient's family, compassionate weaning and autopsy were authorized. CONCLUSIONS Invasive fungal rhinosinusitis is more frequent nowadays owing to increased use of immunosuppressive therapies. However, it is still a disease that mostly affects immunocompromised patients. The development of new microbiologic investigation techniques has enabled the discovery of fungal diseases that can also affect immunocompetent hosts, such as granulomatous invasive rhinosinusitis. This is an extremely rare condition in North America, with very few cases documented in the last few decades.
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Zhou LH, Wang X, Wang RY, Zhao HZ, Jiang YK, Cheng JH, Huang LP, Chen ZQ, Wang DH, Zhu LP. Entities of Chronic and Granulomatous Invasive Fungal Rhinosinusitis: Separate or Not? Open Forum Infect Dis 2018; 5:ofy228. [PMID: 30302354 PMCID: PMC6171569 DOI: 10.1093/ofid/ofy228] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Accepted: 09/10/2018] [Indexed: 01/19/2023] Open
Abstract
Background Chronic and granulomatous invasive fungal rhinosinusitis are important causes of blindness and craniocerebral complications. However, the classification of these 2 diseases remains controversial. Methods We retrospectively analyzed patients with chronic and granulomatous invasive fungal rhinosinusitus in a Chinese tertiary hospital from 2009 to 2017, with a focus on classification and comparisons. Results Among 55 patients enrolled in our study, 11 (11/55, 20%) had granulomatous invasive fungal rhinosinusitis (GIFRS) and 44 (44/55, 80%) had chronic invasive fungal rhinosinusitis (CIFRS). Aspergillus fumigatus and Dematiaceous hyphomycetes were identified in 2 patients with GIFRS. Compared with granulomatous type, CIFRS was more frequently encountered in immunocompromised patients (P = .022), and the time from onset to diagnosis was much shorter (P = .001). Proptosis and orbital apex syndrome showed no significant difference between granulomatous and CIFRS in our study. The treatment options and prognosis of both diseases also showed no significant difference. Conclusions Despite the consensus on histopathology, the classification of the chronic and granulomatous types may need further evaluation in clinical considerations.
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Affiliation(s)
- Ling-Hong Zhou
- Department of Infectious Diseases, Huashan Hospital, Fudan University, Shanghai, China
| | - Xuan Wang
- Department of Infectious Diseases, Huashan Hospital, Fudan University, Shanghai, China
| | - Rui-Ying Wang
- Department of Infectious Diseases, Huashan Hospital, Fudan University, Shanghai, China
| | - Hua-Zhen Zhao
- Department of Infectious Diseases, Huashan Hospital, Fudan University, Shanghai, China
| | - Ying-Kui Jiang
- Department of Infectious Diseases, Huashan Hospital, Fudan University, Shanghai, China
| | - Jia-Hui Cheng
- Department of Infectious Diseases, Huashan Hospital, Fudan University, Shanghai, China
| | - Li-Ping Huang
- Department of Infectious Diseases, Huashan Hospital, Fudan University, Shanghai, China
| | - Zhong-Qing Chen
- Pathology Department, Huashan Hospital, Fudan University, Shanghai, China
| | - De-Hui Wang
- Department of Otolaryngology, Eye and Ear, Nose and Throat Hospital, Fudan University, Shanghai, China
| | - Li-Ping Zhu
- Department of Infectious Diseases, Huashan Hospital, Fudan University, Shanghai, China
- Correspondence: L.-P. Zhu, MD, PhD, Department of Infectious Diseases, Huashan Hospital, Fudan University, 12 Central Urumqi Road, Shanghai 200040, China ()
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12
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Dufour X, Kauffmann-Lacroix C, Roblot F, Goujon JM, Breux JP, Ferrie JC, Michel Klossek J. Chronic Invasive Fungal Rhinosinusitis: Two New Cases and Review of the Literature. ACTA ACUST UNITED AC 2018. [DOI: 10.1177/194589240401800406] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background Chronic invasive fungal rhinosinusitis is rare in the immunocompetent patient. Few cases have been published except for in a specific geographic area (Sudan, India). Methods and Results We reported two new cases of chronic invasive fungal rhinosinusitis due to Aspergillus, which was successfully treated, to analyze the different clinical, radiological, and mycological criteria. Conclusion Through these two new clinical cases and the analysis of the literature, we suggested, in the absence of general agreement on the surgical and medical management, the current strategies available for this rare pathology. New antifungal drugs seem to be an efficient alternative to classic antifungal agents, especially those that require an extended course of oral therapy for the chronic invasive form.
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Affiliation(s)
- Xavier Dufour
- Departments of Ear, Nose, and Throat and Maxillofacial Surgery France
| | | | - France Roblot
- Departments of Infectious Diseases Poitiers Cedex, France
| | | | | | - Jean Claude Ferrie
- Departments of Radiology, C. H. University Poitiers, Poitiers Cedex, France
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Currens J, Hutcheson PS, Slavin RG, Citardi MJ. Primary Paranasal Aspergillus Granuloma: Case Report and Review of the Literature. ACTA ACUST UNITED AC 2018. [DOI: 10.1177/194589240201600308] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background Primary paranasal aspergillus granuloma (PPAG) is a slowly progressive chronic infection of the sinus extending beyond the confines of the sinus. It has been reported only in patients from the Sudan and India. Microscopically, it differs from chronic invasive fungal sinusitis in that there are pseudotubercles containing giant cells, histiocytes, lymphocytes, plasma cells, newly formed capillaries, eosinophils, and Aspergillus fungal elements. Conclusion We describe the first case of PPAG in the United States in an immunocompetent nonatopic woman who had never left Missouri.
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Affiliation(s)
- John Currens
- Departments of Otolaryngology–Head and Neck Surgery and Division of Allergy and Immunology, St. Louis University School of Medicine, St. Louis, Missouri
| | - Patricia S. Hutcheson
- Departments of Internal Medicine, Division of Allergy and Immunology, St. Louis University School of Medicine, St. Louis, Missouri
| | - Raymond G. Slavin
- Departments of Internal Medicine, Division of Allergy and Immunology, St. Louis University School of Medicine, St. Louis, Missouri
| | - Martin J. Citardi
- Department of Otolaryngology and Communicative Disorders, Cleveland Clinic Foundation, Cleveland, Ohio
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14
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Corey JP, Bumsted RM, Panje WR, Shaw GY, Conley D. Allergy and Fungal Screens in Chronic Sinusitis. ACTA ACUST UNITED AC 2018. [DOI: 10.2500/105065890782020971] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Thirty-three patients with chronic sinusitis severe enough to warrant surgery were prospectively screened for atopic disease and fungal sensitivity by history, total IgE levels, an allergen-specific IgE screen panel and fungal IgE levels. Total IgE was elevated in 10 of 31 patients measured. A positive “screen” panel (milk, Candida, house dust, white ash, timothy grass, ragweed) was noted in 57.5%. Fungal sensitivity to one or more of the following molds, Aspergillus, Mucor, Alternaria, Candida, Cladosporium, Penicillin notatum, Helminthosporium, or Curvularia, was noted in 51.5%. Seventeen patients had both positive atopic and fungal screens. All those with positive fungal screens also had positive atopic screens. The predictive value of allergy screens may be useful when the incidence in the population to be tested is 50% or greater. This study suggests that use of allergy screens and/or screens for fungal IgE may have a predictive value of 90% or greater with chronic sinus disease. Measurements of total IgE do not appear to add useful information and have a low predictive value as a test. Preliminary conclusions suggest that the incidence of atopy and elevated fungal IgE is high in patients with chronic sinusitis. Screens for allergies and fungal IgE may be useful to identify patients for further evaluation.
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Affiliation(s)
| | - Robert M. Bumsted
- University of Chicago Pritzker School of Medicine, Chicago, IL 60637
| | - William R. Panje
- University of Chicago Pritzker School of Medicine, Chicago, IL 60637
| | - Gary Y. Shaw
- University of Chicago Pritzker School of Medicine, Chicago, IL 60637
| | - David Conley
- University of Chicago Pritzker School of Medicine, Chicago, IL 60637
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15
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Abstract
Fungal sinusitis can present as one of four distinct clinicopathologic entities: 1) fulminant or acute; and three types of chronic, 2) indolent, 3) mycetoma, and 4) allergic fungal sinusitis (AFS). The first three forms differ both clinically and pathologically from AFS. The first reported cases of AFS were associated with the fungus Aspergillus, but recently other fungal organisms have been implicated. Five different fungal organisms have been found to cause AFS in 14 patients. The prevalence of AFS among patients with chronic sinusitis may be as high as 7%. The diagnosis is made on the histologic findings of inspissated allergic mucin containing 1) numerous eosinophils, 2) scattered noninvasive fungal hyphae, and 3) Charcot-Leyden crystals. In addition, AFS patients have a characteristic clinical and immunologic profile. The clinical presentation, diagnosis, and management of AFS are discussed. Uniformity of the classification of fungal sinusitis is proposed.
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Affiliation(s)
- Bradford K. Ence
- Department of Otolaryngology, Head and Neck Surgery, Allergy and Immunology Service, Department of Pathology, Wilford Hall USAF Medical Center, Lackland AFB, San Antonio, TX 78236-5300
| | - David S. Gourley
- Department of Otolaryngology, Head and Neck Surgery, Allergy and Immunology Service, Department of Pathology, Wilford Hall USAF Medical Center, Lackland AFB, San Antonio, TX 78236-5300
| | - Neil L. Jorgensen
- Department of Otolaryngology, Head and Neck Surgery, Allergy and Immunology Service, Department of Pathology, Wilford Hall USAF Medical Center, Lackland AFB, San Antonio, TX 78236-5300
| | - Frank W. Shagets
- Department of Otolaryngology, Head and Neck Surgery, Allergy and Immunology Service, Department of Pathology, Wilford Hall USAF Medical Center, Lackland AFB, San Antonio, TX 78236-5300
| | - David S. Parsons
- Department of Otolaryngology, Head and Neck Surgery, Allergy and Immunology Service, Department of Pathology, Wilford Hall USAF Medical Center, Lackland AFB, San Antonio, TX 78236-5300
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Tierney P, Thomas M, Samuel D, Patel KS, Stafford N. Recurrent Aspergilloma of the Frontoethmoid Sinus in a Non-Immunocompromised Patient. J R Soc Med 2018; 89:165P-6P. [PMID: 8683523 PMCID: PMC1295704 DOI: 10.1177/014107689608900314] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Management of invasive aspergillosis of the paranasal sinuses requires sufficient experience to initiate appropriate investigations and then utilize the correct treatment protocol. Computed tomography (CT) or magnetic resonance imaging (MRI) is essential to show the extent of the disease and diagnosis is confirmed by histological analysis. Aspergillus flavus is a ubiquitous soil saprophyte in the Sudan and is responsible for many cases originating from this area. The literature is reviewed and treatment options discussed.
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Affiliation(s)
- P Tierney
- Department of Otolaryngology-Head & Neck Surgery, St Mary's Hospital, London, England
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17
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Chakrabarti A, Kaur H. Allergic Aspergillus Rhinosinusitis. J Fungi (Basel) 2016; 2:E32. [PMID: 29376948 PMCID: PMC5715928 DOI: 10.3390/jof2040032] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Revised: 11/29/2016] [Accepted: 12/01/2016] [Indexed: 12/19/2022] Open
Abstract
Allergic fungal rhinosinusitis (AFRS) is a unique variety of chronic polypoid rhinosinusitis usually in atopic individuals, characterized by presence of eosinophilic mucin and fungal hyphae in paranasal sinuses without invasion into surrounding mucosa. It has emerged as an important disease involving a large population across the world with geographic variation in incidence and epidemiology. The disease is surrounded by controversies regarding its definition and etiopathogenesis. A working group on "Fungal Sinusitis" under the International Society for Human and Animal Mycology (ISHAM) addressed some of those issues, but many questions remain unanswered. The descriptions of "eosinophilic fungal rhinosinusitis" (EFRS), "eosinophilic mucin rhinosinusitis" (EMRS) and mucosal invasion by hyphae in few patients have increased the problem to delineate the disease. Various hypotheses exist for etiopathogenesis of AFRS with considerable overlap, though recent extensive studies have made certain in depth understanding. The diagnosis of AFRS is a multi-disciplinary approach including the imaging, histopathology, mycology and immunological investigations. Though there is no uniform management protocol for AFRS, surgical clearing of the sinuses with steroid therapy are commonly practiced. The role of antifungal agents, leukotriene antagonists and immunomodulators is still questionable. The present review covers the controversies, recent advances in pathogenesis, diagnosis, and management of AFRS.
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Affiliation(s)
- Arunaloke Chakrabarti
- Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh 160012, India.
| | - Harsimran Kaur
- Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh 160012, India.
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19
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Analysis of sinonasal anatomical variations associated with maxillary sinus fungal balls. Auris Nasus Larynx 2016; 43:524-8. [DOI: 10.1016/j.anl.2015.12.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Revised: 11/11/2015] [Accepted: 12/23/2015] [Indexed: 11/20/2022]
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Suresh S, Arumugam D, Zacharias G, Palaninathan S, Vishwanathan R, Venkatraman V. Prevalence and clinical profile of fungal rhinosinusitis. ALLERGY & RHINOLOGY 2016; 7:115-20. [PMID: 27349695 PMCID: PMC5010432 DOI: 10.2500/ar.2016.7.0156] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Background: There are only a few landmark studies from the Indian subcontinent on fungal rhinosinusitis. The lack of awareness among clinicians regarding the varying clinical presentations of fungal rhinosinusitis prompted us to undertake this study. Objective: To determine the prevalence, etiologic basis, clinical features, radiologic features, and microscopic features of fungal rhinosinusitis, and to evaluate the various treatment modalities available. Methods: This was a prospective study in which evaluation of 100 patients with chronic rhinosinusitis was done. Specimens collected were subjected to both microbiology and pathologic examination; data collected, including clinical and radiologic features, were analyzed by the Pearson χ2 test and Fisher's exact test. Results: The prevalence of fungal rhinosinusitis in our study was 30% (n = 30). Mucor was the most commonly isolated species (n = 15 [50%]) of fungus. Pathologic examination had a higher sensitivity (76.67%) compared with microbiology tests (50%) in the diagnosis of fungal rhinosinusitis. Fungus ball (n = 14 [46.6%]) was the most prevalent entity in the spectrum of fungal rhinosinusitis. Forty percent of cases (n = 12) were of invasive fungal rhinosinusitis. The prevalence of fungal rhinosinusitis was higher among individuals who were immunocompetent (n = 17 [56.6%]). Of patients who were immunocompromised, 84.6% (n = 11) had mucormycosis. Conclusions: Unilateral involvement of paranasal sinuses was more in favor of fungal etiology. Complications were more common in fungal rhinosinusitis caused by Mucor species. Mucormycosis, a rare clinical entity, in subjects who were immunocompetent, had a high prevalence in our study.
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Affiliation(s)
- Sandeep Suresh
- Department of Otorhinolaryngology, PSG Institute of Medical Sciences & Research, Coimbatore, Tamil Nadu, India
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Thakar A, Sarkar C, Dhiwakar M, Bahadur S, Dahiya S. Allergic Fungal Sinusitis: Expanding the Clinicopathologic Spectrum. Otolaryngol Head Neck Surg 2016; 130:209-16. [PMID: 14990918 DOI: 10.1016/j.otohns.2003.09.004] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE We sought to determine whether histologic tissue invasion occurs in allergic fungal sinusitis (AFS) and, if so, to identify clinical indicators for the same. Study design and setting We conducted a retrospective case record review of all 28 AFS cases identified by histology over a 32-month period at a tertiary care referral center. All histologic specimens were reevaluated for features of invasive pathology, and case records were correlated for clinical, radiologic, or laboratory parameters associated with such invasion. RESULTS In addition to the universal finding of the characteristic allergic mucin with fungal elements on histopathologic examination of the sinus luminal contents, 6 cases (21%) had additional evidence of mucosal invasion as indicated by granulomatous inflammation and branching septate fungal hyphae in the submucosal tissues. Such coexistent invasion was associated with advanced disease as indicated by a higher incidence of orbital involvement on clinical evaluation (P = 0.024), and extrasinus spread (intraorbital or intracranial spread) on the computed tomography evaluation (P = 0.003). The single death that occurred on follow-up was in a patient with coexistent invasion. CONCLUSION Advanced AFS may be complicated by histologic evidence of tissue invasion. SIGNIFICANCE The noninvasive and invasive forms of fungal sinusitis are not necessarily discrete and may coexist in the same patient. Clinical features of orbital involvement or computed tomography manifestations of extrasinus spread should alert the clinician to the possibility of invasion.
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Affiliation(s)
- Alok Thakar
- Department of Otolaryngology-Head and Neck Surgey, All India Institute of Medical Sciences, New Delhi, India
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23
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Lop-Gros J, Gras-Cabrerizo JR, Bothe-González C, Montserrat-Gili JR, Sumarroca-Trouboul A, Massegur-Solench H. Fungus ball of the paranasal sinuses: Analysis of our serie of patients. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2015; 67:220-5. [PMID: 26708329 DOI: 10.1016/j.otorri.2015.09.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2015] [Revised: 08/31/2015] [Accepted: 09/09/2015] [Indexed: 12/28/2022]
Abstract
INTRODUCTION AND OBJECTIVES The fungus ball is the most frequent type of fungal rhino-sinusitis. The objective of this study is to analyze the clinical and surgical features of our patients. METHODS Retrospective analysis of 35 patients with fungus ball treated in our centre between 2006 and 2014. RESULTS Mean age was 55 years old. 49% were men and 51% women. 75% involved the maxillary sinus, whereas 25% involved the sphenoid. 69% of our patients showed microcalcifications in the CT study. All the patients were surgically treated, with no cases of recurrence. CONCLUSIONS Clinical manifestations of fungus ball are non-specific, therefore endoscopy and image study are mandatory. The definitive diagnosis is made by histopathological study of the lesion. Endoscopic sinus surgery is the treatment of choice, with opening of the diseased sinus and complete removal of the fungus ball. The frequency of complications is very low. No oral or topical antimycotic treatments are necessary.
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Affiliation(s)
- Joan Lop-Gros
- Sección de Rinología, Servicio de Otorrinolaringología, Hospital de la Santa Creu i de Sant Pau , Barcelona , España.
| | - Juan R Gras-Cabrerizo
- Sección de Rinología, Servicio de Otorrinolaringología, Hospital de la Santa Creu i de Sant Pau , Barcelona , España
| | - Carolina Bothe-González
- Sección de Rinología, Servicio de Otorrinolaringología, Hospital de la Santa Creu i de Sant Pau , Barcelona , España
| | - Juan R Montserrat-Gili
- Sección de Rinología, Servicio de Otorrinolaringología, Hospital de la Santa Creu i de Sant Pau , Barcelona , España
| | - Anna Sumarroca-Trouboul
- Sección de Rinología, Servicio de Otorrinolaringología, Hospital de la Santa Creu i de Sant Pau , Barcelona , España
| | - Humbert Massegur-Solench
- Sección de Rinología, Servicio de Otorrinolaringología, Hospital de la Santa Creu i de Sant Pau , Barcelona , España
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Intracranial Fungal Granulomas: A Single Institutional Clinicopathologic Study of 66 Patients and Review of the Literature. World Neurosurg 2015; 83:1166-72. [DOI: 10.1016/j.wneu.2015.01.053] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2014] [Revised: 01/22/2015] [Accepted: 01/28/2015] [Indexed: 11/22/2022]
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25
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Granulomatous invasive aspergillosis of paranasal sinuses masquerading as actinomycosis and review of published literature. Mycopathologia 2014; 177:179-85. [PMID: 24570040 DOI: 10.1007/s11046-014-9732-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2013] [Accepted: 02/04/2014] [Indexed: 10/25/2022]
Abstract
Cutaneous aspergillosis is a common systemic mycosis affecting immunosuppressed patients. Here, we describe a novel morphological type of cutaneous aspergillosis in a young immunocompetent woman who presented with a chronic history of multiple nodules and discharging sinuses over left side of the face, mimicking cervicofacial actinomycosis. Skin biopsy showed granulomatous inflammation, and of septate fungal hyphae with acute-angled branching, morphologically resembling Aspergillus. This was confirmed on fungal culture as Aspergillus flavus.
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26
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Schwartz S. [Diagnostic imaging methods and therapy options for cerebral aspergillosis]. Mycoses 2013; 55 Suppl 2:10-6. [PMID: 22519627 DOI: 10.1111/j.1439-0507.2012.02178.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Stefan Schwartz
- Medizinische Klinik III, Charité Campus Benjamin Franklin, Berlin, Deutschland.
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27
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Isolated primary frontal sinus aspergillosis: role of endonasal endoscopic approach. The Journal of Laryngology & Otology 2013; 127:274-8. [PMID: 23388080 DOI: 10.1017/s0022215112003179] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Frontal sinus involvement in aspergillosis associated with the nose and paranasal sinuses is a common occurrence, but the incidence of primary frontal sinus aspergillosis is rare, and there are few reports in the English literature. OBJECTIVE This study aimed to evaluate the role of the endonasal endoscopic surgical approach for isolated primary frontal sinus aspergillosis. METHOD This paper describes a retrospective study of 16 cases of primary frontal sinus aspergillosis. The patients had presented to the out-patient services of the Department of Otolaryngology and Head and Neck Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India, between January 1999 and July 2011. RESULTS The overall success rate of the endonasal endoscopic approach was 82.25 per cent. The disease recurred in three patients and was subsequently managed using the modified Lothrop procedure. CONCLUSION Minimally invasive endonasal endoscopic sinus surgery was found to be an effective and a safe approach for managing primary frontal sinus aspergilloma, even in cases with larger bony defects involving the posterior table of the frontal sinus.
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28
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Kim TH, Jang HU, Jung YY, Kim JS. Granulomatous invasive fungal rhinosinusitis extending into the pterygopalatine fossa and orbital floor: A case report. Med Mycol Case Rep 2012; 1:107-11. [PMID: 24371753 DOI: 10.1016/j.mmcr.2012.10.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2012] [Revised: 10/05/2012] [Accepted: 10/12/2012] [Indexed: 10/27/2022] Open
Abstract
Invasive fungal rhinosinusitis is a rare and life-threatening disease. Granulomatous invasive fungal rhinosinusitis has a time course exceeding 12 weeks, and the destruction of bone progresses slowly. This disease has been reported primarily in Sudan, India, Pakistan, and the USA; however, it is very rare in Korea. In this study, we present the case of a 69-year-old man with granulomatous invasive fungal rhinosinusitis. He was successfully treated with a combination of surgery and itraconazole.
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Affiliation(s)
- Tae Hoon Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Hyun Uk Jang
- Department of Otorhinolaryngology-Head and Neck Surgery, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Yun Young Jung
- Department of Otorhinolaryngology-Head and Neck Surgery, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Jung Soo Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, School of Medicine, Kyungpook National University, Daegu, Korea
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Abstract
Aspergillosis is a common opportunistic fungal infection affecting the nose and paranasal sinuses. The disease presents in various forms ranging from non-invasive to invasive, destructive and allergic types. We report here a rare case of invasive aspergillosis in an immunocompetent host with the literature review.
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Affiliation(s)
- Preeti Sethi
- Department of Oral and Maxillofacial Pathology, Swami Devi Dyal Hospital and Dental College, Golpura, Distt - Panchkula, Haryana, India
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Sundaram C, Murthy JMK. Intracranial Aspergillus granuloma. PATHOLOGY RESEARCH INTERNATIONAL 2011; 2011:157320. [PMID: 22191079 PMCID: PMC3236351 DOI: 10.4061/2011/157320] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/31/2010] [Accepted: 09/06/2011] [Indexed: 11/30/2022]
Abstract
Intracranial fungal granulomas are rare and of the histologically verified granulomas, Aspergillus spp. is the commonest causative fungal pathogen. Most of the reported large series of aspergillus granulomas are from countries with temperate climate like India, Pakistan, Sudan, and Saudi Arabia. In contrast to disseminated aspergillosis that occurs in immunosuppressed individuals, most of the intracranial aspergillus granulomas are reported in immunocompetent individuals. The temperature, humidity, high spore content in the atmosphere during ploughing, and occupation as agricultural worker are implicated in the pathogenesis. The sinocranial spread is the most common route of intracranial extension. Extracerebral firm fibrotic lesions and skull base lesions are common. Extensive fibrosis and large number of multinucleated giant cells are the characteristic histological features and these pathological features have therapeutic relevance.
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Affiliation(s)
- C Sundaram
- Department of Pathology, Nizam's Institute of Medical Sciences, Panjagutta, Hyderabad 500 081, India
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Th1 and Th2 cytokines in a self-healing primary pulmonary Aspergillus flavus infection in BALB/c mice. Cytokine 2010; 52:258-64. [PMID: 20800507 DOI: 10.1016/j.cyto.2010.07.428] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2010] [Revised: 07/14/2010] [Accepted: 07/30/2010] [Indexed: 01/04/2023]
Abstract
Studies with non-immunocompromised mice have demonstrated that Aspergillus flavus is more virulent than almost all other Aspergillus species. However, the type of immune response this fungus induces in mammals has not been investigated thoroughly. The study was carried out to analyze the sequential pathogenesis of pulmonary A. flavus infection and the role of cytokines in host response in BALB/c mice. Two distinct phases were observed in mice: First, an intense rate of clearance of A. flavus occurred, most likely through recruited neutrophils and the resident alveolar macrophages with concurrent release of pro-inflammatory cytokines and second, fungal and cellular debris were cleaned by recruited monocytes, pro-inflammatory cytokine production rapidly decreased and infection self-healed. The pro-inflammatory cytokine IFN-γ demonstrated an upward trend up to 24h PI followed by a steady decline. The titers of TNF-α (a pro-inflammatory Th1 cytokine) were, however, inversely related to the titers of IL-10 an anti-inflammatory Th2 cytokine. The anti-inflammatory cytokine IL-4 showed slightly decreasing trend between 12 and 48 h PI, beyond that it again reached to the titers observed at 6h PI. The infected mice produced signs of Th1 type response with self healing capabilities.
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Nicolai P, Lombardi D, Tomenzoli D, Villaret AB, Piccioni M, Mensi M, Maroldi R. Fungus ball of the paranasal sinuses: experience in 160 patients treated with endoscopic surgery. Laryngoscope 2009; 119:2275-9. [PMID: 19688860 DOI: 10.1002/lary.20578] [Citation(s) in RCA: 95] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
OBJECTIVES/HYPOTHESIS Herein we present our experience in the management of fungus ball (FB) of the paranasal sinuses. Preoperative imaging strategy and findings, surgical technique, and pathologic and microbiologic results are discussed. STUDY DESIGN Retrospective chart review of patients with FB of the paranasal sinuses who underwent endoscopic surgery at the Department of Otorhinolaryngology of the University of Brescia, Italy. METHODS From January 1990 to December 2006, 160 patients with sinonasal fungus ball were treated with a purely endoscopic approach. All patients underwent preoperative computed tomography (CT) and/or magnetic resonance (MR) imaging; an endo-oral dental x-ray or orthopantomography and odontological evaluation were also performed in patients with maxillary sinus localization. All removed material was sent for pathologic and microbiologic evaluation. All patients were prospectively followed with endoscopic control every 2 months during the first postoperative year and subsequently every 6 months. RESULTS The patient cohort included 118 females and 42 males, with an age from 19 to 85 years (mean, 52.7 years). FB was located in the maxillary sinus in 135 (84.4%) patients; in two cases both sinuses were affected. Sphenoid and ethmoid involvement was observed in 23 (14.4%) and 1 (0.6%) patients, respectively. Simultaneous ethmoid and sphenoid involvement was found in one (0.6%) case. In all patients complete removal of fungal debris was obtained through wide sinusotomy. No recurrence was observed. CONCLUSIONS Endoscopic surgery is a safe and effective treatment for paranasal sinuses FB. A proper imaging study by MR and/or CT can address diagnosis, which is based upon detection of fungal hyphae at histology.
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Affiliation(s)
- Piero Nicolai
- Department of Otorhinolaryngology, University of Brescia, Brescia, Italy
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Bradley SF, McGuire NM, Kauffman CA. Sino-Orbital and Cerebral Aspergillosis: Cure with Medical Therapy/Sino-Orbital- und Zerebralaspergillose: Ausheilung durch medikamentöse Therapie. Mycoses 2009. [DOI: 10.1111/j.1439-0507.1987.tb03632.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Abstract
Cerebral aspergillosis is increasingly recognized in severely immunocompromised patients and, until recently, this type of fungal infection was associated with a mortality approaching 100%. The central nervous system is a protected environment and penetration of drugs across the blood-brain barrier is mainly limited by their molecular size and physicochemical properties, as well as drug interaction with transporter systems (e.g., P-glycoprotein) at the blood-brain barrier. Most antifungal agents are large molecules (>700 Da), which makes sufficient penetration into the central nervous system unlikely. In fact, the available data indicate low levels of most antifungal agents in cerebrospinal fluid and brain tissue, except for fluconazole and voriconazole. Concentrations of voriconazole exceeding inhibitory concentrations for Aspergillus species were found repeatedly in cerebrospinal fluid and brain tissue, including brain abscess material. A recent retrospective study confirmed that voriconazole treatment resulted in improved response and survival rates in patients with cerebral aspergillosis. Data from animal models, which explored escalated doses or combinations of antifungal agents in experimental neuroaspergillosis, suggest that selected combination or dose-escalated therapies might further improve the still unsatisfactory prognosis in this particular type of Aspergillus infection.
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Affiliation(s)
- S Schwartz
- Medizinische Klinik III, Charite Campus Benjamin Franklin, Berlin, Germany.
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Shah A, Kala J, Sahay S, Panjabi C. Frequency of familial occurrence in 164 patients with allergic bronchopulmonary aspergillosis. Ann Allergy Asthma Immunol 2008; 101:363-9. [PMID: 18939723 DOI: 10.1016/s1081-1206(10)60311-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Asthma is known to run in families. Allergic bronchopulmonary aspergillosis (ABPA) occurs predominantly in patients with asthma. However, there are only 6 reports of familial occurrence over a period of 35 years. OBJECTIVE To determine the frequency of familial occurrence in 164 patients with ABPA diagnosed over a period of 22 years in one unit. METHODS The 164 patients with ABPA were reviewed for the occurrence of familial ABPA. Symptomatic family members were evaluated for the presence of ABPA as well as allergic Aspergillus sinusitis (AAS). Allergic bronchopulmonary aspergillosis and AAS were diagnosed as per criteria established. RESULTS Of the 164 patients with ABPA, familial occurrence was detected in 4 pairs of first degree relatives, 2 of whom were parent-child while the other 2 were siblings. Familial ABPA was seen in 4.9% of the total patients. Of these 8 patients seven had symptoms of rhinitis while 4 had sinusitis confirmed on computed tomography of paranasal sinuses. Allergic Aspergillus sinusitis was detected in 3 of these 4 patients. The fourth patient with sinusitis did not consent to surgery required to confirm the diagnosis. Five of our 8 patients, prior to referral, had received antituberculous therapy. All patients responded favourably to oral prednisolone. CONCLUSION Familial occurrence was documented in 4.9% of the 164 patients with ABPA.
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Affiliation(s)
- Ashok Shah
- Department of Respiratory Medicine, Vallabhbhai Patel Chest Institute, University of Delhi, Delhi, India.
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Chakrabarti A, Das A, Panda NK. Controversies surrounding the categorization of fungal sinusitis. Med Mycol 2008; 47 Suppl 1:S299-308. [PMID: 18663658 DOI: 10.1080/13693780802213357] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Though rhinosinusitis is a common disorder, controversies surround the categorization of chronic rhinosinusitis (CRS) and the role of fungus in CRS. The diagnosis of each category is important for optimum therapy and predicting the course. Based on histopathological findings, fungal rhinosinusitis (FRS) can be broadly divided into two categories: the invasive and non-invasive depending on invasion of the mucosal layer. Three types of FRS are tissue-invasive: acute invasive, chronic invasive, & granulomatous. The two non-invasive FRS disorders are fungal ball, and fungus related eosinophilic rhinosinusitis including allergic fungal rhinosinusitis (AFRS). The distinction of granulomatous from chronic invasive type is not beyond controversy as both types have a chronic course and predominant orbital involvement. Maximum confusion surrounds the entity of fungus-related eosinophilic rhinosinusitis, and the definition of AFRS. In the diagnosis of AFRS, the detection of fungi in allergic mucin is considered important, although hyphae are sparse in sinus content. This leads to confusion in definition of this entity, especially with the description of two more closely related entities--eosinophilic fungal rhinosinusitis (EFRS) and eosinophilic mucin rhinosinusitis (EMRS). Recently reports of histologic invasion in possible cases of AFRS were also documented. Currently, there are more questions than answers concerning the categorization of FRS.
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Pasqualotto AC. Differences in pathogenicity and clinical syndromes due to Aspergillus fumigatus and Aspergillus flavus. Med Mycol 2008; 47 Suppl 1:S261-70. [PMID: 18654921 DOI: 10.1080/13693780802247702] [Citation(s) in RCA: 95] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
Most of the information available about Aspergillus infections has originated from the study of A. fumigatus, the most frequent species in the genus. This review aims to compare the pathogenicity and clinical aspects of Aspergillosis caused by A. fumigatus an A. flavus. Experimental data suggests that A. flavus is more virulent than A. fumigatus. However, these were mostly models of disseminated Aspergillus infection which do not properly mimic the physiopathology of invasive aspergillosis, a condition that is usually acquired by inhalation. In addition, no conclusive virulence factor has been identified for Aspergillus species. A. flavus is a common cause of fungal sinusitis and cutaneous infections. Chronic conditions such as chronic cavitary pulmonary aspergillosis and sinuses fungal balls have rarely been associated with A. flavus. The bigger size of A. flavus spores, in comparison to those of A. fumigatus spores, may favour their deposit in the upper respiratory tract. Differences between these species justify the need for a better understanding of A. flavus infections.
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Affiliation(s)
- Alessandro C Pasqualotto
- Infection Control Department at Santa Casa Complexo Hospitalar, Porto Alegre, and Post-Graduation Program in Pulmonary Sciences, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil.
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Makhdoom N, Balkheur K, Foda MA, Fadel MM, Haroon A, Othman H, Al Sheikh S. Fungal Sinusitis with Intracranial Extension in Immuno-competent Patients: Surgical Planning According to Relation to Eloquent Neurovascular Structures. J Taibah Univ Med Sci 2008. [DOI: 10.1016/s1658-3612(08)70042-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Grosjean P, Weber R. Fungus balls of the paranasal sinuses: a review. Eur Arch Otorhinolaryngol 2007; 264:461-70. [PMID: 17361410 DOI: 10.1007/s00405-007-0281-5] [Citation(s) in RCA: 144] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2006] [Accepted: 02/14/2007] [Indexed: 02/07/2023]
Abstract
In the past 30 years, thanks in part to the advance of both endoscopic technology and imaging possibilities, the classification, diagnosis, and management of rhinosinusitis caused by fungi have been better defined. These are basically divided into invasive and non-invasive forms based on the presence or absence of microscopic evidence of fungal hyphae within the tissues. Among the non-invasive fungal sinus diseases, fungus ball has been increasingly reported and large published series have allowed better characterization of the disease and the treatment strategies. Fungus ball of the paranasal sinuses is defined as the non-invasive accumulation of dense fungal concrements in sinusal cavities, most often the maxillary sinus. To describe this entity, confusing or misleading terms such as mycetoma, aspergilloma or aspergillosis would be best avoided. Clinical presentation is non-specific and the diagnosis is usually suspected on imaging studies. Surgical treatment, usually through an endonasal endoscopic approach, is curative. In this paper, we review the clinical, radiological, and pathological presentation of the fungus ball of the paranasal sinuses as well as the surgical management with emphasis on the transnasal endoscopic approach.
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Affiliation(s)
- Pierre Grosjean
- Service d'ORL et de Chirurgie Cervico-Faciale, Lausanne, Switzerland.
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Affiliation(s)
- James Kirszrot
- Massachusetts Eye and Ear Infirmary, Department of Ophthalmology, Boston, MA 02114, USA
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Hope WW, Walsh TJ, Denning DW. The invasive and saprophytic syndromes due to Aspergillus spp. Med Mycol 2005; 43 Suppl 1:S207-38. [PMID: 16110814 DOI: 10.1080/13693780400025179] [Citation(s) in RCA: 141] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
Aspergillus spp. produce a wide range of invasive and sapropytic syndromes which may involve any tissue. Within a given tissue or organ the pathology and pathogenesis varies enormously, ranging from angioinvasive disease to noninvasive saprophytic disease. The individual invasive and saprophytic syndromes in which a causative role can be attributed to Aspergillus spp. are detailed specifically with reference to the underlying pathology and pathogenesis, the clinical setting and features, and the manner in which a diagnosis can be established.
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Affiliation(s)
- W W Hope
- University of Manchester and Wythenshawe Hospital, Manchester UK
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Abstract
Primary frontal sinus aspergillosis is extremely uncommon with only few cases reported in the English literature. Isolated frontal sinus aspergillosis is usually asymptomatic and produces symptoms due to orbital or intracranial involvement. We report two cases of primary frontal sinus aspergillosis, presenting as frontoethmoidal mucocele and mimicking a 'Pott's puffy tumor,' respectively. Forehead swelling produced by frontal sinus aspergillosis will be the first to be reported in the English literature.
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Affiliation(s)
- Naresh Kumar Panda
- Department of Otolaryngology and Head and Neck Surgery, PGIMER, Chandigarh, India.
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Chakrabarti A, Das A, Panda NK. Overview of fungal rhinosinusitis. Indian J Otolaryngol Head Neck Surg 2004; 56:251-8. [PMID: 23120090 PMCID: PMC3451156 DOI: 10.1007/bf02974381] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
The incidence of fungal rhinosinusitis has increased to such extent in recent years that fungal infection should be considered in all patients with chronic rhino sinusitis. In India though the disease was reported earlier only from northern regions of this country, nowadays the disease is increasingly diagnosed from other parts as well. The disease has been categorized with possible five types: acute necrothing (fulminant), chronic invasive, chronic granulomatous invasive, fungal hall (sinus mycetoma), allergic. The first three types are tissue-invasive and the last two are non-invasive fungal rhinosinusitis. However, the categorization is still controversial and open to discussion. Chronic fungal rhinosinusitis can occur in otherwise healthy host and Aspergillus flavus is the common etiological agent in Indian scenario. The pathophys iologic mechanism of the disease remains unclear. It may represent an allergic IgE response, a cell-mediated reaction, or a combination of two. Early diagnosis may prevent multiple surgical procedures and lead to effective treatment. Histopathology and radio-imaging techniques help to distinguish different types and delineate extension of disease process. Culture helps to identify the responsible etiological agent. The presence or absence oj precipitating antibody correlates well with disease progression or recovery. The most immediate need regarding management is to establish the respective roles of surgery and antifungal therapy. Non-invasive disease requires surgical debridement and sinus ventilation only, though, additional oral or local corticosterold therapy may be beneficial in allergie type. For invasive disease, the adjuvant medical therapy is recommended to prevent recurrence and further extension. Itraconazole has been found as an effective drug in such situation. Patients with acute neerotizing type require radical surgery and amphotericin B therapy.
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Affiliation(s)
- Arunaloke Chakrabarti
- Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research, PGIMER, 160012 Chandigarh
| | - Ashim Das
- Department of Medical Histopathology, Postgraduate Institute of Medical Education and Research, Chandigarh
| | - Naresh K Panda
- Department of Medical Otolaryngology, Postgraduate Institute of Medical Education and Research, Chandigarh
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Panda NK, Balaji P, Chakrabarti A, Sharma SC, Reddy CEE. Paranasal sinus aspergillosis: its categorization to develop a treatment protocol. Nasennebenhohlen-Aspergillose: Kategorisiertes Behandlungsprotokoll. Mycoses 2004; 47:277-83. [PMID: 15310329 DOI: 10.1111/j.1439-0507.2004.00986.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
A prospective study was conducted in 25 consecutive patients of paranasal sinus aspergillosis to categorize and treat them based on a fixed treatment protocol. The three types of aspergillosis categorized as per definitive criteria were chronic invasive (six), non-invasive (fungus ball) (seven) and non-invasive destructive (12). Adjuvant chemotherapy was employed in non-invasive destructive and chronic invasive disease. Ketoconazole was used in the first variety and itroconazole in the latter. Only two patients had recurrence after a mean follow-up of 11 months (range: 6-20 months). They belonged to the non-invasive destructive category and the recurrence had progressed to invasive variety. It is suggested that non-invasive destructive disease should be followed up regularly with endoscopic examination, CT and fungal serology to detect recurrence. Categorization of the paranasal sinus aspergillosis helps to institute proper treatment. Adjuvant chemotherapy in the form of ketoconazole along with surgery is effective in non-invasive destructive disease to prevent recurrence and progression to invasive disease. Chronic invasive disease with its propensity to involve orbit and intracranial cavity should be managed at the earliest with surgery and itraconazole.
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Affiliation(s)
- N K Panda
- Department of Otolaryngology, Postgraduate Institute of Medical Education and Research, Changigarh, India.
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Abstract
AFS is an increasingly recognized form of HSD, now reported throughout the world. It is probably the most frequently occurring fungal rhinosinusitis disorder. The term fungal sinusitis is no longer appropriate because the five categories of fungal rhinosinusitis can now be differentiated. Each category of fungal rhinosinusitis disorder carries different treatment approaches and prognosis. Diagnostic error can be minimized by adhering to strict diagnostic criteria. The analogy (but not identity) of AFS to ABPA has been supported by histopathology, immunopathology, and the clinical response to OCS treatment. AFS represents a true medical surgical disorder in which both surgery and postoperative medical treatment, if properly coordinated between medical and surgical specialists, leads to the best patient outcomes. Continued advances in the understanding of the immunogenetics and immunopathogenesis of AFS may provide fundamental insights into molecular mechanisms operant in other chronic inflammatory disorders, including other chronic eosinophilic-lymphocytic respiratory mucosal disorders such as common forms of HSD and chronic severe asthma.
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Abstract
Allergic fungal sinusitis (AFS) is a noninvasive form of highly recurrent chronic allergic hypertrophic rhinosinusitis that can be distinguished clinically, histopathologically and prognostically from the other forms of chronic fungal rhinosinusitis. There are three invasive (acute necrotising, chronic invasive and granulomatous invasive) and two noninvasive (fungal ball and allergic fungal) forms of fungal rhinosinusitis currently recognised. Confusion in differentiating between the various forms of fungal rhinosinusitis and between other forms of chronic hypertrophic sinus disease (HSD) can be eliminated by adhering to strict diagnostic criteria. Although there are characteristic presenting clinical history and physical examination findings, laboratory test results, including elevated total serum IgE and positive inhalant allergy skin tests, and sinus computed tomography scans showing chronic rhinosinusitis (often with the presence of hyperattenuating sinus contents) diagnosis of AFS is essentially based on histopathology obtained from sinus surgery. Histopathology shows the presence of eosinophilic-lymphocytic sinus mucosal inflammation, extramucosal allergic mucin (that is also seen grossly at surgery as a characteristic 'peanut-buttery' material), and scattered silver stain positive fungal hyphae within the allergic mucin but not in the mucosa. Treatment and follow up of AFS has been based on its immunopathological analogy to allergic bronchopulmonary aspergillosis, a similar noninvasive fungal hypersensitivity disorder of the lung, and its clinical and pathophysiological relationship to other forms of HSD and asthma. Treatment involves aggressive sinus surgery followed by medical management that includes allergen immunotherapy, topical and systemic corticosteroids, antihistamines and antileukotrienes. Total serum IgE levels should be followed postoperatively as they can be prognostic for recurrent disease. Close follow up and coordination of treatment by both medical and surgical physicians as a team leads to the best clinical outcomes. Ongoing studies are being directed at furthering our understanding of the pathophysiological relationships and treatment options for AFS, and other common forms of chronic hypertrophic rhinosinusitis disorders.
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Lujber L, Gerlinger I, Kuncz Á, Pytel J. Combination therapy for chronic invasive rhinocerebral aspergillosis in a clinically immunocompetent patient. CURRENT THERAPEUTIC RESEARCH 2003; 64:473-83. [PMID: 24944397 PMCID: PMC4053017 DOI: 10.1016/s0011-393x(03)00111-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/30/2003] [Indexed: 11/28/2022]
Abstract
BACKGROUND Adequate therapy for chronic invasive rhinocerebral aspergillosis in immunocompetent patients is controversial. The incidence of the disease is high in the Sudan and the Middle East. Misinterpretation of diagnostic criteria, failure to verify tissue invasion of fungi, and a lack of understanding of the pathophysiology of various forms of fungal rhinosinusitis lead to controversies in nomenclature, diagnosis, and therapy. OBJECTIVE The aim of this report was to detail the clinical presentation and the endoscopic and imaging study findings of a patient with invasive Aspergillus rhinosinusitis with endocranial and orbital extension. This patient was treated with surgical débridement and a combination of antifungal drugs and immunomodulatory therapy. METHODS Endoscopic débridement and high-dose liposomal amphotericin B, in combination with flucytosine and immunomodulators, were used to treat this patient. RESULTS After treatment, the patient experienced 3 years of disease-free follow-up. CONCLUSION Surgical débridement and high-dose systemic combined antifungal therapy with immunomodulatory drugs produced an excellent long-term result for this apparently immunocompetent patient with extensive invasive fungal rhinosinusitis with cerebral and orbital involvement.
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Affiliation(s)
- László Lujber
- Faculty of Medicine, Department of Otorhinolaryngology, Pécs University, Pécs, Hungary
- Tawam Hospital, Abu Dhabi, United Arab Emirates
| | - Imre Gerlinger
- Department of Otolaryngology, Head and Neck Surgery, University of Nottingham, Queens Medical Centre, Nottingham, United Kingdom, and
| | - Ádám Kuncz
- Tawam Hospital, Abu Dhabi, United Arab Emirates
- Faculty of Medicine, Department of Neurosurgery, Szeged University, Szeged, Hungary
| | - József Pytel
- Faculty of Medicine, Department of Otorhinolaryngology, Pécs University, Pécs, Hungary
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Dhiwakar M, Thakar A, Bahadur S, Sarkar C, Banerji U, Handa KK, Chhabra SK. Preoperative diagnosis of allergic fungal sinusitis. Laryngoscope 2003; 113:688-94. [PMID: 12671430 DOI: 10.1097/00005537-200304000-00020] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES/HYPOTHESIS Although the diagnosis of allergic fungal sinusitis is mainly based on characteristic histopathological findings, certain preoperative diagnostic criteria have been proposed. However, their usefulness in differentiating allergic fungal sinusitis from other sinus diseases is unknown. The objective of the study was to identify accurate preoperative diagnostic parameters for allergic fungal sinusitis. STUDY DESIGN Prospective, comparative study. METHODS Twenty consecutive cases of allergic fungal sinusitis were evaluated prospectively and compared with 16 cases of ethmoidal polyposis and 5 cases of invasive sinus aspergillosis, with regard to various clinical, radiological, and immunological parameters. All patients were categorized based on histopathological findings. RESULTS Nasal polyps were seen in all 20 cases of allergic fungal sinusitis, all 16 cases of ethmoidal polyposis, and 2 of 5 cases of invasive sinus aspergillosis. Computed tomography (CT) scan hyper-attenuation was seen in all 20 cases of allergic fungal sinusitis but also in 2 (13%) cases of ethmoidal polyposis and 2 (40%) cases of invasive sinus aspergillosis. Serum levels of specific anti-Aspergillus immunoglobulin E were elevated in 14 (70%) cases of allergic fungal sinusitis, 2 (13%) cases of ethmoidal polyposis, and 3 (60%) cases of invasive sinus aspergillosis. The combination of all three (ie, nasal polyps, CT scan hyper-attenuation, and elevated titers of anti-Aspergillus immunoglobulin) was not found in any case of ethmoidal polyposis or invasive sinus aspergillosis. This triad demonstrated a sensitivity of 70% and a specificity of 100% for the preoperative diagnosis of allergic fungal sinusitis. CONCLUSIONS Nasal polyps, CT scan, and specific immunoglobulin E titers, when considered in combination, have a high preoperative diagnostic value in allergic fungal sinusitis. However, they should not be considered in isolation because considerable overlap occurs with invasive sinus aspergillosis and ethmoidal polyposis.
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Affiliation(s)
- Muthuswamy Dhiwakar
- Department of Otolaryngology and Head-Neck Surgery, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India
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Petrick M, Honegger J, Daschner F, Feuerhake F, Zentner J. Fungal granuloma of the sphenoid sinus and clivus in a patient presenting with cranial nerve III paresis: case report rand review of the literature. Neurosurgery 2003; 52:955-8; discussion 958-9. [PMID: 12657193 DOI: 10.1227/01.neu.0000053026.02658.4b] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2002] [Accepted: 11/11/2002] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE AND IMPORTANCE Isolated fungal granulomas originating within the sphenoid sinus are extremely rare in immunocompetent patients. In their symptoms and morphological appearance, these lesions may be mistaken for pituitary tumors. We report such a case and review the literature. CLINICAL PRESENTATION A 74-year-old man presented with a 3-week history of Cranial Nerve III paresis. The patient had a long-term history of snuff abuse. Computed tomography demonstrated a space-occupying lesion of the sellar and sphenoid sinus region with displacement of the cavernous sinus. INTERVENTION The lesion was operated on via a transnasal-transsphenoidal approach. After the sphenoid sinus was opened, mucus extruded spontaneously, and a brownish, crumbly mass was found and removed. The lesion had completely eroded the sella and clivus. Histological analysis revealed numerous Aspergillus hyphae. Postoperatively, the IIIrd cranial nerve paresis resolved completely within a few days. No systemic fungal infection was found in extensive serological studies. There was no evidence of immunosuppression. CONCLUSION Fungal granuloma must be included in the differential diagnosis of lesions in the sellar region, even in nonimmunosuppressed patients. Early diagnosis and transsphenoidal extirpation is crucial with this potentially life-threatening disease.
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Affiliation(s)
- Manfred Petrick
- Department of Neurosurgery, University Hospital Freiburg, Freiburg, Germany.
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