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Gao M, Yu A, Chen M, Qiu T, Guo Y, Sun X, Wang X. Airborne fungi and human exposure in different areas of composting facilities. ECOTOXICOLOGY AND ENVIRONMENTAL SAFETY 2022; 243:113991. [PMID: 36007318 DOI: 10.1016/j.ecoenv.2022.113991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 06/23/2022] [Accepted: 08/16/2022] [Indexed: 06/15/2023]
Abstract
Airborne fungi can pose serious health concerns in humans; however, the area-specific abundance and composition of airborne fungal microbiota discharged from composting facilities remain unclear. In the present study, we collected air samples from composting, packaging, office, and downwind areas of four commercial composting facilities. The characteristics of airborne fungi, including pathogen/allergen-containing genera, and their corresponding human exposure in different areas of composting facilities were analyzed using high-throughput sequencing and ddPCR. High fungal concentrations and richness were detected in the air of the packaging area. In all four areas, Ascomycota, Basidiomycota, and Mucoromycota were observed to be the primary fungal phyla, with Cladosporium, Alternaria, and Aspergillus as the consistently dominant fungal genera. A large number of endemic airborne fungi were found in the composting and packaging areas, which also shared the most common airborne fungi as well as pathogen/allergen-containing genera. The packaging area contributed substantially to airborne fungi in the office and downwind areas. Area-specific human exposure to broad airborne fungal compositions was revealed, especially regarding the pathogen/allergen-containing genera. Current results provide valuable data for a comprehensive understanding of area-specific airborne fungi in composting facilities and highlight the importance of assessing the inhaled exposure to airborne fungi in evaluating their following health risks.
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Affiliation(s)
- Min Gao
- Beijing Key Laboratory of Agricultural Genetic Resources and Biotechnology, Beijing Agro-Biotechnology Research Center, Beijing Academy of Agriculture and Forestry Sciences, Beijing 100097, China
| | - Aoyuan Yu
- Beijing Key Laboratory of Agricultural Genetic Resources and Biotechnology, Beijing Agro-Biotechnology Research Center, Beijing Academy of Agriculture and Forestry Sciences, Beijing 100097, China; College of Forestry, Northeast Forestry University, Harbin 150040, China
| | - Mo Chen
- Center Environmental Protection Technology Co., Ltd., Beijing 101102, China
| | - Tianlei Qiu
- Beijing Key Laboratory of Agricultural Genetic Resources and Biotechnology, Beijing Agro-Biotechnology Research Center, Beijing Academy of Agriculture and Forestry Sciences, Beijing 100097, China
| | - Yajie Guo
- Beijing Key Laboratory of Agricultural Genetic Resources and Biotechnology, Beijing Agro-Biotechnology Research Center, Beijing Academy of Agriculture and Forestry Sciences, Beijing 100097, China
| | - Xingbin Sun
- College of Forestry, Northeast Forestry University, Harbin 150040, China.
| | - Xuming Wang
- Beijing Key Laboratory of Agricultural Genetic Resources and Biotechnology, Beijing Agro-Biotechnology Research Center, Beijing Academy of Agriculture and Forestry Sciences, Beijing 100097, China.
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Hernández-Restrepo M, Madrid H, Tan Y, da Cunha K, Gené J, Guarro J, Crous P. Multi-locus phylogeny and taxonomy of Exserohilum. PERSOONIA 2018; 41:71-108. [PMID: 30728600 PMCID: PMC6344813 DOI: 10.3767/persoonia.2018.41.05] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Accepted: 12/13/2017] [Indexed: 12/19/2022]
Abstract
Exserohilum includes a number of plant pathogenic, saprobic and clinically relevant fungi. Some of these species are of great importance in human activities, but the genus has never been revised in a phylogenetic framework. In this study, we revise Exserohilum based on available ex-type cultures from worldwide collections, observation of the holotypes and/or protologues, and additional isolates from diverse substrates and geographical origins. Based on nine nuclear loci, i.e., ITS, LSU, act, tub2, cam, gapdh, his, tef1 and rpb2, as well as phenotypic data, the genus and species boundaries are assessed for Exserohilum. Three species, i.e., E. novae-zelandiae, E. paspali and E. sorghicola, are excluded from the genus and reallocated in Sporidesmiella and Curvularia, respectively, whereas E. heteropogonicola and E. inaequale are confirmed as members of Curvularia. Exserohilum rostratum is revealed as conspecific with species previously described in Exserohilum such as E. antillanum, E. gedarefense, E. leptochloae, E. longirostratum, E. macginnisii and E. prolatum. Additionally, E. curvatum is revealed as synonym of E. holmii, and E. fusiforme of E. oryzicola. A total of 11 Exserohilum phylogenetic species are described, illustrated and discussed, including one novel taxon, E. corniculatum. The placements of 15 other doubtful species are discussed, and E. elongatum is validated.
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Affiliation(s)
- M. Hernández-Restrepo
- Westerdijk Fungal Biodiversity Institute, P.O. Box 85167, 3508 AD Utrecht, The Netherlands
- Department of Microbiology and Plant Pathology, Forestry and Agricultural Biotechnology Institute (FABI), University of Pretoria, Pretoria 0002, South Africa
| | - H. Madrid
- Centro de Genómica y Bioinformática, Facultad de Ciencias, Universidad Mayor de Chile, Camino La Pirámide 5750, Huechuraba, Santiago, Chile
| | - Y.P. Tan
- Plant Pathology Herbarium, Department of Agriculture and Fisheries, Ecosciences Precinct, 41 Boggo Road, Dutton Park, QLD 4102, Australia
| | - K.C. da Cunha
- Dermatology Laboratory, Service of Laboratory Medicine, University Hospital of Geneva 4, CH-1 205 Geneva, Switzerland
| | - J. Gené
- Unitat de Micologia, Facultat de Medicina i Ciències de la Salut and IISPV, Univeristat Rovira i Virgili, Reus, Spain
| | - J. Guarro
- Unitat de Micologia, Facultat de Medicina i Ciències de la Salut and IISPV, Univeristat Rovira i Virgili, Reus, Spain
| | - P.W. Crous
- Westerdijk Fungal Biodiversity Institute, P.O. Box 85167, 3508 AD Utrecht, The Netherlands
- Department of Microbiology and Plant Pathology, Forestry and Agricultural Biotechnology Institute (FABI), University of Pretoria, Pretoria 0002, South Africa
- Wageningen University and Research Centre (WUR), Laboratory of Phytopathology, Droevendaalsesteeg 1, 6708 PB Wageningen, The Netherlands
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3
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Alajmi S, Koratum RM, Khan Z, Ahmad S, Jeragh A, Ibrahim H, Joseph L, Varghese S. Allergic Fungal Sinusitis Caused by Exserohilum rostratum and Literature Review. Mycopathologia 2018; 184:89-96. [PMID: 30168078 DOI: 10.1007/s11046-018-0288-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Accepted: 07/06/2018] [Indexed: 12/25/2022]
Abstract
A case of allergic fungal sinusitis (AFS) caused by Exserohilum rostratum, proven by culture and histopathology of the biopsy material, is described. The identity of the isolate was confirmed by sequencing of ITS region of rDNA. To the best of our knowledge, this is the first report of allergic E. rostratum sinusitis from Kuwait and Arabian Peninsula. Ten previously described cases of AFS have been reviewed. The report highlights the emerging importance of E. rostratum as a human pathogen in this region and role of molecular methods in its accurate identification.
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Affiliation(s)
- Salma Alajmi
- Department of Microbiology, Al-Adan Hospital, Hadiya, Kuwait
| | | | - Ziauddin Khan
- Department of Microbiology, Faculty of Medicine, Kuwait University, P. O. Box 24923, Safat, 1311, Kuwait.
| | - Suhail Ahmad
- Department of Microbiology, Faculty of Medicine, Kuwait University, P. O. Box 24923, Safat, 1311, Kuwait
| | - Ahlam Jeragh
- Department of Microbiology, Al-Adan Hospital, Hadiya, Kuwait
| | - Hany Ibrahim
- Department of Pathology, Al-Adan Hospital, Hadiya, Kuwait
| | - Leena Joseph
- Department of Microbiology, Faculty of Medicine, Kuwait University, P. O. Box 24923, Safat, 1311, Kuwait
| | - Soumya Varghese
- Department of Microbiology, Faculty of Medicine, Kuwait University, P. O. Box 24923, Safat, 1311, Kuwait
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4
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Peters AT, Spector S, Hsu J, Hamilos DL, Baroody FM, Chandra RK, Grammer LC, Kennedy DW, Cohen NA, Kaliner MA, Wald ER, Karagianis A, Slavin RG. Diagnosis and management of rhinosinusitis: a practice parameter update. Ann Allergy Asthma Immunol 2015; 113:347-85. [PMID: 25256029 DOI: 10.1016/j.anai.2014.07.025] [Citation(s) in RCA: 111] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2014] [Accepted: 07/22/2014] [Indexed: 02/06/2023]
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Katragkou A, Pana ZD, Perlin DS, Kontoyiannis DP, Walsh TJ, Roilides E. Exserohilum infections: review of 48 cases before the 2012 United States outbreak. Med Mycol 2014; 52:376-86. [PMID: 24682112 DOI: 10.1093/mmy/myt030] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Exserohilum species are soilborne fungi that have been uncommon causes of human disease. The ongoing outbreak in the United States warrants improved understanding of this pathogen. We systematically reviewed all cases of Exserohilum spp. infections published before the outbreak in 2012 in order to provide a better understanding of the organism and its wider spectrum of human disease. Cases of Exserohilum infections were retrieved by searching PubMed. Demographic data, underlying conditions, microbiology, clinical manifestations, therapy, and outcome were recorded and analyzed. Forty-eight evaluable cases were identified from 1975 to 2012. The number of reported cases increased more than twofold during the study period (P < 0.01). Most cases occurred in the southern United States, India, and Israel. Median age of patients was 25 years, with a male predominance. Most infections were due to E. rostratum (60.4%), followed by E. longirostratum (6.3%) and E. mcginnisii (2%), while 31.3% were unidentified species. The most frequent underlying conditions were immunosuppression (27.2%), trauma (16.6%), and atopy (12.5%). Exserohilum disease manifested as systemic (73%), cutaneous (25%), corneal (16.7%), and subcutaneous (10.4%) infection. Antifungal therapy consisted mainly of amphotericin B (44%) alone or combined with a triazole. Surgery was used in 48% of cases and was combined with antifungal therapy in 31%. The all-cause mortality was 23%, which was higher in patients with preexisting immunosuppression (56.2%; odds ratio 15.4; 95% confidence interval, 2.7-88.6). This review of the pre-outbreak reported cases highlights several aspects of epidemiology, clinical presentation, risk factors, and management of this unusual pathogen.
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Affiliation(s)
- Aspasia Katragkou
- Infectious Diseases Unit, 3rd Department of Pediatrics, Aristotle University School of Medicine, Hippokration Hospital, Thessaloniki, Greece
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6
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Thanasumpun T, Batra PS. Oral antifungal therapy for chronic rhinosinusitis and its subtypes: a systematic review. Int Forum Allergy Rhinol 2011; 1:382-9. [DOI: 10.1002/alr.20088] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2011] [Revised: 06/28/2011] [Accepted: 07/01/2011] [Indexed: 12/18/2022]
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7
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Grisoli P, Rodolfi M, Villani S, Grignani E, Cottica D, Berri A, Picco AM, Dacarro C. Assessment of airborne microorganism contamination in an industrial area characterized by an open composting facility and a wastewater treatment plant. ENVIRONMENTAL RESEARCH 2009; 109:135-42. [PMID: 19131053 DOI: 10.1016/j.envres.2008.11.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2008] [Revised: 10/27/2008] [Accepted: 11/10/2008] [Indexed: 05/04/2023]
Abstract
In order to assess the potential exposure hazard to workers and people living in the immediate surroundings of an area characterized by an open composting facility and a wastewater treatment plant, a quantitative and a qualitative analysis of airborne microorganisms were carried out. Air sampling was performed once a week for four consecutive weeks in summer and winter. Six sites were selected as air sampling sites: one was upwind at approximately 40 m from the facilities; the other five were downwind at increasing distances from the facilities, with the furthest at 100 m away. Monitoring permitted us to verify the influence that the composting activities and wastewater treatment had on the bacterial and fungal contamination of the air. The results obtained have been expressed by means of contamination indexes that have already been used in previous works: a major microbiological contamination near the plants was evidenced. Near the facilities, mesophilic bacteria, psychrophilic bacteria and microfungi showed the highest median concentrations, respectively, of 307.5, 327.5 and 257.5 CFU/m(3). Moreover, the season generally influenced the concentration of the bacteria as well as of the fungi; higher in summer than in winter. The contamination index global index of microbial contamination (GIMC/m(3)) showed mean values of 4058.9 in summer and 439.7 in winter and the contamination index-amplification index (AI) showed values of 4.5 and 1.1 in the same seasons, respectively. Controlling the seasonal effect, mesophilic bacteria, Pseudomonas spp. and Enterobacteriaceae showed a significant decline in concentration with respect to upwind air samples and with increasing distance. Both GIMC and AI showed a significant decline with respect to upwind air samples by increasing the distance from facilities after adjusting for the seasonal effect. In conclusion, even if these plants do not represent a potential risk for nearby populations, they may pose a potential health risk for workers.
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Affiliation(s)
- Pietro Grisoli
- Department of Experimental and Applied Pharmacology, Laboratory of Microbiology, University of Pavia, Pavia, Italy.
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8
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Kimura M. [Deep seated mycosis diagnosed at hospital pathology division]. ACTA ACUST UNITED AC 2008; 49:269-73. [PMID: 19001752 DOI: 10.3314/jjmm.49.269] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
A pathological diagnosis can be a decisive diagnosis for deep-seated mycosis. HE stain is used to look for structural changes of the infected lesion and then various special stains are used to visualize the fungus in sections. When viability of the fungus is low, it is faintly stained with HE or PAS. Grocott stain can clearly demonstrate the fungus regardless of viability. Overstaining and understaining sometimes occur. Grocott stain is not suitable to detect structural changes of an infected lesion. Cell walls of Cryptococcus and dematiaceous fungi are stained brown with Fontana-Masson stain because of the existence of melanin. However, it is noteworthy that some Aspergillus and zygomycetes also turn brown with this stain. Fungiflora Y with a fluorescence microscope can readily demonstrate most fungal hyphae except zygomycetes. Immunohistochemistry with antibody against various fungi and in situ hybridization are useful to confirm a fungal genus on paraffin sections. Furthermore, probes to detect specific species of Aspergillus for in situ hybridization are now available.
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Affiliation(s)
- Masatomo Kimura
- Department of Pathology, Kinki University School of Medicine, Osaka-Sayama, Osaka, Japan
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9
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Taxy JB. Paranasal fungal sinusitis: contributions of histopathology to diagnosis: a report of 60 cases and literature review. Am J Surg Pathol 2006; 30:713-20. [PMID: 16723848 DOI: 10.1097/00000478-200606000-00006] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Sixty cases of fungal sinusitis are presented from 2 institutions, accumulated from 1971 to 2005. Fifty cases were from a large suburban general hospital and 10 from a major university referral center. Two of the 50 and 3 of the 10, respectively, were immunocompromised patients and had acute fulminant disease. This suggests that encountering the various forms of this disease may, in part, be dependent on the referral nature of the institution. The remainder were immune competent and had chronic symptoms of nasal discharge, stuffiness, and facial pain. Imaging studies frequently showed sinus expansion, opacification, and bone erosion, although no clinical or radiographic features were predictive of extrasinus extension. Chronic fungal sinusitis is principally represented by fungus ball/mycetoma and allergic fungal sinusitis. The recent literature suggests a predominance of or a predominant interest in allergic fungal sinusitis. Hyphal colonies and the presence of allergic mucin with scattered organisms are histologic observations and are the respective keys to these diagnoses. However, the etiologic role of the fungus in chronic cases is not settled. Patients with chronic sinusitis who yield positive sinus cultures only, but have no organisms visualized histologically, are not universally regarded as having fungal sinusitis. The interest in fungal sinusitis has generated a prominent role for the pathologist. An awareness of the various forms of the disease and thorough histopathologic study, including submission of all tissues removed at surgery and recognition of allergic mucin, are essential. Acute fulminant/invasive fungal sinusitis may require frozen section for adequate management.
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Affiliation(s)
- Jerome B Taxy
- Department of Pathology, Advocate Lutheran General Hospital, Park Ridge, and The University of Chicago, Chicago, IL 60637, USA.
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10
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Adler A, Yaniv I, Samra Z, Yacobovich J, Fisher S, Avrahami G, Levy I. Exserohilum: an emerging human pathogen. Eur J Clin Microbiol Infect Dis 2006; 25:247-53. [PMID: 16511679 DOI: 10.1007/s10096-006-0093-3] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Exserohilum is a dematiaceous fungus that may cause a spectrum of diseases in humans, including skin and corneal infection, invasive disease, and allergic fungal sinusitis. The aim of this work is to describe two new cases of Exserohilum infection and to review the literature. The review yielded 33 cases of Exserohilum infection, of which 23 were reported since 1993. Most occurred in regions with hot climates, such as India, Israel, and the southern USA. Impaired immunity was present in the majority of patients with invasive and skin infections, whereas local trauma and atopy were the predisposing factors in those with corneal infections and allergic fungal sinusitis, respectively. Surgical debridement was the principal mode of therapy for allergic fungal sinusitis. Amphotericin B was the initial single antifungal agent used in all cases of invasive disease; the response rate was low but improved with the addition of triazole agents. Outcome appeared to be better than for other mold infections and depended mainly on the underlying diseases.
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Affiliation(s)
- A Adler
- Unit of Pediatric Infectious Diseases and Hospital Infection Control, Schneider Children's Medical Center of Israel, 14 Kaplan Street, POB 559, Petah Tiqva, 49202, Israel.
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11
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Al-Attar A, Williams CG, Redett RJ. Rare Lower Extremity Invasive Fungal Infection in an Immunosuppressed Patient: Exserohilum longirostratum. Plast Reconstr Surg 2006; 117:44e-47e. [PMID: 16525254 DOI: 10.1097/01.prs.0000200637.31987.7b] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Ali Al-Attar
- Department of Plastic Surgery, Georgetown University, Washington, DC, USA
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12
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Castelnuovo P, De Bernardi F, Cavanna C, Pagella F, Bossolesi P, Marone P, Farina C. Invasive fungal sinusitis due to Bipolaris hawaiiensis. Fallbericht. Invasive Pilzsinusitis verursacht durch Bipolaris hawaiiensis. Mycoses 2004; 47:76-81. [PMID: 14998405 DOI: 10.1046/j.0933-7407.2003.00941.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
A phaeohyphomycotic sinusitis due to Bipolaris hawaiiensis, observed in an immunologically competent patient, is reported and a review of data from the literature is given. The patient was successfully treated by surgical drainage and amphotericin B.
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Affiliation(s)
- P Castelnuovo
- Clinica Otorinolaringoiatrica, IRCCS Policlinico S. Matteo, Università di Pavia, Italy
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13
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Willard CC, Eusterman VD, Massengil PL. Allergic fungal sinusitis: report of 3 cases and review of the literature. ACTA ACUST UNITED AC 2004; 96:550-60. [PMID: 14600689 DOI: 10.1016/s1079-2104(03)00316-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Allergic fungal sinusitis is a form of noninvasive fungal disease resulting from an IgE-mediated hypersensitivity reaction in atopic individuals. Allergic fungal sinusitis can present with a continuum of symptoms. Accumulation of allergic inspissated mucin may cause simple nasal obstruction or progress to facial deformity with osteolytic destruction and intracranial extension. Multiple species of fungi are now recognized as etiologic factors responsible for initiating the inflammatory response. This article discusses 3 cases involving Aspergillus and Curvularia species, and reviews diagnostic image findings, pathophysiology, and medical-surgical management of this increasingly common disease.
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Affiliation(s)
- Craig C Willard
- Madigan Army Medical Center Hospital Dental Clinic, Ft Lewis, WA 98431, USA.
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14
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Levy I, Stein J, Ashkenazi S, Samra Z, Livni G, Yaniv I. Ecthyma gangrenosum caused by disseminated Exserohilum in a child with leukemia: a case report and review of the literature. Pediatr Dermatol 2003; 20:495-7. [PMID: 14651568 DOI: 10.1111/j.1525-1470.2003.20608.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
We report an 8-year-old boy with acute leukemia who developed ecthyma gangrenosum secondary to infection with Exserohilum spp., a rare cause of human disease. The skin, paranasal sinuses and lungs were involved. To the best of our knowledge, this is the first report of ecthyma gangrenosum caused by Exserohilum spp. This case emphasizes the importance of prompt skin biopsy for early diagnosis and treatment of this life-threatening infection.
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Affiliation(s)
- Itzhak Levy
- Department of Pediatric Infectious Diseases, Schneider Children's Medical Center of Israel, Petah Tikva, Israel.
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15
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Colton R, Zeharia A, Karmazyn B, Buller N, Levy Y, Inbal R, Zmira S, Yaniv E. Exserohilum sinusitis presenting as proptosis in a healthy adolescent male. J Adolesc Health 2002; 30:73-5. [PMID: 11755803 DOI: 10.1016/s1054-139x(01)00300-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Roberta Colton
- Department of Pediatrics, Schneider Children's Medical Center of Israel, 14 Kaplan Street, Petah Tiqva 49 202, Israel
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Abstract
Black moulds are a heterogeneous group of darkly pigmented (dematiaceous) fungi, widely distributed in the environment, that occasionally cause infection in humans. The clinical spectrum of infection includes mycetomas, chromoblastomycosis, sinusitis, and superficial, cutaneous, subcutaneous and systemic phaeohyphomycosis. During the last 2 years, there have been reports of infection caused by black moulds in previously healthy individuals and in immunocompromised patients, including an outbreak of fungemia in hospitalized patients. Molecular analysis of strains obtained from patients and from the environment has suggested a common nosocomial source. In addition, data on antifungal susceptibility tests have become available. Surgical excision and antifungal therapy (usually itraconazole) remain the standard treatment for these infections.
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Affiliation(s)
- F Silveira
- Department of Internal Medicine, Jackson Memorial Hospital, University of Miami, Miami, Florida, USA
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17
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Herráez P, Rees C, Dunstan R. Invasive phaeohyphomycosis caused by Curvularia species in a dog. Vet Pathol 2001; 38:456-9. [PMID: 11467482 DOI: 10.1354/vp.38-4-456] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
A 2-year-old female Boxer dog was presented with a history of skin lesions that started 1 month after being given oral glucocorticoids for a neurologic problem. Clinically, the animal had focal areas of alopecia with papules and nodules often with ulceration overlain by crusts. Lesions were most common on the dorsum and the lateral aspects of the trunk and extremities. Histologic evaluation revealed pigmented fungal organisms within the lumina of hair follicles and throughout the dermis and subcutis. These organisms were associated with a multinodular, pyogranulomatous luminal folliculitis/furunculosis, dermatitis, and panniculitis. Curvularia sp. was isolated from the cutaneous lesions. The histologic identification of dematiaceous fungal organisms in the hair follicles may explain how phaeohyphomycosis can occur without history of a penetrating injury.
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Affiliation(s)
- P Herráez
- Department of Histology and Pathological Anatomy, Facultad de Veterinaria, ULPGC, Arucas, Gran Canaria, Spain.
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18
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Khan DA, Cody DT, George TJ, Gleich GJ, Leiferman KM. Allergic fungal sinusitis: an immunohistologic analysis. J Allergy Clin Immunol 2000; 106:1096-101. [PMID: 11112892 DOI: 10.1067/mai.2000.110929] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND Allergic fungal sinusitis is a noninvasive form of fungal sinusitis that has recently been delineated as a distinct clinicopathologic entity. It is increasingly recognized as a cause of chronic sinusitis, with the primary causative agents being members of the Dematiaceae fungus family. Although its immunopathogenesis has not been elucidated, the eosinophil is a prominent inflammatory cell on histologic examination. OBJECTIVE We sought to characterize the involvement of eosinophils in sinus tissue and accompanying mucin from patients with allergic fungal sinusitis. As a comparison, neutrophil and mast cell involvement was also evaluated in the same group of patients. METHODS Tissue specimens from 8 patients with allergic fungal sinusitis, along with 8 nasal polyp specimens from patients without allergic fungal sinusitis, were stained by using indirect immunofluorescence for eosinophil granule major basic protein (MBP). Neutrophil elastase and mast cell tryptase staining was also performed on the same allergic fungal sinusitis and nasal polyp tissues. RESULTS MBP was diffusely localized within the mucin, showing intense staining at the periphery and variable staining of degenerated cell clusters throughout. Extracellular MBP in the mucin was strikingly greater than intact eosinophil staining. Diffuse extracellular neutrophil elastase was also present in the mucin. Mucinous areas showed no tryptase localization. Adjacent nonmucinous areas of respiratory mucosa showed predominantly cellular staining with eosinophil MBP, neutrophil elastase, and mast cell tryptase. MBP staining of nasal polyps showed a predominantly cellular pattern with focal areas of extracellular deposition. CONCLUSIONS Given the known toxicities of eosinophil granule MBP and neutrophil elastase, their extracellular presence supports the contribution of these proteins in the pathogenesis of allergic fungal sinusitis and further indicates that eosinophil and neutrophil activation occurs in the disease.
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Affiliation(s)
- D A Khan
- Departments of Otorhinolaryngology, Medicine and Immunology, and Dermatology, Mayo Clinic and Mayo Foundation, Rochester. MN 55905, USA
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19
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Kuhn FA, Javer AR. Allergic fungal sinusitis: a four-year follow-up. AMERICAN JOURNAL OF RHINOLOGY 2000; 14:149-56. [PMID: 10887620 DOI: 10.2500/105065800782102780] [Citation(s) in RCA: 67] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Allergic fungal sinusitis (AFS), first described over 18 years ago and subsequently identified using established criteria, remains a challenge to treat. Our protocol has included complete functional endoscopic sinus surgery to remove the fungal load and restore physiologic mucous clearance. The patient is treated with prednisone for several months and followed monthly with total serum IgE levels and an established endoscopic mucosal staging system. A group of 11 patients first treated in 1994 and presented at the 1995 American Rhinology Society Spring meeting are being presented again to provide an update on their progress over the past four years. A great deal of experience has been gained from their treatment and has continued to modify our postoperative medical management. An overview of AFS, our evolving and current treatment protocol, and possible future trends are discussed in this paper.
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Affiliation(s)
- F A Kuhn
- Georgia Nasal and Sinus Institute, Savannah, USA
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Abstract
To introduce the general mycologic aspects of fungal rhinosinusitis, this article reviews, in brief, the biology of fungi and the principles of fungal pathogenesis. A glossary of frequently used mycologic terms is provided. The basis of fungal classification and strategies for the diagnosis of mycotic infections are summarized. The morphologic criteria for the identification of the common etiologic agents of rhinosinusitis are presented.
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Affiliation(s)
- T G Mitchell
- Department of Microbiology, Duke University Medical Center, Durham, North Carolina 27710, USA
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Kuhn FA, Javer AR. Allergic fungal rhinosinusitis: perioperative management, prevention of recurrence, and role of steroids and antifungal agents. Otolaryngol Clin North Am 2000; 33:419-33. [PMID: 10736415 DOI: 10.1016/s0030-6665(00)80016-x] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Allergic fungal sinusitis can best be thought of as chronic fungal affectation (not an infection) of the sinuses to which the body's immune system hyperreacts, thereby creating significant inflammation, edema, obstruction, and polyposis. Currently it is felt that allergic fungal sinusitis requires both surgical and medical management. The effectiveness and required duration of the various medical treatments remain unknown and are under active investigation. Both surgical intervention and the use of systemic steroids are recommended in the treatment of allergic fungal sinusitis. Experience with surgical and medical management, follow-up of patients, and proposed treatment protocols are discussed.
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Affiliation(s)
- F A Kuhn
- Georgia Nasal & Sinus Institute, Savannah, Georgia 31403-3357, USA
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22
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Abstract
PURPOSE To highlight allergic fungal sinusitis as a cause of ophthalmic and sinus problems by identifying the profile of the patient with allergic fungal sinusitis and presenting a successful treatment approach. METHODS Six consecutive cases of patients with ophthalmic manifestations of allergic fungal sinusitis were reviewed. Ophthalmic findings, sinus involvement, mycology, immune response, imaging studies, and treatment were examined. The characteristics of this patient group with ophthalmic manifestations of allergic fungal sinusitis were compared with those of the general group of patients with allergic fungal sinusitis. RESULTS All six patients had proptosis. One had symptomatic diplopia and one had visual loss. Imaging studies, fungal characterization, and immune profiles were similar to the reported allergic fungal sinusitis population. After treatment there was no recurrence of ophthalmic or sinus symptoms at a mean follow-up of 34 months (range, 8 to 48 months). There were no complications of treatment. CONCLUSIONS Initial diagnosis of allergic fungal sinusitis requires suspicion on the part of the ophthalmologist. Proptosis is the most common ophthalmic sign. Differentiation from invasive forms of fungal sinus disease is crucial, because systemic antifungal medication and extensive surgical tissue debridement are not required in allergic fungal sinusitis. Treatment consists of extirpation of the allergic mucin and fungus, sinus aeration, and systemic and topical corticosteroids.
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Affiliation(s)
- K D Carter
- Department of Ophthalmology and Visual Sciences, University of Iowa College of Medicine, University of Iowa Hospitals and Clinics, Iowa City, USA
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Berry JA, Davidson TM. Radiology of Unilateral Sinonasal Opacification. EAR, NOSE & THROAT JOURNAL 1999. [DOI: 10.1177/014556139907800108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Two recent cases managed at the University of California San Diego (UCSD) Nasal Dysfunction Clinic are described, with a review of the sinus computed tomography (CT) findings of six common unilateral sinonasal conditions. These include the homogeneous appearance and absence of bony destruction characteristic of unilateral benign polyposis, the focal hyperintensities of fungal sinusitis, the septal bowing seen in inverting papilloma, the involvement of the pterygopalatine fossa by an angiofibroma, the cribiform plate dehiscence associated with an encephalocele/meningocele and the extensive bony destruction characteristic of malignancy, such as epidermoid carcinoma. The clinical appearance and salient sinus CT features may suggest the diagnosis, thereby decreasing the morbidity from invasive tests, such as biopsy of an angiofibroma or an encephalocele, and improving quality resource management.
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Affiliation(s)
- Julie A. Berry
- Otolaryngology-Head and Neck Surgery Resident, University of Maryland, Baltimore, San Diego, California
| | - Terence M. Davidson
- Professor of Surgery and Associate Dean of Continuing Medical Education, Division of Otolaryngology-Head and Neck Surgery, University of California, San Diego, and VA San Diego Healthcare System, San Diego, California
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Spector SL, Bernstein IL, Li JT, Berger WE, Kaliner MA, Schuller DE, Blessing-Moore J, Dykewicz MS, Fineman S, Lee RE, Nicklas RA. Parameters for the diagnosis and management of sinusitis. J Allergy Clin Immunol 1998; 102:S107-44. [PMID: 9847450 DOI: 10.1016/s0091-6749(98)70045-4] [Citation(s) in RCA: 59] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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Abstract
Controversy continues over whether allergic fungal sinusitis represents a true allergy, an infection, or a point somewhere along a spectrum between allergy and infection. The present study describes two experiments that add weight to the argument that allergic fungal sinusitis (AFS) is truly an immunologically mediated hypersensitivity and not a form of infection. In the first experiment, eight patients with Bipolaris culture-positive AFS were prospectively evaluated with Bipolaris antigen skin testing and with inhibition radioallergosorbent (RAST) and enzyme-linked immunosorbent assay (ELISA) for Bipolaris-specific IgE and IgG antibodies. The Bipolaris AFS cases were compared with 10 control patients with no history of AFS. All eight AFS cases demonstrated positive skin testing to Bipolaris and in addition, all tested positive by RAST and ELISA for IgE and IgG Bipolaris antibodies, respectively. In the control group one patient had a positive skin test, ELISA, and RAST and one additional patient had a positive ELISA only. Good correlation was noted between skin test, RAST, and ELISA results. In the second experiment, sinus mucosa from 14 AFS patients and 10 control patients with other forms of surgical sinus disease was analyzed by immunohistocytochemistry for the eosinophilic inflammatory mediators major basic protein (MBP) and eosinophil derived neurotoxin (EDN) and the neutrophil mediator neutrophil elastase. All AFS cases demonstrated evidence of eosinophilic mediator release, and MBP and EDN predominated over neutrophil elastase. In the control group eosinophil and neutrophil mediator release in sinus mucosa was equal. The two experiments support the concept that AFS is an antigen-triggered, IgE- and IgG-mediated hypersensitivity response with a late-phase inflammatory reaction involving release of eosinophilic mediators.
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Affiliation(s)
- S C Manning
- University of Washington School of Medicine, Department of Otolaryngology, Seattle, USA
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Klapper SR, Lee AG, Patrinely JR, Stewart M, Alford EL. Orbital involvement in allergic fungal sinusitis. Ophthalmology 1997; 104:2094-100. [PMID: 9400770 DOI: 10.1016/s0161-6420(97)30054-2] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Although allergic fungal sinusitis is a relatively common, noninvasive form of paranasal sinus mycosis, and despite frequent orbital involvement, there have been few reports of this condition in the ophthalmic literature. METHODS Two cases of allergic fungal sinusitis having orbital symptoms are described. The current classification, typical presentation, and ideal management of fungal sinusitis are reviewed. RESULTS Distinguishing radiologic and pathologic features were present in both patients. Aspergillus flavus was cultured in one case, and Bipolaris spicifera was cultured in the other. CONCLUSIONS Allergic fungal sinusitis is a unique subset of sino-orbital disease with highly characteristic clinical, radiologic, and pathologic features. Unlike invasive forms of mycotic disease, allergic fungal sinusitis may be managed adequately with surgical debridement, aeration of the involved sinuses, and systemic and topical corticosteroids.
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Affiliation(s)
- S R Klapper
- Department of Ophthalmology, Cullen Eye Institute, Baylor College of Medicine, Houston, Texas 77030, USA
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Feger TA, Rupp NT, Kuhn FA, Ford JL, Dolen WK. Local and systemic eosinophil activation in allergic fungal sinusitis. Ann Allergy Asthma Immunol 1997; 79:221-5. [PMID: 9305227 DOI: 10.1016/s1081-1206(10)63005-0] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND In allergic fungal sinusitis diagnostic and monitoring criteria are not firmly established, and the role of eosinophils in pathogenesis is not clear. OBJECTIVE To determine whether assessment of eosinophil activation by measurement of eosinophil cationic protein in serum or allergic mucin would be useful in distinguishing patients with allergic fungal sinusitis from patients with chronic sinusitis of other etiologies. METHODS Thirteen patients referred for possible allergic fungal sinusitis were evaluated and given a definite allergic fungal sinusitis diagnosis if they met five of the following six criteria: (1) history and physical not suggesting another etiology, (2) sinus computed tomography consistent with allergic fungal sinusitis, (3) typical allergic mucin, (4) fungus isolated from allergic mucin, (5) presence of fungal-specific IgE, and (6) elevated total IgE. Eosinophil cationic protein, a marker of eosinophil activation, was measured in serum and allergic mucin. RESULTS Nine patients met criteria for allergic fungal sinusitis. All patients had nasal polyps and were atopic. Eight of the patients had allergic rhinitis and three had asthma. Mean total IgE at surgery was 1,385 IU/mL. A fungus was isolated from allergic mucin of eight patients. All patients demonstrated fungal-specific IgE. Mean allergic mucin eosinophil cationic protein levels obtained at surgery were significantly higher in patients with allergic fungal sinusitis than in four patients not meeting strict diagnostic criteria, and in 16 control patients having sinus surgery for other indications. There was no significant difference in serum eosinophil cationic protein levels between the three groups. Serial allergic mucin eosinophil cationic protein levels appeared to correspond with disease activity in some allergic fungal sinusitis patients. CONCLUSIONS Eosinophils in allergic mucin are activated. Measuring eosinophil cationic protein may be useful in diagnosis of allergic fungal sinusitis and in monitoring response to therapy.
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Affiliation(s)
- T A Feger
- Department of Pediatrics, Medical College of Georgia, Augusta, USA
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28
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Chen DM. Exophiala Jeanselmei Infection in a Patient with Two Primary Malignancies. J Cutan Med Surg 1997. [DOI: 10.1177/120347549700100412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: Dematiaceous fungi are emerging as an important pathogen, particularly in individuals on immunosuppressive medications. These fungi produce brown to black pigment and are responsible for a wide spectrum of diseases, including superficial infections of the skin and eye and, uncommonly, deep infections involving the central nervous system and internal organs. Objective: We present a male patient with localized, cutaneous Exophiala jeanselmei infection. Methods: We review the literature and present a brief discussion of phaeohyphomycotic infections, their clinical features, and their treatment modalities. Results: Workup of our patient revealed an underlying hepatic lymphoma and pulmonary squamous cell carcinoma. Conclusions: Phaeohyphomycotic infections, although uncommon, are increasingly recognized as important pathogens in patients who are immunologically compromised as a result of long-term steroid or other immunosuppressive therapy. Infections by these organisms in healthy-appearing individuals should prompt one to consider an immunodeficiency state and appropriate workup should be performed.
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Affiliation(s)
- Diana M. Chen
- Department of Dermatology, Medical College of Wisconsin, and Zablocki VA Medical Centre, Milwaukee, Wisconsin
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Perez-Jaffe LA, Lanza DC, Loevner LA, Kennedy DW, Montone KT. In situ hybridization for Aspergillus and Penicillium in allergic fungal sinusitis: a rapid means of speciating fungal pathogens in tissues. Laryngoscope 1997; 107:233-40. [PMID: 9023249 DOI: 10.1097/00005537-199702000-00017] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Allergic fungal sinusitis (AFS) is a serious form of sinonasal fungal disease that is commonly associated with Aspergillus or Dematiaceous fungi. This study was performed to determine the incidence of Aspergillus or Penicillium in AFS by using in situ hybridization (ISH) for Aspergillus and Penicillium ribosomal RNA (rRNA). The Fontana-Masson melanin stain (FMMS) was also used to detect pigmented fungi (A. niger and Dematiaceous fungi). ISH was performed on 26 patients: 17 AFS cases with histologic evidence of fungi, 5 AFS cases without histologic evidence of fungi, 3 cases of invasive fungal sinusitis (IFS), and 1 case of fungus ball. Nine AFS specimens with histologic evidence of fungi were ISH positive. Positivity was also noted in two of three IFS cases, while no staining was seen in the fungus ball and in six AFS specimens without fungi demonstrable by silver stains. Six ISH-positive cases were FMMS positive, suggesting A. niger. Five ISH-negative AFS specimens were FMMS positive, suggesting Dematiaceous fungi. In summary, many AFS patients in our institution demonstrate Aspergillus/Penicillium organisms. Ancillary techniques may help identify fungi responsible for AFS if cultures are negative or not performed. ISH for rRNA is a useful means for rapidly speciating fungi in human tissues.
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Affiliation(s)
- L A Perez-Jaffe
- Department of Pathology, University of Pennsylvania Medical Center, Philadelphia 19104, USA
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El-Zaatari MM, Pasarell L, McGinnis MR. Recurrent allergic fungal sinusitis sequentially caused by Exserohilum and Bipolaris. Ann Saudi Med 1996; 16:564-7. [PMID: 17429249 DOI: 10.5144/0256-4947.1996.564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- M M El-Zaatari
- University of Texas Medical Branch, Clinical Microbiology and Immunology Division, and Center for Tropical Diseases, Medical Mycology Research Center and Departments of Patholog, Galveston, USA
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Levin LA, Avery R, Shore JW, Woog JJ, Baker AS. The spectrum of orbital aspergillosis: a clinicopathological review. Surv Ophthalmol 1996; 41:142-54. [PMID: 8890440 DOI: 10.1016/s0039-6257(96)80004-x] [Citation(s) in RCA: 127] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Orbital aspergillosis is an uncommon but serious infection that may first present to the ophthalmologist. Usually arising from the paranasal sinuses, it may present in manifold ways within the orbit. Some presentations, such as optic nerve involvement, can respond to systemic corticosteroids, leading to delays in diagnosis and possibly iatrogenic potentiation of the infectious process. In this review, pertinent clinical and radiographic findings are discussed, and the literature is summarized. Classic approaches to therapy include local treatment, debridement, and systemic amphotericin B. We review novel approaches to treating orbital aspergillosis and detail a flow-chart for its management. Four patients from the spectrum of orbital aspergillosis are also described: initially presenting as an infection of an exenteration socket, a complex dacryocystitis, and optic nerve tumor, and post-operative periorbital swelling. Physicians should be familiar with the clinical spectrum of disease and the variable presentation of this infection, as early diagnosis and rapid institution of appropriate therapy are crucial elements in the management of invasive aspergillosis. In the neutropenic or otherwise immunocompromised patient, a high index of suspicion must be maintained as delays in diagnosis of fulminant aspergillosis may lead to overwhelming and rapidly progressive infection. Obtaining adequate diagnostic material for pathological and microbiological examination is critical. Newer methods of therapy, particularly itraconazole and liposomal amphotericin B, may be beneficial in selected patients.
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Affiliation(s)
- L A Levin
- Department of Ophthalmology, University of Wisconsin Medical School, Madison, USA
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Torres C, Ro JY, el-Naggar AK, Sim SJ, Weber RS, Ayala AG. Allergic fungal sinusitis: a clinicopathologic study of 16 cases. Hum Pathol 1996; 27:793-9. [PMID: 8760012 DOI: 10.1016/s0046-8177(96)90451-7] [Citation(s) in RCA: 78] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Allergic fungal sinusitis (AFS) has been clinicopathologically defined as a noninvasive form of fungal infection. Etiologically, most reported cases have been attributed to pigmented dematiaceous fungi. The authors report 16 cases of AFS from our institution, along with a review of cases from the literature. The patients' age ranged from 8 to 71 years, with a mean age of 25 years. All patients were immunocompetent, although six had a strong history of atopy. Multiple sinuses were affected in all cases; nine patients had bilateral involvement, and seven patients manifested unilateral involvement. Histopathologically, all cases were characterized by the presence of "allergic mucin," with scattered fungal organisms without invasion of mucosa or bone. Fontana-Masson stain identified fungi in all but one case and assisted in distinguishing the pigmented dematiaceous organisms from other septated fungal forms. Accordingly, Fontana-Masson stain can be useful in confirming the diagnosis of AFS in the lack of tissue culture results. Fungal cultures performed on six cases grew Exserohilum (three cases), Bipolaris (one case), Drechslera (Bipolaris) (one case), and Curvularia (one case). All patients were treated with surgical debridement and sinus aeration. Follow-up of at least 6 months was obtained in six cases, of which four showed recurrent disease between 8 months and 4 years after the initial surgical procedure. A literature review showed that the most common etiologic agents were members of the dematiaceous family (81%), with the most common genus being Bipolaris (42%), followed by Curvularia (21.3%). It is believed that type I and III hypersensitivity reactions underlie the pathogenesis of this disease.
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Affiliation(s)
- C Torres
- Department of Pathology, University of Texas, M.D. Anderson Cancer Center, Houston 77030, USA
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Kinsella JB, Rassekh CH, Bradfield JL, Chaljub G, McNees SW, Gourley WK, Calhoun KH. Allergic fungal sinusitis with cranial base erosion. Head Neck 1996; 18:211-7. [PMID: 8860760 DOI: 10.1002/(sici)1097-0347(199605/06)18:3<211::aid-hed1>3.0.co;2-2] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Allergic fungal sinusitis (AFS) usually follows a slow, nonaggressive course. However, massive bone destruction can occur, with extension of the disease process outside of the confines of the sinuses. METHODS Our series of 28 cases of AFS was reviewed. We identified 6 cases of AFS with definite radiographic evidence of skull base erosion. RESULTS Histologic diagnostic criteria for AFS were present in all 6 cases. All patients were managed with surgery, most recently conservative endoscopic surgery. An earlier patient underwent dural resection. Antibiotics were used in all patients, but no antifungal agents were administered. No patient has had a permanent neurologic complication, although one was seen with abducens palsy. There have been no cerebrospinal fluid (CSF) leaks. All 6 cases also had orbital bone erosion, but none has had permanent ophthalmologic sequelae. All patients were initially suspected to have a neoplastic disease. CONCLUSIONS We propose a new diagnostic entity, "skull base allergic fungal sinusitis" (SBAFS), which incorporates the histologic diagnostic criteria of AFS with the computed tomographic (CT) criteria of bone erosion. Biopsy is necessary to rule out invasive fungus or tumor. Otolaryngologists, ophthalmologists, and neurosurgeons should be familiar with SBAFS so that systemic antifungal agents, craniotomy, and dural resection-which might initially appear necessary-can be avoided. Endoscopic surgical debridement and drainage combined with topical steroids can lead to resolution of disease, even in the presence of marked bone erosion and cranial neuropathy.
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Affiliation(s)
- J B Kinsella
- Department of Otolaryngology, University of Texas Medical Branch, Galveston, USA
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Morpeth JF, Rupp NT, Dolen WK, Bent JP, Kuhn FA. Fungal sinusitis: an update. Ann Allergy Asthma Immunol 1996; 76:128-39; quiz 139-40. [PMID: 8595530 DOI: 10.1016/s1081-1206(10)63411-4] [Citation(s) in RCA: 96] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
OBJECTIVE To review the classification of fungal sinusitis as well as discuss current approaches to diagnosis and management. DATA SOURCES A MEDLINE literature search was performed using the index terms sinus infection, fungal, diagnosis, radiology, microbiology, and treatment. The search was restricted to the English language and human subjects. With one exception the references were restricted to the last 10 years. Clinical data from studies performed at our institution were also included. RESULTS Fungal sinusitis can be divided into four primary categories: (1) acute/fulminant (invasive), (2) chronic/indolent (invasive), (3) fungus ball, and (4) allergic fungal sinusitis. Each subtype has unique immunologic, pathologic, and clinical features. Allergic fungal sinusitis is the most recently described and most common form. The treatment and prognosis of fungal sinusitis varies significantly among the four different categories. CONCLUSION Recent advances in endoscopy and computed tomography have enhanced the understanding of fungal sinusitis; however, they remain diseases surrounded by controversy. New insights into the etiology and pathogenesis of these diseases along with advances in diagnosis and treatment will lead to improved medical therapy.
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Affiliation(s)
- J F Morpeth
- Division of Otolaryngology, Department of Surgery, Medical College of Georgia, Augusta, USA
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Cox GM, Schell WA, Scher RL, Perfect JR. First report of involvement of Nodulisporium species in human disease. J Clin Microbiol 1994; 32:2301-4. [PMID: 7814564 PMCID: PMC263989 DOI: 10.1128/jcm.32.9.2301-2304.1994] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Allergic fungal sinusitis is a common disease that results from a hypersensitivity reaction mounted by the host against fungi living in the paranasal sinuses. We have recently treated a patient with allergic fungal sinusitis due to a Nodulisporium species. This is the first description of a Nodulisporium species involved in human disease. The genus Nodulisporium contains both dematiaceous and nondematiaceous members. These fungi occur worldwide in nature, often as accompanying conidial anamorphs of certain wood decay ascomycetes. Clinical mycology laboratories may encounter this new agent of phaeohyphomycosis.
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Affiliation(s)
- G M Cox
- Department of Medicine, Duke Medical Center, Durham, North Carolina 27710
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Abstract
Fungal sinus disease is being reported with increasing frequency. We could find no previously reported cases of sinonasal infections with Malbranchea pulchella and only two previously reported cases of human infection of any kind. We now report on a case of suspected sinonasal Malbranchea pulchella in a patient with aspirin-sensitive triad asthma.
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Affiliation(s)
- T J Benda
- University of Chicago, Section of Otolaryngology, Head and Neck Surgery, IL
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WICKERN GREGORYM. Pediatric Allergic Fungal Sinusitis: Another "Great Masquerader". ACTA ACUST UNITED AC 1993. [DOI: 10.1089/pai.1993.7.147] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Goldstein MF, Dvorin DJ, Dunsky EH, Lesser RW, Heuman PJ, Loose JH. Allergic Rhizomucor sinusitis. J Allergy Clin Immunol 1992; 90:394-404. [PMID: 1527322 DOI: 10.1016/s0091-6749(05)80020-x] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- M F Goldstein
- Department of Medicine, Hahnemann University School of Medicine, Philadelphia, PA
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Goldstein MF. Allergic fungal sinusitis: an underdiagnosed problem. HOSPITAL PRACTICE (OFFICE ED.) 1992; 27:73-4, 79-84, 87-8 passim. [PMID: 1597500 DOI: 10.1080/21548331.1992.11705434] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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