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Huang F, Liu F, Zhen X, Gong S, Chen W, Song Z. Pathogenesis, Diagnosis, and Treatment of Infectious Rhinosinusitis. Microorganisms 2024; 12:1690. [PMID: 39203531 PMCID: PMC11357447 DOI: 10.3390/microorganisms12081690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2024] [Revised: 08/10/2024] [Accepted: 08/14/2024] [Indexed: 09/03/2024] Open
Abstract
Rhinosinusitis is a common inflammatory disease of the sinonasal mucosa and paranasal sinuses. The pathogenesis of rhinosinusitis involves a variety of factors, including genetics, nasal microbiota status, infection, and environmental influences. Pathogenic microorganisms, including viruses, bacteria, and fungi, have been proven to target the cilia and/or epithelial cells of ciliated airways, which results in the impairment of mucociliary clearance, leading to epithelial cell apoptosis and the loss of epithelial barrier integrity and immune dysregulation, thereby facilitating infection. However, the mechanisms employed by pathogenic microorganisms in rhinosinusitis remain unclear. Therefore, this review describes the types of common pathogenic microorganisms that cause rhinosinusitis, including human rhinovirus, respiratory syncytial virus, Staphylococcus aureus, Pseudomonas aeruginosa, Aspergillus species, etc. The damage of mucosal cilium clearance and epithelial barrier caused by surface proteins or secreted virulence factors are summarized in detail. In addition, the specific inflammatory response, mainly Type 1 immune responses (Th1) and Type 2 immune responses (Th2), induced by the entry of pathogens into the body is discussed. The conventional treatment of infectious sinusitis and emerging treatment methods including nanotechnology are also discussed in order to improve the current understanding of the types of microorganisms that cause rhinosinusitis and to help effectively select surgical and/or therapeutic interventions for precise and personalized treatment.
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Affiliation(s)
- Fujiao Huang
- School of Basic Medical Sciences, Southwest Medical University, Luzhou 646000, China
| | - Fangyan Liu
- School of Basic Medical Sciences, Southwest Medical University, Luzhou 646000, China
| | - Xiaofang Zhen
- School of Basic Medical Sciences, Southwest Medical University, Luzhou 646000, China
| | - Shu Gong
- The Public Platform of Cell Biotechnology, Public Center of Experimental Technology, Southwest Medical University, Luzhou 646000, China
| | - Wenbi Chen
- School of Basic Medical Sciences, Southwest Medical University, Luzhou 646000, China
| | - Zhangyong Song
- School of Basic Medical Sciences, Southwest Medical University, Luzhou 646000, China
- Molecular Biotechnology Platform, Public Center of Experimental Technology, Southwest Medical University, Luzhou 646000, China
- Hemodynamics and Medical Engineering Combination Key Laboratory of Luzhou, Luzhou 646000, China
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Babu AR, Amulya TM, Sandhya D, Premkumar BS, Chandresh S. Decoding the Complexity: A Case Series on Isolated Sphenoid Sinus Fungal Ball. Indian J Otolaryngol Head Neck Surg 2024; 76:3128-3132. [PMID: 39130272 PMCID: PMC11306443 DOI: 10.1007/s12070-024-04627-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Accepted: 03/08/2024] [Indexed: 08/13/2024] Open
Abstract
Fungal rhinosinusitis accounts for a significant portion of paranasal sinus diseases, with fungus ball being the most frequently observed form, constituting 27% of cases. While commonly affecting the maxillary sinus, sphenoid sinus localization occurred in 24.78% of cases. Managing fungal balls in the sphenoid sinus poses challenges because of their proximity to critical structures, necessitating a careful and effective approach. A retrospective analysis was conducted on patients diagnosed with a paranasal sinus fungal ball, specifically isolated sphenoidal localization. Trans-nasal sphenoidotomy was performed, and the patients were followed up postoperatively for recurrence or residual disease. Among four identified cases, headache was the predominant symptom, and all patients underwent successful endoscopic surgery without complications. The follow-up revealed no recurrence or residual disease. Fungal ball in the sphenoid sinus, although uncommon, present diagnostic challenges with symptoms that often mimic other conditions. CT scans play a crucial role in diagnosis and reveal dense masses with characteristic features. Surgical intervention, particularly endoscopic sphenoidotomy, remains the primary and successful treatment, emphasizing the importance of early detection. This study emphasizes the effectiveness of endoscopic sphenoidotomy for managing isolated sphenoid sinus fungal ball. This also highlights the importance of early detection and treatment to prevent complications. Headache, a primary symptom, was successfully resolved after surgery, reinforcing the role of surgery as the primary treatment.
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Affiliation(s)
- A. R. Babu
- Department of ENT, Head and Neck Surgery, JSS Medical College, JSS Academy of Higher Education and Research (JSSAHER), Mysuru, Karnataka 570004 India
| | - T. M. Amulya
- Department of ENT, Head and Neck Surgery, JSS Medical College, JSS Academy of Higher Education and Research (JSSAHER), Mysuru, Karnataka 570004 India
| | - D. Sandhya
- Department of ENT, Head and Neck Surgery, JSS Medical College, JSS Academy of Higher Education and Research (JSSAHER), Mysuru, Karnataka 570004 India
| | - B. S. Premkumar
- Department of ENT, Head and Neck Surgery, JSS Medical College, JSS Academy of Higher Education and Research (JSSAHER), Mysuru, Karnataka 570004 India
| | - Swathi Chandresh
- Department of ENT, Head and Neck Surgery, JSS Medical College, JSS Academy of Higher Education and Research (JSSAHER), Mysuru, Karnataka 570004 India
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Dohin I, Vinciguerra A, Sama A, Verillaud B, Herman P. Destructive non-invasive infection in isolated frontal sinus aspergilloma: Prevalence and proposition of a new pathogenetic model. Clin Otolaryngol 2024; 49:524-528. [PMID: 38705146 DOI: 10.1111/coa.14173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Revised: 04/03/2024] [Accepted: 04/20/2024] [Indexed: 05/07/2024]
Affiliation(s)
- Isabelle Dohin
- Unit of Otorhinolaryngology-Head and Neck Surgery, Department of Surgical and Medical Specialities, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | | | - Anshul Sama
- Department of Neurosurgery, Nottingham University Hospital NHS Trust, Nottingham, UK
| | - Benjamin Verillaud
- Otorhinolaryngology and Skull Base Center, AP-HP, Hospital Lariboisière, Paris, France
- Université Paris Cité, Paris, France
- Inserm U1141, Paris, France
| | - Philippe Herman
- Otorhinolaryngology and Skull Base Center, AP-HP, Hospital Lariboisière, Paris, France
- Université Paris Cité, Paris, France
- Inserm U1141, Paris, France
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Shao Y, Shen M, Peng D, Cheng W, Mao C, Zhang H, Sun Y. Observation of a Bone Invasion Model of Aspergillus fumigatus In Vitro and Analysis of the Antifungal Susceptibility. Mycopathologia 2024; 189:4. [PMID: 38231458 DOI: 10.1007/s11046-023-00817-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Accepted: 12/13/2023] [Indexed: 01/18/2024]
Abstract
BACKGROUND Recently, the prevalence of invasive fungal infections has been on the rise, and one of the prevalent symptoms frequently observed is bone deterioration and bone loss. MATERIALS AND METHODS Using an in vitro model we studied how Aspergillus fumigatus invades the bone. Pathological analysis was then employed to observe the structure and distinctive features of the invading fungal elements within the bone invasion model. Meanwhile, the antifungal effects of itraconazole, voriconazole, posaconazole, and amphotericin B were evaluated. RESULTS The pathological findings showed that in the experimental group, fungal spores and hyphae invaded the bone tissue or were observed growing in the vicinity of the bone edge tissues, as indicated by both HE and PAS staining. In contrast, no fungal elements were observed in the control group, indicating that the in vitro bone invasion model of A. fumigatus was successfully constructed. Furthermore, the findings from the antifungal sensitivity test demonstrated that the lowest effective concentrations of antifungal drugs against the bone invasion model were as follows: 4 μg/ml for itraconazole, 0.5 μg/ml for voriconazole, 2 μg/ml for posaconazole, and 2 μg/ml for amphotericin B. DISCUSSION The successful construction of the bone invasion model of A. fumigatus has provided a solid basis for future investigations into the mechanisms underlying A. fumigatus bone invasion and the study of its virulence factors. Utilizing bone models is of utmost importance in advancing the development of novel antifungal treatment approaches, as well as in effectively preventing and treating fungal bone invasion and osteolytic diseases.
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Affiliation(s)
- Yan Shao
- Department of Orthopedics, Jingzhou Hospital Affiliated to Yangtze University, Jingzhou, Hubei, China
| | - Min Shen
- Department of Otolaryngology Head and Neck Surgery, Jingzhou Hospital Affiliated to Yangtze University, Jingzhou, Hubei, China
| | - Dan Peng
- Department of Otolaryngology Head and Neck Surgery, Jingzhou Hospital Affiliated to Yangtze University, Jingzhou, Hubei, China
| | - Wenxu Cheng
- Department of Otolaryngology Head and Neck Surgery, Jingzhou Hospital Affiliated to Yangtze University, Jingzhou, Hubei, China
| | - Chenggang Mao
- Department of Otolaryngology Head and Neck Surgery, Jingzhou Hospital Affiliated to Yangtze University, Jingzhou, Hubei, China
| | - Heng Zhang
- Department of Dermatology, Jingzhou Hospital Affiliated to Yangtze University, Jingzhou, 434020, Hubei, China
| | - Yi Sun
- Department of Dermatology, Jingzhou Hospital Affiliated to Yangtze University, Jingzhou, 434020, Hubei, China.
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Van Ngo C, Nguyen H, Aklinski J, Nguyen DMT, Le HH, Le TTB, Nguyen HQ, Huynh HH, Hanh Nhi LH, Minh LHN. The Combined Middle and Inferior Antrostomy for Fungal Maxillary Sinusitis Treatment. Indian J Otolaryngol Head Neck Surg 2023; 75:2850-2855. [PMID: 37974720 PMCID: PMC10645746 DOI: 10.1007/s12070-023-03863-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Accepted: 05/04/2023] [Indexed: 11/19/2023] Open
Abstract
Aims: The objective of this study is to assess the effectiveness of the combined middle and inferior meatal antrostomy (MIMA) in management of patients with maxillary fungal sinusitis. Material and Methods: Design: retrospective cross sectional study. Setting and subjects: From September 2018 to March 2021, fifty-five patients with non-invasive maxillary fungal sinusitis, who underwent transnasal endoscopic combined MIMA. Methods: The study compared patients' pre- and post-operative subjective symptoms, including nasal obstruction, discharge, facial pain or pressure, halitosis, anosmia, and other non-specific symptoms. Endoscopic characteristics of recurrent fungal maxillary sinusitis and postoperative complications were also observed. Closure of the IMA site was evaluated at three and six months post-surgery and patients were categorized into three groups based on closure degree. Results: All clinical symptoms, including nasal discharge, nasal obstruction, nasal pruritus, anosmia, halitosis, sneezing, facial pain, ophthalmic and otologic symptoms, were resolved over six months after combined MIMA in majority of cases (94 - 100%). After three and six months, the postoperative endoscopic evaluation revealed recurrent fungal maxillary sinusitis in 1.8% and 5.4% of cases, respectively. Partial stenosis of the inferior antrostomy was observed in 7.2% and 16% of cases, while complete stenosis was noted in 3.6% and 7.2% of cases after three months and six months. Conclusions: The combined MIMA is effective and has better outcomes than the medial meatal antrostomy approach alone without additional operative time. Supplementary Information The online version contains supplementary material available at 10.1007/s12070-023-03863-6.
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Affiliation(s)
- Cong Van Ngo
- Department of Otolaryngology-Head and Neck Surgery, Cho Ray Hospital, Ho Chi Minh City, 700000 Vietnam
| | - Hoang Nguyen
- Department of Foundation Science, Nova Southeastern University, The Kiran C. Patel College of Osteopathic Medicine (NSU-KPCOM), Clearwater, FL 33025 USA
- Department of Preventative Medicine, School of Medicine, University of California at Los Angeles/Charles R. Drew (UCLA), Los Angeles, CA USA
| | - Joseph Aklinski
- Department of Foundation Science, Nova Southeastern University, The Kiran C. Patel College of Osteopathic Medicine (NSU-KPCOM), Clearwater, FL 33025 USA
| | - Dung My Thi Nguyen
- Faculty of Otolaryngology, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, 700000 Vietnam
| | - Hoang Huy Le
- Faculty of Otolaryngology, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, 700000 Vietnam
| | - Trang Thi Bich Le
- Cardiovascular Research Department, Methodist Hospital, Merrillville, IN 46410 USA
| | - Hien Quang Nguyen
- Cardiovascular Research Department, Methodist Hospital, Merrillville, IN 46410 USA
| | - Hong-Han Huynh
- School of Biotechnology, Tan Tao University, Long An, Vietnam
- Interdisciplinary and Translational Medicine Internship Training Program, College of Medical Science and Technology, Taipei Medical University, Taipei, 110 Taiwan
- International Master Program for Translational Science, College of Medical Science and Technology, Taipei Medical University, Taipei, 110 Taiwan
| | - Le Huu Hanh Nhi
- Cardiovascular Research Department, Methodist Hospital, Merrillville, IN 46410 USA
- Faculty of Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, 700000 Vietnam
| | - Le Huu Nhat Minh
- International Ph.D. Program in Medicine, College of Medicine, Taipei Medical University, Taipei, 110 Taiwan
- Research Center for Artificial Intelligence in Medicine, Taipei Medical University, Taipei, 106 Taiwan
- Emergency Department, University Medical Center, Ho Chi Minh City, Vietnam
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Ku CH, Lee HN, Park SM, Lee HS, Lee JW, Hong SH, Park DJ, Lee EJ. Clinical features of chronic fungal rhinosinusitis in Korean geriatric and non-geriatric patients. Eur Arch Otorhinolaryngol 2023; 280:4969-4977. [PMID: 37389593 DOI: 10.1007/s00405-023-08089-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2022] [Accepted: 06/20/2023] [Indexed: 07/01/2023]
Abstract
PURPOSE Worldwide, the incidence of chronic fungal rhinosinusitis (CFRS) has increased. Although ageing leads to weakening of the immune system, which increases susceptibility to CFRS, the CFRS characteristics in geriatric patients are unclear. Therefore, we comparatively analysed the clinical characteristics of CFRS in geriatric and non-geriatric patients. METHODS This retrospective analysis compared the demographics, rhinologic symptoms, multiple allergen simultaneous tests, olfactory function tests, paranasal sinus computed tomography findings, and outcomes of 131 patients with CFRS who underwent functional endoscopic sinus surgery and 131 enrolled patients were divided in geriatric (> 65 years) and non-geriatric (≤ 65 years) groups. RESULTS Among the geriatric and non-geriatric participants (n = 65, 49.6% and n = 66, 50.4%, respectively), hypertension and diabetes mellitus were more common in the geriatric group. Demographics, including symptoms, showed no significant intergroup differences. Normosmia and hyposmia were significantly less prevalent, whereas phantosmia and parosmia were more prevalent in the geriatric group than in the non-geriatric group (p = 0.03 and p = 0.01, respectively). Sphenoidal sinus involvement was significantly higher in geriatric patients than in non-geriatric patients (p = 0.02). CONCLUSION Based on greater sphenoidal sinus involvement, a deeper anatomical area is more vulnerable to fungal infection in the geriatric group than in the non-geriatric group. Increasing clinicians' awareness of CFRS in geriatric patients with olfactory dysfunction, including phantosmia and parosmia, is important for early intervention.
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Affiliation(s)
- Cheol Hyo Ku
- Department of Otorhinolaryngology, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, 20 Ilsan-Ro, Wonju, Gangwon-Do, Republic of Korea
| | - Ha Neul Lee
- Department of Otorhinolaryngology, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, 20 Ilsan-Ro, Wonju, Gangwon-Do, Republic of Korea
| | - Sang Man Park
- Department of Otorhinolaryngology, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, 20 Ilsan-Ro, Wonju, Gangwon-Do, Republic of Korea
| | - Hyun Su Lee
- Department of Otorhinolaryngology, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, 20 Ilsan-Ro, Wonju, Gangwon-Do, Republic of Korea
| | - Jae Woo Lee
- Department of Otorhinolaryngology, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, 20 Ilsan-Ro, Wonju, Gangwon-Do, Republic of Korea
| | - Se Hwa Hong
- Department of Biostatistics, Yonsei University Wonju College of Medicine, Wonju, South Korea
| | - Dong-Joon Park
- Department of Otorhinolaryngology, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, 20 Ilsan-Ro, Wonju, Gangwon-Do, Republic of Korea
| | - Eun Jung Lee
- Department of Otorhinolaryngology, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, 20 Ilsan-Ro, Wonju, Gangwon-Do, Republic of Korea.
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Kim K, Lim CY, Shin J, Chung MJ, Jung YG. Enhanced artificial intelligence-based diagnosis using CBCT with internal denoising: Clinical validation for discrimination of fungal ball, sinusitis, and normal cases in the maxillary sinus. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2023; 240:107708. [PMID: 37473588 DOI: 10.1016/j.cmpb.2023.107708] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 07/03/2023] [Accepted: 07/04/2023] [Indexed: 07/22/2023]
Abstract
BACKGROUND AND OBJECTIVE The cone-beam computed tomography (CBCT) provides three-dimensional volumetric imaging of a target with low radiation dose and cost compared with conventional computed tomography, and it is widely used in the detection of paranasal sinus disease. However, it lacks the sensitivity to detect soft tissue lesions owing to reconstruction constraints. Consequently, only physicians with expertise in CBCT reading can distinguish between inherent artifacts or noise and diseases, restricting the use of this imaging modality. The development of artificial intelligence (AI)-based computer-aided diagnosis methods for CBCT to overcome the shortage of experienced physicians has attracted substantial attention. However, advanced AI-based diagnosis addressing intrinsic noise in CBCT has not been devised, discouraging the practical use of AI solutions for CBCT. We introduce the development of AI-based computer-aided diagnosis for CBCT considering the intrinsic imaging noise and evaluate its efficacy and implications. METHODS We propose an AI-based computer-aided diagnosis method using CBCT with a denoising module. This module is implemented before diagnosis to reconstruct the internal ground-truth full-dose scan corresponding to an input CBCT image and thereby improve the diagnostic performance. The proposed method is model agnostic and compatible with various existing and future AI-based denoising or diagnosis models. RESULTS The external validation results for the unified diagnosis of sinus fungal ball, chronic rhinosinusitis, and normal cases show that the proposed method improves the micro-, macro-average area under the curve, and accuracy by 7.4, 5.6, and 9.6% (from 86.2, 87.0, and 73.4 to 93.6, 92.6, and 83.0%), respectively, compared with a baseline while improving human diagnosis accuracy by 11% (from 71.7 to 83.0%), demonstrating technical differentiation and clinical effectiveness. In addition, the physician's ability to evaluate the AI-derived diagnosis results may be enhanced compared with existing solutions. CONCLUSION This pioneering study on AI-based diagnosis using CBCT indicates that denoising can improve diagnostic performance and reader interpretability in images from the sinonasal area, thereby providing a new approach and direction to radiographic image reconstruction regarding the development of AI-based diagnostic solutions. Furthermore, we believe that the performance enhancement will expedite the adoption of automated diagnostic solutions using CBCT, especially in locations with a shortage of skilled clinicians and limited access to high-dose scanning.
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Affiliation(s)
- Kyungsu Kim
- Medical AI Research Center, Research Institute for Future Medicine, Samsung Medical Center, Seoul, Republic of Korea; Department of Data Convergence and Future Medicine, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea; Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Chae Yeon Lim
- Department of Medical Device Management and Research, SAIHST, Sungkyunkwan University, Seoul, Republic of Korea
| | - Joongbo Shin
- Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Myung Jin Chung
- Medical AI Research Center, Research Institute for Future Medicine, Samsung Medical Center, Seoul, Republic of Korea; Department of Data Convergence and Future Medicine, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea; Department of Medical Device Management and Research, SAIHST, Sungkyunkwan University, Seoul, Republic of Korea; Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Yong Gi Jung
- Medical AI Research Center, Research Institute for Future Medicine, Samsung Medical Center, Seoul, Republic of Korea; Department of Data Convergence and Future Medicine, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea; Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
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Lara-Olivas JA, Sangrador-Deitos MV, Marian-Magaña R, Padilla-Leal KE, Soto-Hernández JL, Gomez-Amador JL. Endoscopic endonasal resection of a Drechslera hawaiiensis sphenoid fungal ball. Surg Neurol Int 2023; 14:321. [PMID: 37810321 PMCID: PMC10559376 DOI: 10.25259/sni_469_2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Accepted: 08/22/2023] [Indexed: 10/10/2023] Open
Abstract
Background Fungal infections should always be considered in difficult-to-treat paranasal sinus conditions. Sphenoid fungal balls are characterized by the presence of dense fungal masses in the sinus cavity without invasion of surrounding tissues. This case emphasizes the importance of accurate terminology and management and also highlights the involvement of rare pathogens such as Drechslera hawaiiensis. Diagnosis is typically based on imaging studies and intraoperative findings. Accurate identification of the pathogen is crucial. Fungal infections of the paranasal sinuses, including fungus balls, can present challenges in diagnosis and treatment. D. hawaiiensis, although infrequent, can cause potential life-threatening infections. Case Description We present a 26-year-old non-HIV male patient who presented with nasal symptoms and mild headaches. The patient underwent an endoscopic exploration that revealed a soft, grayish lesion with a buttery consistency. Gross total resection was achieved and the lesion was identified as being caused by D. hawaiiensis; thus, intravenous antifungal treatment was given. Conclusion Endoscopic surgery remains the preferred approach for disease control. Considering alternative treatments and exploring novel approaches are essential in managing complex pathologies in neurosurgical practice.
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Affiliation(s)
| | | | - Ricardo Marian-Magaña
- Department of Neurosurgery, National Institute of Neurology and Neurosurgery, Mexico City, Mexico
| | | | - José L. Soto-Hernández
- Department of Neuroinfectology, National Institute of Neurology and Neurosurgery, Mexico City, Mexico
| | - Juan L. Gomez-Amador
- Department of Neurosurgery, National Institute of Neurology and Neurosurgery, Mexico City, Mexico
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Litzistorf Y, Gorostidi F, Lambercy K, Reinhard A. Utility of flexible interventional endoscopy in endoscopic sinus surgery: a case series. Eur Arch Otorhinolaryngol 2023; 280:1231-1239. [PMID: 36136149 PMCID: PMC9899715 DOI: 10.1007/s00405-022-07655-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 09/12/2022] [Indexed: 02/07/2023]
Abstract
PURPOSE During endoscopic sinus surgery (ESS), difficult-to-reach pathologies need an extended endoscopic approach or an external approach. We started to use a flexible interventional endoscope (FIE) to evaluate the necessity of those approaches. The study's objective is to describe our experience and define patients who could benefit from this technique. METHODS We reviewed every patient who benefited from FIE associated with ESS at our tertiary University Hospital between January 2021 and February 2022. RESULTS During this period, we did 107 ESS, and 14 patients benefited from the FIE, representing 13% of our ESS. The median duration of the flexible endoscopy time was 14 min (4-38 min). We identified three groups of patients who can benefit from the FIE. The first one is for patients with a fungal infection, to control and to clean lateral recesses in a noninvasive manner. The second one is for patients with a pathology of the lateral frontal sinus, to remove the frontoethmoidal cells or mucocele with the biopsy forceps through the working channel. The third group is for patients with inverted papillomas, to precisely identify the insertion and to decide on the most appropriate surgical approach. CONCLUSIONS In selected cases, using flexible endoscopy during ESS helps decide the optimal surgical approach and sometimes treat the pathology through a limited approach. Prospective studies for each group of patients are needed to confirm the benefit of this new combined procedure.
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Affiliation(s)
- Yann Litzistorf
- Departement of Otorhinolaryngology Head and Neck Surgery, Centre Hospitalier Universitaire Vaudois (CHUV), University of Lausanne (UNIL), Lausanne, Switzerland
| | - François Gorostidi
- Departement of Otorhinolaryngology Head and Neck Surgery, Centre Hospitalier Universitaire Vaudois (CHUV), University of Lausanne (UNIL), Lausanne, Switzerland
| | - Karma Lambercy
- Departement of Otorhinolaryngology Head and Neck Surgery, Centre Hospitalier Universitaire Vaudois (CHUV), University of Lausanne (UNIL), Lausanne, Switzerland
| | - Antoine Reinhard
- Departement of Otorhinolaryngology Head and Neck Surgery, Centre Hospitalier Universitaire Vaudois (CHUV), University of Lausanne (UNIL), Lausanne, Switzerland.
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Biomimetic Nanopillar Silicon Surfaces Rupture Fungal Spores. Int J Mol Sci 2023; 24:ijms24021298. [PMID: 36674814 PMCID: PMC9864238 DOI: 10.3390/ijms24021298] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 12/17/2022] [Accepted: 12/28/2022] [Indexed: 01/11/2023] Open
Abstract
The mechano-bactericidal action of nanostructured surfaces is well-documented; however, synthetic nanostructured surfaces have not yet been explored for their antifungal properties toward filamentous fungal species. In this study, we developed a biomimetic nanostructured surface inspired by dragonfly wings. A high-aspect-ratio nanopillar topography was created on silicon (nano-Si) surfaces using inductively coupled plasma reactive ion etching (ICP RIE). To mimic the superhydrophobic nature of insect wings, the nano-Si was further functionalised with trichloro(1H,1H,2H,2H-perfluorooctyl)silane (PFTS). The viability of Aspergillus brasiliensis spores, in contact with either hydrophobic or hydrophilic nano-Si surfaces, was determined using a combination of standard microbiological assays, confocal laser scanning microscopy (CLSM), and focused ion beam scanning electron microscopy (FIB-SEM). Results indicated the breakdown of the fungal spore membrane upon contact with the hydrophilic nano-Si surfaces. By contrast, hydrophobised nano-Si surfaces prevented the initial attachment of the fungal conidia. Hydrophilic nano-Si surfaces exhibited both antifungal and fungicidal properties toward attached A. brasisiensis spores via a 4-fold reduction of attached spores and approximately 9-fold reduction of viable conidia from initial solution after 24 h compared to their planar Si counterparts. Thus, we reveal, for the first time, the physical rupturing of attaching fungal spores by biomimetic hydrophilic nanostructured surfaces.
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Kikuta S, Han B, Yoshihara S, Nishijima H, Kondo K, Yamasoba T. High CT Attenuation Values Relative to the Brainstem Predict Fungal Hyphae Within the Sinus. Front Surg 2022; 9:876340. [PMID: 35784936 PMCID: PMC9243468 DOI: 10.3389/fsurg.2022.876340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 05/30/2022] [Indexed: 11/25/2022] Open
Abstract
Objectives There is currently no established objective diagnostic indicator for the differentiation of sinus fungal ball (SFB) from unilateral nonfungal chronic sinusitis (UCRS). This study evaluated whether computed tomography (CT) attenuation values relative to those of the brainstem (relative CT number) are useful for differentiating SFB from UCRS. Materials and Methods Consecutive patients who were pathologically diagnosed with SFB or UCRS between 2013 and 2021 were retrospectively identified. The relative CT numbers of region of interest (ROIs) within the sinuses were compared between the two patient groups. Factors with predictive power for differentiating SFBs from UCRSs were identified by uni/multivariable logistic regression analyses. Results One hundred and eighty-three patients with unilateral chronic sinusitis were finally analyzed (SFB, 86 cases; UCRS, 97 cases). Regardless of the presence or absence of calcified lesions, the relative CT numbers in SFB were significantly higher than those in UCRS. ROIs showing high relative CT numbers were those where fungal hyphae were present. In the uni/multivariable logistic regression analysis, age (p < 0.001), relative CT number (p < 0.001), and calcification (p = 0.002) had predictive value for distinguishing SFB from UCRS. Within those cases not showing calcification, age (p = 0.004) and relative CT number (p < 0.001) were predictive factors for differentiating SFB from UCRS. A relative CT number >1.5 was significantly associated with SFB (sensitivity, 70%; specificity, 91%), with a significantly larger area under the receiver operating characteristics curve than age. Conclusions High relative CT numbers within the sinus are strongly associated with the presence of fungal hyphae, and measurement of relative CT number is a powerful adjunctive diagnostic method for distinguishing between SFB and UCRS.
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Tran LV, Nguyen HT, Psaltis A, Senior B. Trans-superior meatal surgery: A targeted approach for isolated posterior ethmoid diseases. Am J Otolaryngol 2022; 43:103425. [PMID: 35339774 DOI: 10.1016/j.amjoto.2022.103425] [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: 02/08/2022] [Accepted: 03/18/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND Surgical treatment for posterior ethmoid diseases has historically been performed through a trans-ethmoid approach which usually required medialization of the middle turbinate, a middle meatal antrostomy and total ethmoidectomy. This can destabilize the basal lamella of the middle turbinate and also sacrifices the integrity of ostiomeatal complex and the healthy bulla if the patient has the disease only in the posterior ethmoid sinus. The aim of this study is to present of a novel minimally disruptive approach for the management of isolated posterior ethmoid diseases. METHODS Retrospective case series analysis. RESULTS 19 patients with isolated posterior ethmoid fungal balls were operated on via a trans-superior meatal approach. The most common signs and symptoms were headache (78.9%), and purulent/mucoid discharge from the superior meatus (89.5%). The technique is described in detail with the preservation of the ostiomeatal complex and bulla ethmoidalis. Complete removal of the disease was achieved in all cases through this access, with no intra-operative complications. The posterior ethmoid cavity remained patent postoperatively in all patients. No recurrence was noted during the follow-up period which ranged from 6 to 12 months. CONCLUSION This is a minimally invasive approach, which is safe and effective for the surgical management of isolated posterior ethmoid diseases.
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Affiliation(s)
- Luan Viet Tran
- Department of Otolaryngology Head and Neck Surgery, Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Viet Nam; Department of Rhinology, Ear Nose Throat Hospital of Ho Chi Minh City, Ho Chi Minh City, Viet Nam.
| | - Hai Thanh Nguyen
- Department of Rhinology, Ear Nose Throat Hospital of Ho Chi Minh City, Ho Chi Minh City, Viet Nam
| | - Alkis Psaltis
- Department of Otolaryngology Head and Neck Surgery, University of Adelaide, Adelaide, Australia
| | - Brent Senior
- Department of Otolaryngology Head and Neck Surgery, University of North Carolina at Chapel Hill, NC, United States
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13
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The Endonasal Endoscopic Approach to Different Sinonasal Fungal Balls. Int J Otolaryngol 2022; 2022:6721896. [PMID: 35360416 PMCID: PMC8964197 DOI: 10.1155/2022/6721896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Accepted: 02/25/2022] [Indexed: 11/18/2022] Open
Abstract
Background. Fungal ball sinusitis is a sinonasal fungus ball that usually affects immunocompetent adults with female predominance. The most affected sinus is the maxillary sinus. Aspergillus species is the most typically found fungus. Computed tomography (CT) scan is the gold standard tool in order to diagnose fungal ball sinusitis. The ultimate method for a fungal ball is functional endoscopic sinus surgery (FESS), which has a high success rate and a low morbidity rate. Objective. This study aims to demonstrate the various clinical presentations of fungal ball sinusitis including isolated maxillary sinus, sphenoid sinus, simultaneous occurrence of maxillary and sphenoid fungal ball, and post endonasal endoscopic pituitary surgery fungal ball with various age groups. Also, this study aims to emphasize the importance of early diagnosis and treatment in such cases. Patients and Methods. A retrospective study that was carried in the otorhinolaryngology department of two hospitals: King Fahad Specialist Hospital and Qatif Central Hospital, Eastern Region, Saudi Arabia. The study was conducted on a total of 16 patients who were diagnosed with paranasal sinuses fungal ball in an 11-year period from January 2008 and November 2019. Results. Out of 16 patients with paranasal sinuses fungal ball, 11 cases were female and 5 males, with age ranging between 16 and 46 years. Results showed eight isolated sphenoid (50%), six isolated maxillary fungal ball (38%), one simultaneous occurrence of the sphenoid and maxillary fungal ball (6%), and one post endonasal endoscopic pituitary surgery for pituitary adenoma (6%). CT scan was performed for all 16 cases which is the standard tool for the diagnosis of the fungal ball. Conclusion. Fungal ball may present with variety of symptoms but most commonly with postnasal discharge (PND), headache, and facial pain. CT sinuses is the diagnostic radiological modality to confirm the diagnosis. The FESS functional endoscopic sinus surgery is the gold safe approach for patients with fungal ball to manage their symptoms, confirm the diagnosis, and removal of disease with no morbidities.
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Wu PW, Lee TJ, Yang SW, Huang Y, Lee YS, Ho CF, Huang CC. Differences in clinical and imaging presentation of maxillary sinus fungus ball with and without intralesional hyperdensity. Sci Rep 2021; 11:23945. [PMID: 34907314 PMCID: PMC8671531 DOI: 10.1038/s41598-021-03507-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 12/01/2021] [Indexed: 11/09/2022] Open
Abstract
Maxillary sinus fungal balls (MSFBs) mostly occur in older individuals and demonstrate female predominance. Early diagnosis is important to avoid treatment delays. Intralesional hyperdensity (IH) indicates the presence of heavy metal deposition within fungal hyphae and has been the most specific characteristic of MSFB on computed tomography (CT). For those without IH on CT, the diagnosis of MSFB remains challenging. This study aimed to characterize clinical presentation of MSFB with and without IH and to study factors contributing to MSFB with no IH formation. We retrospectively identified 588 patients with MSFB. The clinical characteristics and CT findings were reviewed. Patients with unilateral MSFB had a mean age of 57.4 years and demonstrated female predominance (64.63%). The female-to-male ratio was highest at 51–60 years (2.02) and rose to 2.60 in MSFB with IH only. Compared to those with IH, MSFB without IH was significantly more common in males (OR = 2.49), in those with diabetes mellitus (DM) (OR = 1.87), adjacent maxillary odontogenic pathology (OR = 1.75). Complete opacification on CT was less common in MSFB without IH (OR = 0.60). Patients with MSFB without IH were more likely to have DM, no female predominance, adjacent maxillary odontogenic pathology, and partial opacification of the sinus, compared to those with IH. These may be helpful in better understanding of the formation of MSFBs without IH, early identification of them and prevention of post-operative recurrence.
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Affiliation(s)
- Pei-Wen Wu
- Division of Rhinology, Department of Otolaryngology, Chang Gung Memorial Hospital and Chang Gung University, No. 5, Fu-Shin Street, Kweishan, Taoyuan, 333, Taiwan, ROC.,Department of Otolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital and Chang Gung University, Keelung, Taiwan, ROC
| | - Ta-Jen Lee
- Division of Rhinology, Department of Otolaryngology, Chang Gung Memorial Hospital and Chang Gung University, No. 5, Fu-Shin Street, Kweishan, Taoyuan, 333, Taiwan, ROC.,School of Medicine, Chang Gung University, Taoyuan, Taiwan, ROC.,Xiamen Chang Gung Hospital, Xiamen, People's Republic of China
| | - Shih-Wei Yang
- Department of Otolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital and Chang Gung University, Keelung, Taiwan, ROC.,School of Medicine, Chang Gung University, Taoyuan, Taiwan, ROC.,Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan, ROC
| | - Yenlin Huang
- Department of Anatomic Pathology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan, ROC
| | - Yun-Shien Lee
- Department of Biotechnology, Ming Chuan University, Taoyuan, Taiwan, ROC.,Genomic Medicine Research Core Laboratory, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan, ROC
| | - Che-Fang Ho
- Department of Otolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital and Chang Gung University, Keelung, Taiwan, ROC
| | - Chien-Chia Huang
- Division of Rhinology, Department of Otolaryngology, Chang Gung Memorial Hospital and Chang Gung University, No. 5, Fu-Shin Street, Kweishan, Taoyuan, 333, Taiwan, ROC. .,School of Medicine, Chang Gung University, Taoyuan, Taiwan, ROC. .,Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan, ROC.
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15
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Fadda GL, Martino F, Andreani G, Succo G, Catalani M, Di Girolamo S, Cavallo G. Definition and management of invasive fungal rhinosinusitis: a single-centre retrospective study. ACTA ACUST UNITED AC 2021; 41:43-50. [PMID: 33746222 PMCID: PMC7982758 DOI: 10.14639/0392-100x-n0848] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 09/14/2020] [Indexed: 12/18/2022]
Abstract
Objectives The purpose of this study was to correlate acute invasive fungal rhinosinusitis (AIFRS) and chronic invasive fungal rhinosinusitis with underlying diseases, aetiological microorganisms, clinical symptoms, radiological findings, and surgical and medical treatment to determine the subset of patients who require more accurate diagnostic investigation and to prevent irreversible complications. Methods This retrospective monocentric study included 17 patients who underwent endoscopic sinus surgery evaluated by paranasal computed tomography and magnetic resonance imaging. Age, sex and symptoms, and location of the invasive fungal infection and the causative fungus were analysed. Results In total, 4 patients were affected by the AIFRS form, and 13 by the chronic form. Diabetes mellitus was reported in 41.17% of cases, and haematological diseases in 23.52%. The maxillary sinuses were involved in 47.05% of cases and sphenoidal sinuses in 52.94%; Aspergillus fumigatus was the fungus in 76.47% of cases, and Zygomycetes in 23.53%. Conclusions An understanding of the different types of fungal sinusitis and knowledge of their features play a crucial role in reaching prompt diagnosis and initiation of appropriate therapy, which is essential to avoid a protracted or fatal outcome.
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Affiliation(s)
- Gian Luca Fadda
- Department of Otolaryngology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
| | - Federica Martino
- Department of Otolaryngology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy.,Otorhinolaryngology Unit, Department of Clinical Sciences and Translational Medicine, Tor Vergata University, Rome, Italy
| | - Giacomo Andreani
- Department of Clinical and Biological Sciences, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
| | - Giovanni Succo
- FPO IRCCS, Head & Neck Oncology Unit, Candiolo Cancer Institute, Turin, Italy.,Oncology Dept. University of Turin, Italy; 6 Department of Otolaryngology, Humanitas Cellini, Turin, Italy
| | - Maurizio Catalani
- Oncology Dept. University of Turin, Italy; 6 Department of Otolaryngology, Humanitas Cellini, Turin, Italy
| | - Stefano Di Girolamo
- Otorhinolaryngology Unit, Department of Clinical Sciences and Translational Medicine, Tor Vergata University, Rome, Italy
| | - Giovanni Cavallo
- Department of Otolaryngology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
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Answer to August 2021 Photo Quiz. J Clin Microbiol 2021; 59:e0277020. [PMID: 34279117 DOI: 10.1128/jcm.02770-20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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17
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Dellière S, Dannaoui E, Fieux M, Bonfils P, Gricourt G, Demontant V, Podglajen I, Woerther PL, Angebault C, Botterel F. Analysis of Microbiota and Mycobiota in Fungal Ball Rhinosinusitis: Specific Interaction between Aspergillus fumigatus and Haemophilus influenza? J Fungi (Basel) 2021; 7:550. [PMID: 34356929 PMCID: PMC8305266 DOI: 10.3390/jof7070550] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 07/02/2021] [Accepted: 07/06/2021] [Indexed: 12/22/2022] Open
Abstract
Fungal ball (FB) rhinosinusitis (RS) is the main type of non-invasive fungal RS. Despite positive direct examination (DE) of biopsies, culture remains negative in more than 60% of cases. The aim of the study was to evaluate the performance/efficacy of targeted metagenomics (TM) to analyze microbiota and mycobiota in FB and find microbial associations. Forty-five sinus biopsies from patients who underwent surgery for chronic RS were included. After DE and culture, DNA was extracted, then fungal ITS1-ITS2 and bacterial V3-V4 16S rDNA loci were sequenced (MiSeqTM Illumina). Operational taxonomic units (OTUs) were defined via QIIME and assigned to SILVA (16S) and UNITE (ITS) databases. Statistical analyses were performed using SHAMAN. Thirty-eight patients had FB and seven had non-fungal rhinosinusitis (NFRS). DE and culture of FB were positive for fungi in 97.3 and 31.6% of patients, respectively. TM analysis of the 38 FB yielded more than one fungal genus in 100% of cases, with Aspergillus in 89.5% (34/38). Haemophilus was over-represented in FB with >1000 reads/sample in 47.3% (18/38) compared to NFRS (p < 0.001). TM allowed fungal identification in biopsies with negative culture. Haemophilus was associated with FB. Pathogenesis could result from fungi-bacteria interactions in a mixed biofilm-like structure.
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Affiliation(s)
- Sarah Dellière
- Unité de Parasitologie-Mycologie, Département de Prévention, Diagnostic et Traitement des Infections, APHP, GHU Hôpitaux Universitaires Henri-Mondor, 94010 Créteil, France; (S.D.); (C.A.)
- Unité de Parasitologie-Mycologie, Hôpital Saint-Louis, Assistance Publique des Hôpitaux de Paris, Université de Paris, 75010 Paris, France
| | - Eric Dannaoui
- UR DYNAMiC 7380, Faculté de Santé, Université Paris-Est Créteil, 94010 Créteil, France; (E.D.); (P.-L.W.)
- UR DYNAMiC 7380, Ecole Nationale Vétérinaire d’Alfort, USC Anses, 94700 Maison-Alfort, France
- Unité de Parasitologie-Mycologie, Département de Microbiologie, Hôpital Européen George Pompidou, APHP, Université de Paris, 75015 Paris, France
| | - Maxime Fieux
- Département d’Otorhinolaryngologie, Hôpital Européen George Pompidou, APHP, Université de Paris, 75015 Paris, France; (M.F.); (P.B.)
- Service d’Otorhinolaryngologie, d’Otoneurochirurgie et de Chirurgie Cervico-Faciale, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, 69310 Pierre Bénite, France
| | - Pierre Bonfils
- Département d’Otorhinolaryngologie, Hôpital Européen George Pompidou, APHP, Université de Paris, 75015 Paris, France; (M.F.); (P.B.)
| | - Guillaume Gricourt
- Plate-Forme Genomiques, APHP-IMRB, GHU Hôpitaux Universitaires Henri-Mondor, UPEC, 94010 Créteil, France; (G.G.); (V.D.)
| | - Vanessa Demontant
- Plate-Forme Genomiques, APHP-IMRB, GHU Hôpitaux Universitaires Henri-Mondor, UPEC, 94010 Créteil, France; (G.G.); (V.D.)
| | - Isabelle Podglajen
- Unité de Bactériologie, Département de Microbiologie, Hôpital Européen George Pompidou, APHP, Université de Paris, 75015 Paris, France;
| | - Paul-Louis Woerther
- UR DYNAMiC 7380, Faculté de Santé, Université Paris-Est Créteil, 94010 Créteil, France; (E.D.); (P.-L.W.)
- Unité de Bactériologie, Département de Prévention, Diagnostic et Traitement des Infections, APHP, GHU Hôpitaux Universitaires Henri-Mondor, 94010 Créteil, France
| | - Cécile Angebault
- Unité de Parasitologie-Mycologie, Département de Prévention, Diagnostic et Traitement des Infections, APHP, GHU Hôpitaux Universitaires Henri-Mondor, 94010 Créteil, France; (S.D.); (C.A.)
- UR DYNAMiC 7380, Faculté de Santé, Université Paris-Est Créteil, 94010 Créteil, France; (E.D.); (P.-L.W.)
- UR DYNAMiC 7380, Ecole Nationale Vétérinaire d’Alfort, USC Anses, 94700 Maison-Alfort, France
| | - Françoise Botterel
- Unité de Parasitologie-Mycologie, Département de Prévention, Diagnostic et Traitement des Infections, APHP, GHU Hôpitaux Universitaires Henri-Mondor, 94010 Créteil, France; (S.D.); (C.A.)
- UR DYNAMiC 7380, Faculté de Santé, Université Paris-Est Créteil, 94010 Créteil, France; (E.D.); (P.-L.W.)
- UR DYNAMiC 7380, Ecole Nationale Vétérinaire d’Alfort, USC Anses, 94700 Maison-Alfort, France
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Clinical features in maxillary sinus fungus ball in patients with malignant hematological disease. Eur Arch Otorhinolaryngol 2021; 279:1919-1927. [PMID: 34216265 DOI: 10.1007/s00405-021-06973-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 06/27/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE Previous studies on fungus balls have primarily focused on immunocompetent patients, and only a few studies have described the clinical characteristics of fungus balls in malignant hematological disease (MHD) patients. Therefore, we compared the clinical features of maxillary sinus fungus ball (MSFB) between immunosuppressive patients with MHD and immunocompetent patients. METHODS Twenty patients with MHD and 40 randomly selected immunocompetent patients were enrolled and divided into MHD and non-MHD groups. All patients were diagnosed with MSFB and their clinical features were retrospectively analyzed. RESULTS Patients in the MHD group had non-specific clinical symptoms and endoscopic manifestations of MSFB, similar to those in the non-MHD group. On computed tomography (CT), the MHD group showed higher Lund-Mackay scores, lesser single sinus opacifications, more multiple sinus opacifications on the affected side, and more bilateral opacifications compared to the non-MHD group. The MHD group had a lower frequency of central hyper-density and heterogeneous opacifications than the non-MHD group. There were no significant differences between the two groups in terms of the fungal-infected side, lateral sinus wall ratio, sclerosis of the lateral sinus wall, erosion of the inner sinus wall, and nasal septum deviation. CONCLUSION The clinical symptoms and endoscopic manifestations of MSFB in patients with MHD were similar to those of immunocompetent patients. However, more atypical signs and wider mucosal inflammation were found on CT scans of MSFB patients with MHD. These results indicate that caution should be executed when excluding the possibility of fungus balls in immunosuppressive patients.
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Raiesi O, Hashemi SJ, Mohammadi Ardehali M, Ahmadikia K, Getso MI, Pakdel F, Rezaie S, Dai Ghazvini R, Khodavaisy S, Gerami Shoar M, Borjian Boroujeni Z. Molecular identification and clinical features of fungal rhinosinusitis: A 3-year experience with 108 patients. Microb Pathog 2021; 158:105018. [PMID: 34098021 DOI: 10.1016/j.micpath.2021.105018] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 04/24/2021] [Accepted: 05/23/2021] [Indexed: 02/06/2023]
Abstract
This study aimed to determine the prevalence, the causative agents, clinical features, and the risk factors associated with the fungal rhinosinusitis in a tertiary health center with a view to providing valid grounds that may guide healthcare professionals to effectively prevent, control, and treat fungal infections. All patients were subjected to diagnostic nasal endoscopy and CT scan of paranasal sinuses and FRS were confirmed by routine and complementary mycological and molecular methods. The inclusion criteria for invasive FRS were: confirmed diagnosis of IFRS according to the guidelines of the EORTC/MSG criteria (i.e., clinical, microbiological, and histological evidence of invasive fungal infection). From a total of 512 suspected patients, FRS was confirmed in 108 cases (21.1%). Our results showed FB (38/108; 35.2%) is the most common form of FRS followed by AIFRS (33/108; 30.6%), AFS (32/108; 29.6%), and CIFRS (5/108; 4.6%). A. flavus and Rhizopus oryzae were the most common causes of infection in AFS, FB, CIFRS, and AIFRS, respectively. Univariate analysis of variables predictive of AIFRS revealed 3 variables significantly associated with AIFRS. These included mucosal abnormalities of the middle turbinate and septum, and specifically, necrosis of the middle turbinate (P < .0001). Microbiological cultures, although useful for mycological speciation, are less sensitive. Furthermore, we used molecular methods to confirm the identity of some isolates that were not detectable using routine methods. Our data showed that the molecular methods and histologic diagnosis in all patients were more sensitive than the unenhanced sinus CT scan, and conventional microbiological methods.
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Affiliation(s)
- Omid Raiesi
- Department of Medical Parasitology and Mycology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Seyed Jamal Hashemi
- Department of Medical Parasitology and Mycology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
| | - Mojtaba Mohammadi Ardehali
- Department of Otorhinolaryngology, School of Medicine, Tehran University of Medical Sciences, Amiralam Hospital, Tehran, Iran
| | - Kazem Ahmadikia
- Department of Medical Parasitology and Mycology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Muhammad Ibrahim Getso
- Department of Medical Microbiology and Parasitology, College of Health Sciences, Bayero, University Kano PMB, 3011, Kano-Nigeria
| | - Farzad Pakdel
- Ophthalmic Plastic & Reconstructive Surgery Department, Farabi Hospital, Tehran University of Medical Sciences, Vice Chair of Iranian Research Association for Vision and Ophthalmology (IRAVO), Iran
| | - Sassan Rezaie
- Department of Medical Parasitology and Mycology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Roshanak Dai Ghazvini
- Department of Medical Parasitology and Mycology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Sadegh Khodavaisy
- Department of Medical Parasitology and Mycology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohsen Gerami Shoar
- Department of Medical Parasitology and Mycology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Zeinab Borjian Boroujeni
- Department of Medical Parasitology and Mycology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
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Villemure-Poliquin N, Nadeau S. Surgical treatment of isolated sphenoid sinusitis - A case series and review of literature. Int J Surg Case Rep 2021; 79:18-23. [PMID: 33422847 PMCID: PMC7808905 DOI: 10.1016/j.ijscr.2020.12.091] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 12/26/2020] [Accepted: 12/27/2020] [Indexed: 11/06/2022] Open
Abstract
Isolated sphenoid opacification is a rare pathology that is increasingly being described and it represents 1–2% of sinus infections. The most frequent symptom associated with isolated sphenoid sinusitis is intractable headache. Isolated sphenoid sinusitis is usually treated surgically and endoscopic transnasal sphenoidectomy is the preferred surgical technique. Highly inflammatory diseases such as fungal infections may be associated with an increased risk of re-ossification of the sphenoid ostium following sphenoidectomy.
Introduction Isolated sphenoid opacification is a rare pathology. Unlike other sinusitis, the treatment is most often surgical. Only few studies reporting the recurrence rates with long-term follow-ups are available in the literature. In our experience, isolated sphenoid sinusitis tends to have a significant recurrence rate after a first surgical intervention. This study aims to describe our experience with patients operated for isolated sphenoid sinusitis and to compare our reoperation and complication rates with those reported in the literature. Methods We conducted an electronic chart review of patients operated at the CHU de Québec between 2007 and 2018 for isolated sphenoid sinusitis. Results 29 patients were analyzed. All patients had a sphenoidectomy with a transnasal approach. The reoperation rate was 103% (3/29) and the mean recurrence time was 15 (9–26) months. Among the patients reoperated, 2 patients had a fungus ball and one had a mucocele. Both patients with fungal balls had reossification of their sphenoidal ostium whereas the patient with the mucocele rather had a mucosal closure. No patient encountered any serious post-operative complication. Median duration of follow-up was 44 months (IQR: 25–68) for the 29 patients analyzed in our study. Conclusion Reoperation rates reported in the literature are probably underestimated. Our series emphasizes the importance of long-term follow-up for these pathologies. Highly inflammatory and chronic conditions such as fungal diseases could be linked to an increase in the occurrence of relapses.
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Affiliation(s)
- Noémie Villemure-Poliquin
- Department of Ophthalmology and Otolaryngology - Head and Neck Surgery, Université Laval, Quebec City, Quebec, Canada.
| | - Sylvie Nadeau
- Department of Ophthalmology and Otolaryngology - Head and Neck Surgery, Université Laval, Quebec City, Quebec, Canada.
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Pérez-Sayáns M, Suárez Peñaranda JM, Quintanilla JAS, Chamorro Petronacci CM, García AG, Carrión AB, Vila PG, Sánchez YG. Clinicopathological features of 214 maxillary sinus pathologies. A ten-year single-centre retrospective clinical study. Head Face Med 2020; 16:24. [PMID: 33050926 PMCID: PMC7552481 DOI: 10.1186/s13005-020-00239-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 10/01/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Diagnosis of maxillary sinus pathology must include the clinical radiological study (CRS) and histopathological analysis. The aim of this study is 1) to describe the clinicopathological features of maxillary sinus lesions, obtained successively in a single medical centre over the last 10 years and 2) to determine the sensitivity and specificity for the diagnosis of malignant lesions based exclusively on the CRS. METHODS It is a single-centre observational retrospective clinical study on patients who attended the University Hospital Complex of Santiago de Compostela (CHUS) with sinus pathologies during the period of 2009-2019. RESULTS The sample consisted of 133 men (62.1%) and 81 women (37.9%), with an average age of 46.9 years (SD = 18.8). In terms of frequency, the most frequent pathology was the unspecified sinusitis (44.4%), followed by polyps (18.2%), malignant tumours (9.8%), inverting papilloma (7.5%), fungal sinusitis (4.7%), cysts (3.7%), benign tumours (2.3%), mucocele (2.3%) and other lesions (1.9%). Cysts and benign tumours were diagnosed earliest Vs malignant tumours (65.2 years (SD = 16.1)) were diagnosed the latest (p < 0.001). Based only on the CRS for malignancies, diagnostic indexes were 71.4% sensitivity and 97.9% specificity, with a Kappa value of 0.68 with (p < 0.001). CONCLUSION Maxillary sinus pathology is very varied with therapeutic and prognostic repercussions. CRS is sometimes insufficient and histopathological confirmation is essential.
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Affiliation(s)
- Mario Pérez-Sayáns
- Health Research Institute of Santiago (IDIS), Oral Medicine, Oral Surgery and Implantology Unit (MedOralRes), Faculty of Medicine and Dentistry, University of Santiago de Compostela, C.P. 15782, Santiago de Compostela, Spain.
| | - José M Suárez Peñaranda
- Pathological Anatomy Service, University Hospital Complex of Santiago (CHUS), C.P. 15782, Santiago de Compostela, Spain
| | - Juan Antonio Suárez Quintanilla
- Area of Human Anatomy and Embryology, Faculty of Medicine and Dentistry, University of Santiago de Compostela, C.P. 15782, Santiago de Compostela, Spain
| | - Cintia M Chamorro Petronacci
- Health Research Institute of Santiago (IDIS), Oral Medicine, Oral Surgery and Implantology Unit (MedOralRes), Faculty of Medicine and Dentistry, University of Santiago de Compostela, C.P. 15782, Santiago de Compostela, Spain
| | - Abel García García
- Health Research Institute of Santiago (IDIS), Oral Medicine, Oral Surgery and Implantology Unit (MedOralRes), Faculty of Medicine and Dentistry, University of Santiago de Compostela, C.P. 15782, Santiago de Compostela, Spain
| | - Andrés Blanco Carrión
- Health Research Institute of Santiago (IDIS), Oral Medicine, Oral Surgery and Implantology Unit (MedOralRes), Faculty of Medicine and Dentistry, University of Santiago de Compostela, C.P. 15782, Santiago de Compostela, Spain
| | - Pilar Gándara Vila
- Health Research Institute of Santiago (IDIS), Oral Medicine, Oral Surgery and Implantology Unit (MedOralRes), Faculty of Medicine and Dentistry, University of Santiago de Compostela, C.P. 15782, Santiago de Compostela, Spain
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22
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TOMRUKÇU D, KÖSE T, DURSUN E. Maxillary sinus fungus ball: a case report. ACTA ODONTOLOGICA TURCICA 2020. [DOI: 10.17214/gaziaot.621595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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23
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Kim SC, Ryoo I, Shin JM, Suh S, Jung HN, Shin SU. MR Findings of Fungus Ball: Significance of High Signal Intensity on T1-Weighted Images. J Korean Med Sci 2020; 35:e22. [PMID: 31950777 PMCID: PMC6970076 DOI: 10.3346/jkms.2020.35.e22] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Accepted: 12/02/2019] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Central dark-signal intensity with high-signal, hypertrophic mucosal wall of paranasal sinuses on T2-weighted images (T2WI) is a characteristic magnetic resonance imaging (MRI) feature of sinonasal fungus ball. However, this finding is usually interpreted as non-fungal chronic sinusitis with central normal sinus air. In addition, T1-weighted images (T1WI) and T2WI are basic sequences of all magnetic resonance (MR) examinations. Therefore, we evaluated the usefulness of T1WI for detecting fungus balls comparing with computed tomography (CT) findings and T2-weighted MRI findings. METHODS This retrospective study was approved by the Institutional Review Board of Korea University Guro Hospital. Two reviewers assessed preoperative CT and MR images of 55 patients with pathologically confirmed fungus balls. Reviewers evaluated the presence and patterns of calcifications on CT. Overall signals and the presence and extent of certain signals of fungus balls on MRI were also assessed. The relationship between calcifications and MRI signals was also evaluated. RESULTS Of the patients, 89.1% had calcifications on CT. All had dark signal portions with high signal, hypertrophic mucosal walls on T2WI. Most (92.7%) patients showed iso- to hyper-intense overall signals on T1WI and 89.1% had T1-weighted high signal portions on MRI. The presence, patterns, and location of calcifications had no significant correlation with T1-weighted high-signal intensity portion. CONCLUSION Fungus ball can be suggested by the presence of the hyper-signal intensity portions in the fungal mass on T1WI in conjunction with dark-signal lesions surrounded by high-signal, hypertrophic mucosal walls in paranasal sinuses on T2WI.
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Affiliation(s)
- Soo Chin Kim
- Department of Radiology, Seoul National University Hospital Healthcare System Gangnam Center, Seoul National University College of Medicine, Seoul, Korea
| | - Inseon Ryoo
- Department of Radiology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea.
| | - Jae Min Shin
- Department of Otorhinolaryngology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Sangil Suh
- Department of Radiology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Hye Na Jung
- Department of Radiology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Sung Ui Shin
- Department of Radiology, Seoul National University Hospital Healthcare System Gangnam Center, Seoul National University College of Medicine, Seoul, Korea
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24
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Costa F, Emanuelli E, Franz L, Tel A, Sembronio S, Robiony M. Fungus ball of the maxillary sinus: Retrospective study of 48 patients and review of the literature. Am J Otolaryngol 2019; 40:700-704. [PMID: 31239183 DOI: 10.1016/j.amjoto.2019.06.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2019] [Accepted: 06/15/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND Maxillary fungus ball (FB) is the most frequent paranasal localization. OBJECTIVE To review clinical presentation, surgery and results of treatment in our series of patients with maxillary FB. To review the literature concerning treatment of maxillary FB. PATIENTS AND METHODS 48 patients with a diagnosis of maxillary FB were treated with endoscopic sinus surgery (ESS) alone or in association with external approaches. Before surgery all patients received computed tomography (CT), nasal endoscopy and dental examination. All the patients were followed for 1 year after surgery. Studies concerning surgical treatment of maxillary FB from 2006 were reviewed. RESULTS The mean age of patients was 53.6 ± 11.9 years. 20 patients (41.6%) did not present any symptom, 19 patients (39.7%) had nasal symptoms, 3 patients (6.2%) had facial pain, 6 patients (12.5%) had a combination of both. Endoscopic examination was positive in 31 patients (64.6%), 17 patients (35.4%) showed negative findings. Logit regression model demonstrated that clinical symptoms contribute to the prediction of a positive endoscopic examination. 25 patients (52.1%) presented odontogenic factors. Complete clinical and radiological resolution of FB was observed in 46 patients (95.8%). CONCLUSIONS Comparing our sample to the studies reviewed we may concluded that odontogenic factors were frequently reported and should be treated at the same time of maxillary FB. ESS alone or in association with external approaches is an effective treatment for patients with maxillary FB.
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Affiliation(s)
- Fabio Costa
- Maxillofacial Surgery Unit, Azienda Ospedaliero Universitaria of Udine, Udine, Italy.
| | - Enzo Emanuelli
- Department of Otorhinolaryngology and Otologic Surgery, Azienda Ospedaliera - Policlinico of Padova, Padova, Italy
| | - Leonardo Franz
- Azienda Ospedaliera - Policlinico of Padova, Padova, Italy
| | - Alessandro Tel
- Azienda Ospedaliero Universitaria of Udine, Udine, Italy
| | - Salvatore Sembronio
- Maxillofacial Surgery Unit, Azienda Ospedaliero Universitaria of Udine, Udine, Italy
| | - Massimo Robiony
- Azienda Ospedaliero Universitaria of Udine, Department of Medical and Biological Science, University of Udine, Udine, Italy
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Tuang GJ, Zahedi FD, Akashah I, Lee JPH, Abidin ZAZ. An unusual presentation of sphenoid Candida fungal ball: a case report. J Surg Case Rep 2019; 2019:rjz240. [PMID: 31423297 PMCID: PMC6690168 DOI: 10.1093/jscr/rjz240] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Accepted: 07/20/2019] [Indexed: 11/30/2022] Open
Abstract
The clinical presentation of a sphenoid fungal ball (FB) is often non-specific and tends to be overlooked, particularly in hosts with an intact immune status. Rarely, potentially life-threatening complications may arise, owning its anatomical characteristics with contiguous structures. Herein, we present an unusual case of sphenoid FB complicated with orbital apex syndrome in an immunocompetent patient. The diagnosis dilemma and subsequent management are further discussed.
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Affiliation(s)
- Geng Ju Tuang
- Department of Otorhinolaryngology, Head and Neck Surgery, Hospital Selayang, Lebuh Raya Selayang - Kepong, 68100 Batu Caves, Selangor, Malaysia
| | - Farah Dayana Zahedi
- Department of Otorhinolaryngology, Head and Neck Surgery, Universiti Kebangsaan Malaysia Medical Centre, Jalan Yaacob Latif, Bandar Tun Razak, 56000, Kuala Lumpur , Wilayah Persekutuan, Malaysia
| | - Izzah Akashah
- Department of Otorhinolaryngology, Head and Neck Surgery, Hospital Selayang, Lebuh Raya Selayang - Kepong, 68100 Batu Caves, Selangor, Malaysia
| | - Jennifer Peak Hui Lee
- Department of Otorhinolaryngology, Head and Neck Surgery, Hospital Selayang, Lebuh Raya Selayang - Kepong, 68100 Batu Caves, Selangor, Malaysia
| | - Zainal Azmi Zainal Abidin
- Department of Otorhinolaryngology, Head and Neck Surgery, Hospital Selayang, Lebuh Raya Selayang - Kepong, 68100 Batu Caves, Selangor, Malaysia
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26
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Stacchi C, Del Lupo V, Berton F, Lombardi T, Bressan R, Di Lenarda R, Lagatolla C. Aspergillus fumigatus biofilm formation on different bone substitutes used in maxillary sinus augmentation: an in vitro analysis. Int J Implant Dent 2019; 5:22. [PMID: 31218468 PMCID: PMC6584595 DOI: 10.1186/s40729-019-0175-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2019] [Accepted: 05/06/2019] [Indexed: 12/04/2022] Open
Abstract
Background Fungus ball (FB) typically affects healthy adults, and Aspergillus fumigatus is the most frequent etiologic agent: iatrogenic factors represent an important issue in FB pathogenesis. Moreover, a recent study suggested a significant association between the use of anorganic bovine bone as sinus grafting material and subsequent development of FB. The aim of the present investigation is to evaluate in vitro eventual differences in the ability of Aspergillus fumigatus to colonize different bone grafting materials and grow on them as biofilm. Findings Five different bone substitutes (demineralized bone matrix, anorganic bovine bone, ß-tricalcium phosphate, synthetic nano-hydroxyapatite, and synthetic hydroxyapatite), commonly used in sinus floor augmentation procedures, were inoculated with conidia suspensions of A. fumigatus and incubated at 37 °C for 4 and 8 h, in standardized conditions. Biofilm bound to the different materials underwent quantitative and qualitative analysis by confocal and scanning electron microscopy. A. fumigatus proved to be able to adhere and form biofilm on all the tested bone substitutes. The surface plot representation of the samples displayed some differences in the density of the superficial layer, due to the physical characteristics of the biomaterials. Nevertheless, Kruskal–Wallis test showed no significant differences in biomass amount among the five bone substitutes (p = 0.236 and p = 0.55 after 4 and 8 h adhesion, respectively). Conclusions All the bone substitutes normally used in sinus floor augmentation represent a favorable substrate for fungal growth, due to their physical and chemical characteristics. During sinus floor elevation procedures, Schneiderian membrane integrity should be maintained in order to avoid the exposure of the grafting material at the respiratory environment, with potential risks of fungal colonization.
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Affiliation(s)
- Claudio Stacchi
- Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy.
| | - Veronica Del Lupo
- Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy
| | - Federico Berton
- Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy
| | | | - Raffaela Bressan
- Department of Life Sciences, University of Trieste, Trieste, Italy
| | - Roberto Di Lenarda
- Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy
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27
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Ahn SH, Lee EJ, Hong MP, Shin GC, Kim KS. Comparison of the clinical characteristics of bilateral and unilateral fungal balls in Korea. Eur Arch Otorhinolaryngol 2019; 276:1975-1980. [DOI: 10.1007/s00405-019-05408-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2018] [Accepted: 03/25/2019] [Indexed: 01/09/2023]
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28
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Min HK, Kwon OE, Min JY, Kim SW. Two Cases of Actinomycosis with Aspergillosis in Unilateral Paranasal Sinuses. JOURNAL OF RHINOLOGY 2019. [DOI: 10.18787/jr.2019.26.2.122] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- Hye Kyu Min
- Department of Otorhinolaryngology-Head and Neck Surgery, School of Medicine, Kyung Hee University, Seoul, Korea
| | - Oh Eun Kwon
- Department of Otorhinolaryngology-Head and Neck Surgery, School of Medicine, Kyung Hee University, Seoul, Korea
- Department of Otorhinolaryngology-Head and Neck Surgery, Graduate School, Kyung Hee University, Seoul, Korea
| | - Jin Young Min
- Department of Otorhinolaryngology-Head and Neck Surgery, School of Medicine, Kyung Hee University, Seoul, Korea
| | - Sung Wan Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, School of Medicine, Kyung Hee University, Seoul, Korea
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29
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Ho CF, Lee TJ, Wu PW, Huang CC, Chang PH, Huang YL, Lee YL, Huang CC. Diagnosis of a maxillary sinus fungus ball without intralesional hyperdensity on computed tomography. Laryngoscope 2018; 129:1041-1045. [PMID: 30582161 DOI: 10.1002/lary.27670] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Revised: 09/30/2018] [Accepted: 10/12/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVES/HYPOTHESIS Maxillary sinus fungus ball (MSFB) is the most common type of noninvasive fungal rhinosinusitis. Surgical removal of the ball achieves good outcomes. Making a rapid and accurate diagnosis is important to avoid unnecessary medical therapy. Intralesional hyperdensity (IH) on computed tomography (CT) is reportedly a good indicator. The aim of this study was to evaluate the diagnostic features of MSFB without IH on preoperative CT images. STUDY DESIGN Retrospective database review. METHODS Two hundred fifty-eight patients with histopathological evidence of a sinus fungal ball were retrospectively investigated. Forty-seven of 222 patients with MSFB did not show IH on preoperative CT images and were enrolled in the MSFB group. Forty-one patients with unilateral nonfungal chronic rhinosinusitis were enrolled in a control group. CT features previously reported to have diagnostic significance were evaluated. RESULTS Sclerosis of the lateral sinus wall, erosion of the inner sinus wall, and irregular surface of the material were significantly more common in the MSFB group than in the control group. In the subgroup of patients with total opacification in the maxillary sinus, the sensitivity, specificity, and positive and negative predictive values for erosion of the inner sinus wall were more than 90%. In the subgroup with partial opacification, the sensitivity, specificity, and positive predictive value of an irregular surface of the material were more than 80%. CONCLUSIONS We have devised an algorithm to help diagnose MSFB without IH on preoperative CT images. Use of this algorithm would improve the diagnostic accuracy and ensure appropriate treatment. LEVEL OF EVIDENCE 4 Laryngoscope, 129:1041-1045, 2019.
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Affiliation(s)
- Che-Fang Ho
- Division of Rhinology, Department of Otolaryngology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan.,Department of Otolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital and Chang Gung University, Keelung, Taiwan
| | - Ta-Jen Lee
- Division of Rhinology, Department of Otolaryngology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan
| | - Pei-Wen Wu
- Division of Rhinology, Department of Otolaryngology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan.,Department of Otolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital and Chang Gung University, Keelung, Taiwan
| | - Chi-Che Huang
- Division of Rhinology, Department of Otolaryngology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan.,the Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Po-Hung Chang
- Division of Rhinology, Department of Otolaryngology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan.,the Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yen-Lin Huang
- Department of Anatomic Pathology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan
| | - Yueh-Lin Lee
- Department of Radiology, Chang Gung Memorial Hospital and Chang Gung University, Keelung, Taiwan
| | - Chien-Chia Huang
- Division of Rhinology, Department of Otolaryngology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan.,the Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan
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30
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Naros A, Peters JP, Biegner T, Weise H, Krimmel M, Reinert S. Fungus Ball of the Maxillary Sinus-Modern Treatment by Osteoplastic Approach and Functional Endoscopic Sinus Surgery. J Oral Maxillofac Surg 2018; 77:546-554. [PMID: 30448431 DOI: 10.1016/j.joms.2018.10.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Revised: 10/06/2018] [Accepted: 10/08/2018] [Indexed: 10/28/2022]
Abstract
PURPOSE Functional endoscopic sinus surgery (FESS) is considered standard surgical therapy for fungus ball of the maxillary sinus. However, recent findings have indicated an odontogenic etiology, which requires simultaneous treatment of the dental origin. This study presents the authors' treatment results of fungus ball of the maxillary sinus using a combination of FESS and an endoscopically assisted osteoplastic approach through the anterior wall of the maxillary sinus, enabling simultaneous treatment of the dental origin. MATERIALS AND METHODS A cohort of 22 patients with histopathologically confirmed fungus ball of the maxillary sinus was retrospectively analyzed. Clinical records and medical imaging data were reviewed to evaluate the etiology, clinical and radiologic findings, and postoperative outcome. RESULTS Only 15 patients presented nonspecific clinical symptoms compatible with chronic unilateral maxillary sinusitis. Computed tomography visualized complete opacity of the maxillary sinus in 11 patients and intralesional hyperdensity in 12 patients. An odontogenic association was verified in 18 patients. Twenty-one patients underwent endoscopically assisted osteoplastic surgery through the anterior maxillary sinus wall. In 12 cases, the assumed persistent odontogenic source was treated simultaneously. Depending on the patency of the ostiomeatal complex, the accompanying chronic sinusitis was treated by FESS. CONCLUSIONS The present data support the assumption of an odontogenic etiology of fungus ball of the maxillary sinus. Hence, surgical management requires simultaneous treatment of the fungal mass, the odontogenic origin of the disease, and the accompanying chronic sinusitis. To properly treat fungus ball, the authors present a modern treatment concept, using a minimally invasive endoscopically assisted osteoplastic approach through the anterior maxillary wall, for sufficient and necessary surgical treatment.
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Affiliation(s)
- Andreas Naros
- Resident, Department of Oral and Maxillofacial Surgery, University Hospital Tuebingen, Tuebingen, Germany.
| | - Jens Peter Peters
- Medical Specialist, Department of Oral and Maxillofacial Surgery, University Hospital Tuebingen, Tuebingen, Germany
| | - Thorsten Biegner
- Resident, Institute of Pathology and Neuropathology, University Hospital Tuebingen, Tuebingen, Germany
| | - Hannes Weise
- Medical Specialist, Department of Oral and Maxillofacial Surgery, University Hospital Tuebingen, Tuebingen, Germany
| | - Michael Krimmel
- Vice Chairman, Department of Oral and Maxillofacial Surgery, University Hospital Tuebingen, Tuebingen, Germany
| | - Siegmar Reinert
- Department Head, Department of Oral and Maxillofacial Surgery, University Hospital Tuebingen, Tuebingen, Germany
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31
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Małek M, Bogusz B, Mrowiec P, Szuta M, Opach M, Skiba-Kurek I, Nowak P, Klesiewicz K, Budak A, Karczewska E. Nested PCR for the detection of Aspergillus species in maxillary sinus samples of patients with chronic sinusitis. Rev Iberoam Micol 2018; 35:140-146. [PMID: 30274951 DOI: 10.1016/j.riam.2018.04.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Revised: 03/27/2018] [Accepted: 04/05/2018] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Fungal rhinosinusitis has become an increasingly recognized disease, being Aspergillus species responsible for most of the cases. Its diagnosis is quite difficult because of the non-specific symptoms and low sensitivity of the current diagnostic methods. AIMS An Aspergillus-specific nested polymerase chain reaction (PCR) assay using biopsy specimens taken from the maxillary sinuses was performed in order to assess its usefulness. Conventional diagnostic methods (histology and culture) were also carried out. METHODS A case-control study was performed in the Institute of Stomatology, Jagiellonian University in Kraków, between 2011 and 2014. The case group consisted of 21 patients with suspected rhinosinusal mycetoma while the control group included 46 patients with no suspicion of fungal rhinosinusitis. The two-step PCR assay amplified an Aspergillus specific portion of the 18S rRNA gene. Interval estimation of sensitivity, specificity, positive (PPV) and negative (NPV) predictive values were calculated to assess the diagnostic test performance. The agreement between the PCR and the other tests was evaluated using the Kappa coefficient (k). RESULTS Ninety percent of the samples obtained from patients diagnosed with mycetoma yielded positive PCR results. The PCR showed almost perfect concordance with histology (k=0.88). Sensitivity, specificity, PPV and NPV estimates were 90%; 95% CI: (55.5-99.7%), 98.3%; 95% CI: (90.9-100%), 90%; 95% CI: (55.5-99.7%) and 98.3%; 95% CI: (90.9-100%), respectively. One clinical sample showed growth of Aspergillus fumigatus and positive PCR despite the negative histological examination. CONCLUSIONS Nested PCR assay is a promising diagnostic tool to evaluate the presence of Aspergillus in the tissue of maxillary sinus from patients with suspicion of sinus aspergillosis.
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Affiliation(s)
- Marianna Małek
- Department of Pharmaceutical Microbiology, Faculty of Pharmacy, Jagiellonian University Medical College, Kraków, Poland
| | - Bożena Bogusz
- Microbiological Laboratory, Department of Laboratory Diagnostics, Ludwik Rydygier Memorial Hospital, Kraków, Poland
| | - Paulina Mrowiec
- Department of Pharmaceutical Microbiology, Faculty of Pharmacy, Jagiellonian University Medical College, Kraków, Poland.
| | - Mariusz Szuta
- Department of Cranio-Maxillofacial, Oncological and Reconstructive Surgery, Institute of Stomatology, Jagiellonian University Medical College, Kraków, Poland
| | - Maciej Opach
- Department of Cranio-Maxillofacial, Oncological and Reconstructive Surgery, Institute of Stomatology, Jagiellonian University Medical College, Kraków, Poland
| | - Iwona Skiba-Kurek
- Department of Pharmaceutical Microbiology, Faculty of Pharmacy, Jagiellonian University Medical College, Kraków, Poland
| | - Paweł Nowak
- Department of Pharmaceutical Microbiology, Faculty of Pharmacy, Jagiellonian University Medical College, Kraków, Poland
| | - Karolina Klesiewicz
- Department of Pharmaceutical Microbiology, Faculty of Pharmacy, Jagiellonian University Medical College, Kraków, Poland
| | - Alicja Budak
- Department of Pharmaceutical Microbiology, Faculty of Pharmacy, Jagiellonian University Medical College, Kraków, Poland
| | - Elżbieta Karczewska
- Department of Pharmaceutical Microbiology, Faculty of Pharmacy, Jagiellonian University Medical College, Kraków, Poland
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Jiang RS, Huang WC, Liang KL. Characteristics of Sinus Fungus Ball: A Unique Form of Rhinosinusitis. CLINICAL MEDICINE INSIGHTS. EAR, NOSE AND THROAT 2018; 11:1179550618792254. [PMID: 30090023 PMCID: PMC6077877 DOI: 10.1177/1179550618792254] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Accepted: 07/10/2018] [Indexed: 11/26/2022]
Abstract
Objective: The purpose of this study was to investigate the characteristics of this unique form of rhinosinusitis. Methods: Ninety-one patients with sinus fungus balls were evaluated for clinical characteristics. Nasal tissues obtained from 38 patients with sinus fungus ball, along with 26 controls were used for histopathological, cytokines/chemokines, western blotting, and genetic analyses. Results: Patients with fungus balls had significantly more females and their age was older. The presentation of fungus ball was predominantly unilateral (97.8%). Thirty-three patients (36.3%) had risk factors for fungal infection. Macrophage and neutrophil dominated cellular infiltration was found in nasal tissues of fungus ball patients. A tendency of reduced tight junction staining (e-cadherin) and protein expression was found. Interleukin 8 (IL8) and granulocyte colony stimulating factor (G-CSF) significantly increased in sinus fungus ball tissue homogenates when compared with those from controls. Higher prevalence of a single single nucleotide polymorphism (SNP) with E-cadherin was found in the patients with fungus ball. Conclusions: We found that patients with sinus fungus ball had robust immune responses, allowing recruitment and activation of macrophages and neutrophils. However, patients with sinus fungus ball could have genetic or acquired weakness in immunity. The fungal hyphae were localized and accumulated within single sinus instead of being eradicated by host.
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Affiliation(s)
- Rong-San Jiang
- Department of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan.,School of Medicine, Chung Shan Medical University, Taichung, Taiwan.,Department of Nursing, Hungkuang University, Taichung, Taiwan
| | - Wan-Chun Huang
- Department of Otolaryngology, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Kai-Li Liang
- School of Medicine, Chung Shan Medical University, Taichung, Taiwan.,Department of Otolaryngology, Taichung Veterans General Hospital, Taichung, Taiwan.,Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan
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A Case of Fungus Ball-Type Maxillary Sinusitis Due to Penicillium Roqueforti. Mycopathologia 2017; 183:439-443. [PMID: 29075960 DOI: 10.1007/s11046-017-0217-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Accepted: 10/19/2017] [Indexed: 10/18/2022]
Abstract
The Penicillium genera, encompassing about 225 different species of fungi, are naturally present in the environment. These genera are poorly linked to human disease, except for Penicillium marneffei causing septicemia in immunocompromised hosts. Thus, Penicillium species recovered from respiratory tract samples are often considered as inhaled contaminants in the clinical laboratory. However, we report here a case of fungal maxillary sinusitis due to Penicillium roqueforti diagnosed in a 40-year-old female, a teacher, complaining of moderate pain for months in the maxillary sinus and chronic posterior rhinorrhea. CT scanner and MRI enabled a preliminary diagnosis of left maxillary fungus ball-type sinusitis with calcified material seen on CT and marked very low signal in T2 weighted images seen on MRI. Anatomopathological and mycological examination of sinusal content showed septate hyphae. Direct sequencing of the sinusal content revealed P. roqueforti. P. roqueforti has been traditionally used in France for more than 200 years for cheese ripening. However, to our knowledge, this ascomycetous fungus has very rarely been associated in the literature with human disease. P. roqueforti is associated only with cheese worker's lung, a hypersensitivity pneumonitis affecting employees in blue cheese factories. Other species in the Penicillium genus are reported to cause various disorders such as invasive infection, superficial infection or allergic diseases. P. roqueforti has never previously been reported as a cause of human infection. Thus, we report the first case of fungus ball due to P. roqueforti in an immunocompetent patient.
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Fungus Ball of the Maxillary Sinus Presenting With Epiphora. Ophthalmic Plast Reconstr Surg 2017; 33:S27-S29. [PMID: 26863042 DOI: 10.1097/iop.0000000000000654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The authors report a case of fungus ball of the maxillary sinus with bone erosion presenting with epiphora, which was diagnosed after treatment failure using silicone intubation for nasolacrimal duct obstruction. Symptoms of sinus fungus ball are similar to those of chronic bacterial rhinosinusitis, although occasionally asymptomatic. To our knowledge, epiphora has never been reported as a symptom of sinus fungus ball. The purpose of this report is to emphasize the importance of considering sinonasal causes when evaluating epiphora patients, as well as to suggest the use of preoperative CT scans for a more accurate diagnosis and to prevent unnecessary procedures.
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Sasso M, Barrot A, Carles MJ, Griffiths K, Rispail P, Crampette L, Lallemant B, Lachaud L. Direct identification of molds by sequence analysis in fungal chronic rhinosinusitis. J Mycol Med 2017; 27:514-518. [PMID: 28827018 DOI: 10.1016/j.mycmed.2017.07.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Revised: 06/20/2017] [Accepted: 07/17/2017] [Indexed: 11/30/2022]
Abstract
Fungi are widely implicated in chronic rhinosinusitis. Direct microscopic examination (DME) is used to confirm the biological diagnosis of fungal rhinosinusitis (FRS). Diagnostic sensitivity of DME is better than culture, however DME does not allow fungal species identification. In this study, we included 54 sinus samples demonstrating hyphae on DME. Direct sequencing was compared to culture for the identification of the fungal species. Sequence analysis identified fungi in 81.5% of cases while culture was positive in only 31.5%. The most common genus was Aspergillus and the identified species belonged to section Fumigati or to section Flavi. Among other fungi identified by sequence analysis, Schizophyllum commune was present in three samples attesting to the importance of this Basidiomycetes in FRS. Our results clearly demonstrate the superiority of sequencing compared to culture when performed on specimens with hyphal elements at DME, and contributes to the epidemiological knowledge of fungi involved in FRS.
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Affiliation(s)
- M Sasso
- Laboratoire de parasitologie-mycologie, CHU de Nîmes, place du Pr-Debré, 30029 Nîmes cedex 9, France; Faculté de médecine de Montpellier-Nîmes, université de Montpellier, Montpellier, France
| | - A Barrot
- Laboratoire de parasitologie-mycologie, CHU de Nîmes, place du Pr-Debré, 30029 Nîmes cedex 9, France; Faculté de médecine de Montpellier-Nîmes, université de Montpellier, Montpellier, France
| | - M-J Carles
- Laboratoire de virologie, CHU de Nîmes, Nîmes, France
| | - K Griffiths
- Service biostatistique et technologies de l'information et de la communication, AP-HM, hôpital de la Timone, Marseille, France
| | - P Rispail
- Département de parasitologie-mycologie, CHU de Montpellier, Marseille, France
| | - L Crampette
- Faculté de médecine de Montpellier-Nîmes, université de Montpellier, Montpellier, France; Service d'otorhinolaryngologie, CHU de Montpellier, Marseille, France
| | - B Lallemant
- Faculté de médecine de Montpellier-Nîmes, université de Montpellier, Montpellier, France; Service d'otorhinolaryngologie, CHU de Nîmes, Nîmes, France
| | - L Lachaud
- Laboratoire de parasitologie-mycologie, CHU de Nîmes, place du Pr-Debré, 30029 Nîmes cedex 9, France; Faculté de médecine de Montpellier-Nîmes, université de Montpellier, Montpellier, France.
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Abstract
Although sinusitis affects about 20 % of the population, fungal sinusitis is rare. Aspergillus sp. are most frequently implicated. Fungal sinusitis represents a wide spectrum of disorders, including acute or chronic and invasive or non-invasive forms. Invasive fungal sinusitis may develop in an immunocompromised or diabetic patient, whereas non-invasive fungal sinusitis should be considered in a chronic situation, resistant to antibiotics in immunocompetent patients. Allergic fungal sinusitis is related to hypersensitivity of the host to the fungus. The diagnosis of these infections requires radiological examination and endoscopy with mucosal biopsies examined histologically and mycologically in order to distinguish the different types of sinusitis. In the non-invasive forms, surgical treatment is essential, sometimes combined with antifungal and anti-inflammatory treatment. The invasive forms require antifungal treatment, combined with surgery in some forms, particularly mucormycosis.
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Ni Mhurchu E, Ospina J, Janjua AS, Shewchuk JR, Vertinsky AT. Fungal Rhinosinusitis: A Radiological Review with Intraoperative Correlation. Can Assoc Radiol J 2017; 68:178-186. [DOI: 10.1016/j.carj.2016.12.009] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Accepted: 12/30/2016] [Indexed: 10/19/2022] Open
Abstract
The interaction between fungi and the sinonasal tract results in a range of clinical presentations with a broad spectrum of clinical severity. The most commonly accepted classification system divides fungal rhinosinusitis into invasive and noninvasive subtypes based on histopathological evidence of tissue invasion by fungi. Invasive fungal rhinosinusitis is subdivided into acute invasive and chronic invasive categories. The chronic invasive category includes a subcategory of chronic granulomatous disease. Noninvasive fungal disease includes localized fungal colonization, fungal ball, and allergic fungal rhinosinusitis. Noninvasive disease is simply fungal material (or the products of the inflammatory reaction of the sinus mucosa) that fills the sinuses but does not invade tissue. Bone loss is related to expansion of the sinus(es). Invasive disease causes tissue destruction, such that it expands past the bony confines of the sinuses. It can rapidly spread, causing acute necrosis. Alternatively, there may be slow tissue invasion characterized by symptoms confused with normal sinusitis, but destruction of normal nasal and paranasal structures.
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Affiliation(s)
- Elaine Ni Mhurchu
- Neuroradiology, University of British Columbia, Vancouver General Hospital, Vancouver, British Columbia, Canada
| | - Javier Ospina
- Otolaryngology - Head & Neck Surgery, University of British Columbia, Vancouver General Hospital and St Paul's Hospital, Vancouver, British Columbia, Canada
| | - Arif S. Janjua
- Otolaryngology - Head & Neck Surgery, University of British Columbia, Vancouver General Hospital and St Paul's Hospital, Vancouver, British Columbia, Canada
| | - Jason R. Shewchuk
- Neuroradiology, University of British Columbia, Vancouver General Hospital, Vancouver, British Columbia, Canada
| | - Alexandra T. Vertinsky
- Neuroradiology, University of British Columbia, Vancouver General Hospital, Vancouver, British Columbia, Canada
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Odontogenic sinusitis maxillaris: A retrospective study of 121 cases with surgical intervention. J Craniomaxillofac Surg 2017; 45:520-525. [DOI: 10.1016/j.jcms.2017.01.023] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2016] [Revised: 12/17/2016] [Accepted: 01/23/2017] [Indexed: 01/27/2023] Open
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Bernardini E, Karligkiotis A, Fortunato S, Castelnuovo P, Dallan I. Surgical and pathogenetic considerations of frontal sinus fungus ball. Eur Arch Otorhinolaryngol 2017; 274:2493-2497. [PMID: 28289831 DOI: 10.1007/s00405-017-4531-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2017] [Accepted: 03/07/2017] [Indexed: 11/30/2022]
Abstract
Fungus ball (FB) is an non-invasive form of mycosis, that generally affects immunocompetent and non-atopic subjects. Involvement of the frontal sinus is extremely rare. We report two cases with frontal sinus fungus ball that underwent endoscopic endonasal frontal Draf type IIb or III sinusotomy with complete removal of the cheesy clay-like material. There were no intra-operative or postoperative complications, and no recurrence of disease was evident during the follow-up of 51 and 26 months, respectively. The Draf type IIb or type III frontal sinusotomy seems to be highly effective for the treatment of frontal sinus FB and can represent a valid alternative to the traditional external approaches.
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Affiliation(s)
- Elena Bernardini
- Division of Otorhinolaryngology, Department of Biotechnology and Life Sciences, University of Insubria-Varese, ASST Sette Laghi, Ospedale di Circolo e Fondazione Macchi, Via Guicciardini 9, 21100, Varese, Italy
| | - Apostolos Karligkiotis
- Division of Otorhinolaryngology, Department of Biotechnology and Life Sciences, University of Insubria-Varese, ASST Sette Laghi, Ospedale di Circolo e Fondazione Macchi, Via Guicciardini 9, 21100, Varese, Italy. .,Head and Neck Surgery & Forensic Dissection Research Center (HNS&FDRC), Department of Biotechnology and Life Sciences, University of Insubria-Varese, ASST Sette Laghi, Ospedale di Circolo e Fondazione Macchi, Varese, Italy.
| | | | - Paolo Castelnuovo
- Division of Otorhinolaryngology, Department of Biotechnology and Life Sciences, University of Insubria-Varese, ASST Sette Laghi, Ospedale di Circolo e Fondazione Macchi, Via Guicciardini 9, 21100, Varese, Italy.,Head and Neck Surgery & Forensic Dissection Research Center (HNS&FDRC), Department of Biotechnology and Life Sciences, University of Insubria-Varese, ASST Sette Laghi, Ospedale di Circolo e Fondazione Macchi, Varese, Italy
| | - Iacopo Dallan
- Head and Neck Surgery & Forensic Dissection Research Center (HNS&FDRC), Department of Biotechnology and Life Sciences, University of Insubria-Varese, ASST Sette Laghi, Ospedale di Circolo e Fondazione Macchi, Varese, Italy.,Department of Otorhinolaryngology, University of Pisa, Pisa, Italy
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Isolated sphenoid sinus fungus ball: a retrospective study conducted at a tertiary care referral center in Korea. Eur Arch Otorhinolaryngol 2017; 274:2453-2459. [PMID: 28251318 DOI: 10.1007/s00405-017-4468-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2016] [Accepted: 01/16/2017] [Indexed: 10/20/2022]
Abstract
Fungus ball (FB) is the most common form of extramucosal fungal rhinosinusitis involving one or more paranasal sinuses. The sphenoid sinus is an uncommon site of this disease. Here, we present our 20-year experience of managing isolated sphenoid sinus FB (SSFB). We retrospectively reviewed a series of 47 cases of isolated SSFB encountered between 1996 and 2015 with reference to the chronological incidence, demographics, clinical features, radiological findings, treatment modalities, and outcome. Recently, the number of patients with isolated SSFB has increased markedly. The mean age of the patients in this study was 63.1 years (range 26-84 years), and there was significant female predominance. The most common symptom was headache (72.3%), which was localised in various regions. On the other hand, nasal symptoms presented at a relatively low rate. On computed tomography, the most common findings were total opacification, calcification, and sclerosis of the bony walls. There was no significant difference in the presence of SSFB between the ipsilateral and contralateral sides of the nasal septal deviation and concha bullosa. Magnetic resonance imaging demonstrated an isointensity on T1-weighted images and marked hypointensity on T2-weighted images. Treatment consisted of endonasal endoscopic sphenoidotomy with complete removal of the FB. The prognosis was good, with no recurrence after a mean follow-up of 13.2 months. Isolated SSFB is a rare disease, but its prevalence is increasing. Although the clinical presentation is usually vague and nonspecific, SSFB should be considered in patients with unexplained headache, especially in elderly women. Endoscopic sphenoidotomy is a reliable treatment with low morbidity and recurrence rates.
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"Gauze Technique" in the Treatment of the Fungus Ball of the Maxillary Sinus: A Technique as Simple as It Is Effective. Int J Otolaryngol 2016; 2016:4169523. [PMID: 28083071 PMCID: PMC5204116 DOI: 10.1155/2016/4169523] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Revised: 11/06/2016] [Accepted: 11/27/2016] [Indexed: 11/21/2022] Open
Abstract
Fungus ball of maxillary sinus generally affects immunocompetent and nonatopic subjects. Although endoscopic removal is the current gold standard treatment, removal is at times difficult due to an accumulation of fungal elements in the anterior ad inferior recesses. Aim. To present our experience of maxillary fungus ball treated by the “gauze technique” that avoids these removal difficulties. Materials and Methods. A retrospective, cross-sectional, and descriptive study of 25 patients affected by maxillary fungus ball was carried out: 19 were treated by the “gauze technique” and 6 were treated without “gauze technique.” Results. A comparison was made between the two groups for surgery procedure time, length of hospitalization, time from surgery to nasal unpacking, complications, and postsurgical patient satisfaction. The only statistically significant difference observed was a shorter surgical procedure time (p < 0.05) for the “gauze technique.” Conclusions. The data obtained in this study demonstrated that the “gauze technique” is a safe, simple, and quick technique, able to reduce surgery procedure time whilst providing excellent functional outcomes and patient satisfaction.
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Vinciguerra A, Saibene AM, Lozza P, Maccari A. Unusual case of bilateral maxillary fungus ball. BMJ Case Rep 2016; 2016:bcr-2016-217930. [PMID: 27979848 DOI: 10.1136/bcr-2016-217930] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
An otherwise healthy 34-year-old man was referred to our ear, nose and throat (ENT) clinic for a bilateral maxillary radiologic opacity. This condition was accidentally discovered with a panoramic radiography performed during a follow-up visit after a bilateral endodontic treatment. The patient did not report any specific sinonasal symptom such as purulent nasal discharge, loss of smell and cough, apart from an unspecific sinus pressure. The CT scans showed a bilateral inflammatory process into the maxillary-ethmoidal sinuses and an iron-like density within the maxillary sinuses, while nasal endoscopy showed purulent discharge in the ostiomeatal complex. The patient underwent functional endoscopic sinus surgery under general anaesthesia and the inflammatory material collected was histologically diagnosed as a rare case of bilateral fungus ball. The patient was dismissed the following day with no complications; there were not any sign of recurrence or symptoms during a 4 month follow-up.
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Affiliation(s)
- Alessandro Vinciguerra
- Otolaryngology Department, ASST Santi Paolo e Carlo, Department of Health Sciences, Università degli Studi di Milano, Milan, Italy
| | - Alberto Maria Saibene
- Otolaryngology Department, ASST Santi Paolo e Carlo, Department of Health Sciences, Università degli Studi di Milano, Milan, Italy
| | - Paolo Lozza
- Otolaryngology Department, ASST Santi Paolo e Carlo, Department of Health Sciences, Università degli Studi di Milano, Milan, Italy
| | - Alberto Maccari
- Otolaryngology Department, ASST Santi Paolo e Carlo, Department of Health Sciences, Università degli Studi di Milano, Milan, Italy
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Abstract
Chronic sphenoid rhinosinusitis is a spectrum of inflammatory diseases in isolated sphenoid sinus which may persist over a period of 12 weeks. It is a different entity from other types of rhinosinusitis because clinical presentations include headache, visual loss or diplopia, and patients may or may not have nasal obstruction or nasal discharge. Nasal endoscopic examination is useful, and computed tomography is mandatory. The disease requires comprehensive knowledge and appropriate imaging technique for diagnosis. To treat patients with chronic sphenoid rhinosinusitis, surgical treatment with endoscopic transnasal sphenoidotomy is often required. As there are no recent updated reviews of chronic sphenoid rhinosinusitis, in this article, we review the anatomy of the sphenoid sinus and its clinical relationship with the clinical signs and symptoms of the disease, the imaging findings of each diagnosis and the comprehensive surgical techniques.
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Affiliation(s)
- Natamon Charakorn
- Department of Otolaryngology Head and Neck Surgery, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Kornkiat Snidvongs
- Department of Otolaryngology Head and Neck Surgery, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
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45
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Comacle P, Belaz S, Jegoux F, Ruaux C, Le Gall F, Gangneux JP, Robert-Gangneux F. Contribution of molecular tools for the diagnosis and epidemiology of fungal chronic rhinosinusitis. Med Mycol 2016; 54:794-800. [PMID: 27335058 DOI: 10.1093/mmy/myw041] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2016] [Accepted: 04/21/2016] [Indexed: 11/13/2022] Open
Abstract
Chronic rhinosinusitis (CRS) rank second at chronic inflammatory diseases in industrialized countries and are an important public health concern. Diagnosis relies on a set of arguments including clinical signs, imaging, histopathologic and mycological analyses of sinus specimens, collected during nasal endoscopy. The sensitivity of fungal cultures is reported to be poor, even when direct examination is positive, thus the epidemiology of fungal chronic sinusitis is ill-known. This study evaluated the sensitivity of molecular diagnosis in 70 consecutive samples (61 patients with CRS) analysed at the University Hospital of Rennes during a 3-year period. DNA detection was performed using a conventional PCR method targeting the ITS1/ITS2 sequence and the resulting amplification products were sequenced. Fungal CRS was proven in 42 patients (69%), of which only 20 (48%) had a positive culture. 37/42 (88%) patients were diagnosed with a fungus ball, 3 with allergic fungal CRS and 2 with undetermined fungal CRS. PCR was positive in all 42 cases and direct sequencing allowed to identify fungi in all cases but one, and detected multiple infection in 3. Aspergillus fumigatus was present in 69% of patients; Cladosporium cladosporoides in 9.5%, Scedosporium sp., A. nidulans and A. flavus in 7% each. In 2/19 patients with negative direct examination, sequencing analysis revealed the presence of Capnobotryella sp. and C. cladosporoides, in clinical settings compatible with fungal sinusitis. In conclusion, ITS1/ITS2 PCR had a twice better sensitivity than culture, and combined sequencing provides accurate epidemiological data on fungal CRS.
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Affiliation(s)
- Pauline Comacle
- Laboratoire de Parasitologie-Mycologie, Centre Hospitalier Universitaire de Rennes, Rennes, France
| | - Sorya Belaz
- Laboratoire de Parasitologie-Mycologie, Centre Hospitalier Universitaire de Rennes, Rennes, France Inserm U1085-IRSET, Université Rennes 1, Rennes, France
| | - Franck Jegoux
- Service d'Otorhino-laryngologie, Centre Hospitalier Universitaire de Rennes, Rennes, France
| | | | - François Le Gall
- Service d'Anatomo-Pathologie, Centre Hospitalier Universitaire de Rennes, Rennes, France
| | - Jean-Pierre Gangneux
- Laboratoire de Parasitologie-Mycologie, Centre Hospitalier Universitaire de Rennes, Rennes, France Inserm U1085-IRSET, Université Rennes 1, Rennes, France
| | - Florence Robert-Gangneux
- Laboratoire de Parasitologie-Mycologie, Centre Hospitalier Universitaire de Rennes, Rennes, France Inserm U1085-IRSET, Université Rennes 1, Rennes, France
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Kim JS, Kim BK, Hong SD, Kim HJ, Kim HY. Clinical Characteristics of Sphenoid Sinus Fungal Ball Patients With Visual Disturbance. Clin Exp Otorhinolaryngol 2016; 9:326-331. [PMID: 27136367 PMCID: PMC5115146 DOI: 10.21053/ceo.2015.01571] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Revised: 12/17/2015] [Accepted: 12/22/2015] [Indexed: 11/30/2022] Open
Abstract
Objectives A sphenoid sinus fungal ball is a rare disease that can cause visual disturbances. Most afflicted patients remain in an indolent state. However, once the visual disturbance has occurred, the recovery rate is very low. The purpose of this study was to overview the clinical characteristics of patients with a sphenoid sinus fungal ball and ascertain factors possibly related to the occurrence of a visual disturbance. Methods We retrospectively reviewed the medical records of all patients who underwent endoscopic sinus surgery for a sphenoid sinus fungal ball at our hospital. We enrolled 47 patients in this study. Results Old age and a female predominance were noted. Nasal symptoms were the most common symptom. Eight patients showed visual disturbances. We also compared the clinical characteristics between patients with and without visual disturbances in univariate analysis. Old age, underlying diabetes mellitus, and a sphenoid sinus wall defect visible by computed tomography were factors significantly related to the occurrence of visual disturbances. But only sphenoid sinus wall defect showed significance in multivariate analysis. Conclusion It is important to prevent complications, such as visual disturbance, in patients with a sphenoid sinus fungal ball. This study describes an early surgical treatment that may be required for patients with a sphenoid sinus fungal ball and particularly patients with a sphenoid sinus wall defect.
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Affiliation(s)
- Jong Sei Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Byung Kil Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sang Duk Hong
- Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyung Jin Kim
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyo Yeol Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Jiang Z, Zhang K, Huang W, Yuan Q. A Preliminary Study on Sinus Fungus Ball with MicroCT and X-Ray Fluorescence Technique. PLoS One 2016; 11:e0148515. [PMID: 26978273 PMCID: PMC4792473 DOI: 10.1371/journal.pone.0148515] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2015] [Accepted: 01/19/2016] [Indexed: 11/18/2022] Open
Abstract
Background Sinus fungus ball, an accumulation of fungal dense concretions, is a common disease in practice, and might cause fatal complications or lead to death once converted into invasive type. Early preoperative diagnosis of this disease can lead to appropriate treatment for patients and prevent multiple surgical procedures. Up to now, the diagnostic criteria of sinus fungus ball have been defined and computed tomography (CT) scan was considered as a valuable preoperative diagnostic tool. However, the sensitivity of clinical CT is only about 62%. Thus, investigating the factors which influence sensitivity is necessary for clinical CT to be a more valuable preoperative diagnosis tool. Furthermore, CT scan usually presents micro-calcifications or spots with metallic density in sinus fungus ball. Previous literatures show that there are some metallic elements such as calcium and zinc in fungus ball, and they concluded that endodontic treatment has a strong correlation with the development of maxillary sinus fungus ball and zinc ion was an exogenous risk factor. But the pathogenesis of sinus fungus ball still remains unclear because fungus ball can also develop in other non-maxillary sinuses or the maxillary sinus without root canal treatment. Is zinc ion the endogenous factor? Study on this point might be also helpful for investigating the pathogenesis of sinus fungus ball. In this paper, we tried to investigate the factors which influence the sensitivity of clinical CT by imaging sinus fungus ball with microCT. The origin of zinc ion was also studied through elements test for different fungal ball samples using x-ray fluorescence technique. Methods Specimens including fungal ball material and sinus mucosa from patients confirmed by pathological findings were extracted after surgery. All fungal ball specimens came from sphenoid sinus, ethmoidal sinus and maxillary sinus with or without previous endodontic treatment respectively. All of them were imaged by microCT with spatial resolution up to 5μm to acquire three-dimensional structure, and then the heavy metal elements were detected with x-ray fluorescence spectrometer analysis. Result High concentration of zinc and calcium were detected in all fungal ball specimens compared to sinus mucosa membrane. Particles with different size varied from disperse to density, which have similar shape to the result of clinical CT but with different size, were found in three-dimensional reconstruction results of microCT. Conclusions Spatial resolution is an influent factor of clinical CT sensitivity for sinus fungus ball. Improving the resolution of clinical CT will help to improve its sensitivity. Besides iatrogenic endodontic materials, endogenous metal elements of zinc and calcium might associate with the growth of fungal ball and the micro-calcifications or spots with metallic density of CT imaging.
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Affiliation(s)
- Zidong Jiang
- Department of Otolaryngology, Peking Union Medical College Hospital, Beijing, China
- * E-mail: (ZJ); (QY)
| | - Kai Zhang
- Institute of High Energy Physics, Chinese Academy of Science, Beijing, China
| | - Wanxia Huang
- Institute of High Energy Physics, Chinese Academy of Science, Beijing, China
| | - Qingxi Yuan
- Institute of High Energy Physics, Chinese Academy of Science, Beijing, China
- * E-mail: (ZJ); (QY)
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Successful living-donor liver transplantation after treatment of sinus aspergillosis by endoscopic mycetoma removal and sinus drainage. Surg Case Rep 2016; 1:29. [PMID: 26943397 PMCID: PMC4747917 DOI: 10.1186/s40792-015-0029-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2014] [Accepted: 02/18/2015] [Indexed: 12/05/2022] Open
Abstract
A 47-year-old female was admitted to our hospital for treatment of end-stage liver disease due to primary biliary cirrhosis. Preoperative routine nasal sinus magnetic resonance imaging revealed diffuse inflammatory mucosal hyperplasia of the right maxillary sinus and mycetoma without invasive fungal sinusitis. Aspergillus antigen was positive. With a diagnosis of sinus aspergillosis, endoscopic sinus drainage and removal of mycetoma were performed. After endoscopic treatment, the right maxillary sinus was irrigated using amphotericin B for 2 weeks and then treated by iodine with gentamicin and ketoconazole for 6 weeks. At 1 month after endoscopic treatment, the mycetoma had disappeared. At 3 months after the endoscopic treatment, the patient underwent living-donor liver transplantation using the left and caudate lobe of her daughter. The patient made a satisfactory recovery and was discharged on 19 days after transplant. As of 44 months after transplant, she remains well without recurrence of aspergillosis.
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49
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Scolozzi P, Perez A, Verdeja R, Courvoisier DS, Lombardi T. Association between maxillary sinus fungus ball and sinus bone grafting with deproteinized bovine bone substitutes: a case-control study. Oral Surg Oral Med Oral Pathol Oral Radiol 2016; 121:e143-7. [PMID: 26972422 DOI: 10.1016/j.oooo.2016.01.022] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2015] [Revised: 12/20/2015] [Accepted: 01/28/2016] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To evaluate the association between sinus bone graft and the development of fungus ball (FB) of the maxillary sinus. STUDY DESIGN The charts of all patients seen for surgical treatment of maxillary sinus FB following sinus bone grafting between 2006 and 2014 were reviewed. The charts of 49 participants were selected from our internal registry for comparison as controls. The association between FB and age, gender, smoking habits, associated co-morbidities, and bone grafting material was evaluated. FB of the maxillary sinus was estimated by using an odds ratio with a Yates' correction. P values were computed using Fisher's exact test, and the statistical significance was set at a P value < .05. RESULTS All 13 cases (100%) with FB of the maxillary sinus had received anorganic bovine bone as the bone substitute (P = .0001). There were significantly more women in the case group than in the control group (84.6% in the cases vs 40.8% in the controls; P = .01). CONCLUSIONS This study demonstrated a significant association between a specific deproteinized bovine bone substitute use as sinus bone graft material and subsequent development of FB of the maxillary sinus.
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Affiliation(s)
- Paolo Scolozzi
- Head, Division of Oral and Maxillofacial Surgery, Department of Surgery, University of Geneva & University Hospitals of Geneva, Geneva, Switzerland.
| | - Alexandre Perez
- Resident, Division of Oral and Maxillofacial Surgery, Unit of Oral Surgery and Implantology, Department of Surgery, University of Geneva & University Hospitals of Geneva, Geneva, Switzerland
| | - Raul Verdeja
- Maxillofacial Surgeon, Private Practice, Fribourg, Switzerland
| | - Delphine S Courvoisier
- Biostatistician, CRC & Division of Clinical Epidemiology, Department of Health and Community Medicine, University of Geneva & University Hospitals of Geneva, Geneva, Switzerland
| | - Tommaso Lombardi
- Head, Division of Oral and Maxillofacial Surgery, Unit of Oral and Maxillofacial Medicine and Pathology, Department of Surgery, University of Geneva & University Hospitals of Geneva, Geneva, Switzerland
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Meier JC, Scangas GA, Remenschneider AK, Sadow P, Chambers K, Dedmon M, Lin DT, Holbrook EH, Metson R, Gray ST. Skull base erosion and associated complications in sphenoid sinus fungal balls. ALLERGY & RHINOLOGY 2016; 7:227-232. [PMID: 28683250 PMCID: PMC5244283 DOI: 10.2500/ar.2016.7.0182] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Sphenoid sinus fungal balls (SSFB) are rare entities that can result in serious orbital and intracranial complications. There are few published reports of complications that result from SSFB. OBJECTIVE To review the incidence of skull base erosion and orbital or intracranial complications in patients who present with SSFB. METHODS A retrospective review was performed of all the patients with SSFB who were treated at the Massachusetts Eye and Ear Infirmary from 2006 to 2014. Presenting clinical data, radiology, operative reports, pathology, and postoperative course were reviewed. RESULTS Forty-three patients with SSFB were identified. Demographic data were compared between patients with (39.5%) and those without (61.5%) skull base erosion. Two patients underwent emergent surgery for acute complications of SSFB (one patient with blindness, one patient who had a seizure). Both patients with acute complications had evidence of skull base erosion, whereas no patients with an intact skull base developed an orbital or intracranial complication (p = 0.15). All the patients were surgically managed via an endoscopic approach. CONCLUSION SSFBs are rare but may cause significant skull base erosion and potentially severe orbital and intracranial complications if not treated appropriately. Endoscopic sphenoidotomy is effective in treating SSFB and should be performed emergently in patients who presented with associated complications.
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Affiliation(s)
- Josh C Meier
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boson, Massachusetts, USA
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