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Sriramajayam L, Kaur R, Dhakad MS, Gulati A. Antifungal Resistance Profile of Fungal Isolates from Fungal Rhinosinusitis Patients: A Study from Tertiary Care Hospital. J Lab Physicians 2023; 15:488-492. [PMID: 37780889 PMCID: PMC10539057 DOI: 10.1055/s-0043-1764484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 01/16/2023] [Indexed: 04/07/2023] Open
Abstract
Objective Fungal rhinosinusitis is on the rise worldwide and it is endemic especially in North India. The main purpose of this study was to determine the antifungal resistance profile of fungal isolates from the cases of fungal rhinosinusitis. Methods Antifungal susceptibility testing of isolated fungi to fluconazole, amphotericin B, itraconazole, and voriconazole was determined by standard CLSI broth microdilution method. Results Sixty-eight fungal isolates of Aspergillus spp . ( n = 49), Rhizopus spp. ( n = 9), Candida spp . ( n = 4), Penicillium spp . ( n = 2), Mucor spp . ( n = 2), Bipolaris spp . ( n = 1), and Alternaria spp . ( n = 1) were obtained from 60 different clinical samples as exudate from nasal mucosa ( n = 28), allergic mucin ( n = 8), nasal lavage ( n = 2), tissue biopsy from nasal polyps ( n = 14), and intraoperative nasal mucosa ( n = 8). Of the 68 isolates, 75% were resistant to fluconazole, 13.23% were resistant to itraconazole, 2.94% to amphotericin B, and none were resistant to voriconazole. Aspergillus flavus (5%) was the only fungi found resistant to amphotericin B, while against itraconazole, A. flavus (7.5%) and A. niger (100%) were found resistant. All the isolates of A. flavus , A. fumigatus , A. niger , and Penicillium spp. were resistant to fluconazole. Conclusion Although amphotericin B stills remains to be the most effective drug, more prospective studies are needed for the requirement of knowledge of the sensitivity pattern for optimal treatment and reduction in morbidity in the long run.
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Affiliation(s)
- Lavanya Sriramajayam
- Department of Microbiology, Maulana Azad Medical College, New Delhi, India
- Department of Microbiology, PSG Institute of Medical Sciences and Research, Coimbatore, Tamil Nadu, India
| | - Ravinder Kaur
- Department of Microbiology, Maulana Azad Medical College, New Delhi, India
- Department of Microbiology, Lady Hardinge Medical College & Associated Hospitals, New Delhi, India
| | - Megh Singh Dhakad
- Department of Microbiology, Maulana Azad Medical College, New Delhi, India
- Department of Microbiology, Lady Hardinge Medical College & Associated Hospitals, New Delhi, India
| | - Achal Gulati
- Department of ENT, Maulana Azad Medical College & Associated Hospitals, New Delhi, India
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Alrayes N, Alhumaizi A, Alomair A, Simsim R. Rhinolith Misdiagnosed as Fungal Mucin. Cureus 2023; 15:e46648. [PMID: 37937012 PMCID: PMC10627519 DOI: 10.7759/cureus.46648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/05/2023] [Indexed: 11/09/2023] Open
Abstract
Foreign body insertion inside the nose is not uncommon in pediatric age groups. It can pass unnoticed by parents, sometimes underdiagnosed or incompletely removed by a clinician. In another scenario, it may be incidentally discovered by imaging during dental workups commonly. This foreign body acts like a nidus for a rhinolith, as it gets calcified over years and becomes like a stone, causing unilateral nasal symptoms. Herein, we present a case of a young female with a rhinolith mistaken for fungal mud. We aim to emphasize this rare clinical condition that, if left unperceived, may lead to complications including, but not limited to, sinusitis, pressure necrosis to the surrounding structure causing septal perforation, or naso-palatal fistula.
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Affiliation(s)
- Nuha Alrayes
- Otolaryngology-Head and Neck Surgery, King Abdullah bin Abdulaziz University Hospital, Riyadh, SAU
| | - Abdulrahman Alhumaizi
- Otolaryngology-Head and Neck Surgery, King Abdullah bin Abdulaziz University Hospital, Riyadh, SAU
| | - Alanoud Alomair
- Clinical Sciences, Princess Nourah bint Abdulrahman University, Riyadh, SAU
| | - Rehab Simsim
- Clinical Sciences, Princess Nourah bint Abdulrahman University, Riyadh, SAU
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Bapodra MK, Navadiya AJ, Baxi SN, Gohil MR, Parmar PK. Rapid Diagnosis and Epidemiology of Fungal Rhinosinusitis in PostCOVID-19 Patients. J Microsc Ultrastruct 2023; 11:237-241. [PMID: 38213651 PMCID: PMC10779442 DOI: 10.4103/jmau.jmau_63_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 08/28/2021] [Accepted: 09/29/2021] [Indexed: 01/19/2023] Open
Abstract
Background Fungal rhinosinusitis (FRS) cases are not exiguous for the world. However, their spike as a postCOVID sequelae has alarmed the world, especially India. Adding to the woes is the high mortality rate and poor prognosis associated with acute invasive fungal rhinosinusitis (AIFR) in such immunocompromised patients. In such a scenario, early and precise diagnosis of AIFR is what a patient and physician banks upon. KOH and histopathology are the two frontline investigations for the diagnosis of FRS. Our study aimed at analyzing the cases of FRS by histopathology and comparing these with KOH. Study Design and Materials and Methods Prospective longitudinal study including suspected postCOVID FRS patients over a period of 1.5 months. Their clinical, histopathological, and KOH findings were then correlated. Results About 72.5% clinically suspected fungal infection specimens were found to be positive for fungal elements on histopathology. Of these, only 30 cases were positive by KOH mount. Maximum patients belonged to 40-70 years of age; males (67%) more than females. Sites involved were paranasal sinuses (100%), nasal (88%), and orbital (25%). Histopathology revealed mucormycosis (100%) and aspergillosis (16%). Angioinvasion was identified in 38% of the mucormycosis cases. Conclusion In a state of crisis, when the gold standard for fungal identification i.e., culture can take as many as 21 days for final report and early and judicious antifungal treatment is sine qua non of recovery, histopathology has proved to be better than KOH as far as early and precise diagnosis of fungal elements and their invasion is concerned.
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Affiliation(s)
- Mayuri K. Bapodra
- Department of Pathology, GMC and Sir T Hospital, Bhavnagar, Gujarat, India
| | | | - Seema N. Baxi
- Department of Pathology, GMC and Sir T Hospital, Bhavnagar, Gujarat, India
| | | | - Pankita K. Parmar
- Department of Pathology, GMC and Sir T Hospital, Bhavnagar, Gujarat, India
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Kakuno S, Imoto W, Teranishi Y, Kakeya H. Lomentospora prolificans-induced Invasive Fungal Sinusitis. Intern Med 2023; 62:2761-2762. [PMID: 36642520 PMCID: PMC10569913 DOI: 10.2169/internalmedicine.1074-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 11/13/2022] [Indexed: 01/15/2023] Open
Affiliation(s)
- Shigeki Kakuno
- Department of Infection Control Science, Osaka Metropolitan University Graduate School of Medicine, Japan
- Department of Infectious Disease Medicine, Osaka Metropolitan University Hospital, Japan
- Department of Infection Control and Prevention, Osaka Metropolitan University Hospital, Japan
| | - Waki Imoto
- Department of Infection Control Science, Osaka Metropolitan University Graduate School of Medicine, Japan
- Department of Infectious Disease Medicine, Osaka Metropolitan University Hospital, Japan
- Department of Infection Control and Prevention, Osaka Metropolitan University Hospital, Japan
| | - Yuichi Teranishi
- Department of Otorhinolaryngology, Osaka Metropolitan University Graduate School of Medicine, Japan
| | - Hiroshi Kakeya
- Department of Infection Control Science, Osaka Metropolitan University Graduate School of Medicine, Japan
- Department of Infectious Disease Medicine, Osaka Metropolitan University Hospital, Japan
- Department of Infection Control and Prevention, Osaka Metropolitan University Hospital, Japan
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Cha CH, Chen WC, Wang YM, Wu SC, Chiu TJ, Wu CN, Wee Y, Wang CS, Yang YH, Luo SD. Comparison of Fungal and Non-Fungal Rhinosinusitis by Culture-Based Analysis. J Pers Med 2023; 13:1368. [PMID: 37763136 PMCID: PMC10532977 DOI: 10.3390/jpm13091368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 09/04/2023] [Accepted: 09/08/2023] [Indexed: 09/29/2023] Open
Abstract
BACKGROUND Incidence of fungal rhinosinusitis has increased in recent few years. We investigated the differences in microbiological findings between patients with fungal and non-fungal rhinosinusitis by growing microbiological cultures from samples obtained from sinus surgery. METHODS Using the Chang Gung Research Database, we enrolled all chronic rhinosinusitis (CRS) patients who had ever undergone sinus surgery from 2001 to 2019 and had microbiological culture during sinus surgery. Enrolled patients were divided into fungal and non-fungal groups, based on fungal culture and surgical pathology. RESULTS A total of 898 patients were diagnosed with fungal rhinosinusitis and 2884 with non-fungal rhinosinusitis. The fungal group had a higher age distribution (56.9 ± 13.1 vs. 47.0 ± 14.9), a larger proportion of females (62.4% vs. 37.0%), more unilateral lesions (80.4% vs. 41.6%), a lower incidence of the need for revision surgery (3.6% vs. 6.0%, p = 0.004), and a higher proportion of Pseudomonas aeruginosa in the culture (14.3% vs. 4.6%, p < 0.001). CONCLUSIONS This large-scale study showed that Pseudomonas aeruginosa are more commonly found in patients with fungal rhinosinusitis and in patients who needed revision surgery, suggesting that efforts aimed at eliminating Pseudomonas are needed in order to improve the disease outcomes of patients with fungal rhinosinusitis.
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Affiliation(s)
- Chih-Hung Cha
- Department of Otolaryngology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung 833, Taiwan; (C.-H.C.)
| | - Wei-Chih Chen
- Department of Otolaryngology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung 833, Taiwan; (C.-H.C.)
| | - Yu-Ming Wang
- Department of Radiation Oncology and Proton & Radiation Therapy Center, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung 833, Taiwan
| | - Shao-Chun Wu
- Department of Anesthesiology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung 833, Taiwan
- Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
| | - Tai-Jan Chiu
- Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
- Department of Hematology-Oncology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung 833, Taiwan
| | - Ching-Nung Wu
- Department of Otolaryngology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung 833, Taiwan; (C.-H.C.)
| | - Yinshen Wee
- Department of Pathology, University of Utah, Salt Lake City, UT 84112, USA
| | - Ching-Shuen Wang
- School of Dentistry, College of Oral Medicine, Taipei Medical University, Taipei 110, Taiwan;
| | - Yao-Hsu Yang
- Department of Traditional Chinese Medicine, Chang Gung Memorial Hospital, Chiayi 613, Taiwan
- Health Information and Epidemiology Laboratory of Chang Gung Memorial Hospital, Chiayi 613, Taiwan
- School of Traditional Chinese Medicine, College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
| | - Sheng-Dean Luo
- Department of Otolaryngology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung 833, Taiwan; (C.-H.C.)
- Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
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Alharbi SM, Alzarei A, Ardi T, Saleh NF, Al Hamoud M, Al Malwi K, Asiri M, Ahmed S. Orbital Complications of Extensive Allergic Fungal Rhinosinusitis: A Case Report. Cureus 2023; 15:e39555. [PMID: 37378227 PMCID: PMC10291911 DOI: 10.7759/cureus.39555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/26/2023] [Indexed: 06/29/2023] Open
Abstract
Allergic fungal rhinosinusitis is an immunoglobulin E-mediated disease caused by fungal antigens. Orbital complications due to bone erosion by the expanding, mucin-filled sinuses are considered uncommon, but they require immediate intervention. We report a successful management of a complicated case of allergic fungal rhinosinusitis in a 16-year-old female complaining of progressive nasal obstruction for four months, who only sought medical advice after developing proptosis and visual affection. The patient underwent surgical debridement and corticosteroid therapy followed by dramatic improvement of proptosis and vision. The differential diagnosis of proptosis with sinusitis must include allergic fungal rhinosinusitis.
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Affiliation(s)
- Salmah M Alharbi
- Otorhinolaryngology-Head and Neck Surgery Department, Aseer Central Hospital, Abha, SAU
| | - Ali Alzarei
- Otorhinolaryngology-Head and Neck Surgery Department, Aseer Central Hospital, Abha, SAU
| | - Talat Ardi
- Otorhinolaryngology-Head and Neck Surgery Department, Aseer Central Hospital, Abha, SAU
| | - Norah F Saleh
- Family Medicine Department, Alqabel Primary Health Care Center, Ministry of Health, Abha, SAU
| | - Mohammed Al Hamoud
- Otorhinolaryngology-Head and Neck Surgery Department, Aseer Central Hospital, Abha, SAU
| | - Khalid Al Malwi
- Otorhinolaryngology-Head and Neck Surgery Department, Aseer Central Hospital, Abha, SAU
| | - Mohammed Asiri
- Otorhinolaryngology-Head and Neck Surgery Department, Aseer Central Hospital, Abha, SAU
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Manivel MK, Vivek V, Ganesh K. Radiation-Induced Papillary Meningioma: A Case Report. Asian J Neurosurg 2022; 17:664-667. [PMID: 36570756 PMCID: PMC9771624 DOI: 10.1055/s-0042-1758847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Meningiomas are the most common tumors that develop following cranial radiotherapy. They have a shorter latency period and an aggressive behavior when compared with spontaneously occurring meningiomas. We report a 69-year-old male who underwent high-dose radiotherapy for recurrent pituitary adenoma and later developed temporal high-grade meningioma which was excised. Patient developed tumor bed bleed twice in the postoperative period and succumbed subsequently to the disease. After a thorough review of literature, this may be the second case of radiation-induced grade III papillary meningioma which has been reported.
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Affiliation(s)
- Manoj Kumar Manivel
- Department of Neurosurgery, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India,Address for correspondence Manoj Kumar Manivel, MBBS No. 42, Sakthi nagar, 4th Avenue, Nolambur, Mogappair west, Chennai, 600095, Tamil NaduIndia
| | - Visweswaran Vivek
- Department of Neurosurgery, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India
| | - Krishnamurthy Ganesh
- Department of Neurosurgery, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India
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Chemudugunta R, Bindu C, Indrani K, Ramesh BH. Study of mucormycosis in COVID-19 patients in a tertiary care center, Raichur Institute of Medical Sciences, Raichur. J Oral Maxillofac Pathol 2022; 26:593. [PMID: 37082037 PMCID: PMC10112096 DOI: 10.4103/jomfp.jomfp_425_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 01/10/2022] [Indexed: 04/22/2023] Open
Abstract
Context Coronavirus disease-2019 (COVID-19), caused by severe acute respiratory syndrome (SARS-CoV-2), has become an emergency global public health issue. Disease pattern of COVID-19 ranges from mild to life-threatening pneumonia with associated bacterial and fungal coinfections. Due to associated comorbidities (e.g., diabetes mellitus and chronic obstructive pulmonary disease) and immunocompromised conditions (e.g., corticosteroid therapy), these patients are prone to develop severe opportunistic infections. Aims The aim of this study was to investigate the incidence of fungal coinfection of hospitalized patients with COVID-19 infection (SARS-CoV-2) in RIMS, Raichur. Materials and Methods Our study included 94 patients with invasive fungal infection who presented with either COVID-19 infection or had recovered from COVID-19 infection. Tissue samples from suspected sites were received in formalin for histopathological examination, and these were stained stains with hematoxylin and eosin and with periodic acid-Schiff/Gomori's methenamine silver wherever required. Results A total of 94 biopsies were received with clinical suspicion of mucormycosis. Out of these, 52 (55.3%) were positive for mucormycosis and 42 (44.7%) were negative. Out of 52 positive cases, 46 (88.4%) were males and 6 (11.6%) were females. The highest number of cases was seen in age group of 51-60 years (26.92%). Out of the 52 positive cases, KOH mount was positive for fungal elements in 8 cases and negative for fungal elements in 29 cases. Conclusions Uncontrolled diabetes and overzealous use of steroids are two of the main factors aggravating the incidence of mucormycosis in COVID-19 patients. Early surgical intervention, histopathological confirmation and rapid and judicious intravenous antifungal treatment should be initiated for better patient outcomes.
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Affiliation(s)
- Rajkumar Chemudugunta
- Department of Pathology, Raichur Institute of Medical Sciences, Raichur, Karnataka, India
| | - Channabasappa Bindu
- Department of Oral and Maxillofacial Surgery, M R Ambedkar Dental College, Bengaluru, Karnataka, India
| | - K. Indrani
- Department of Pathology, Raichur Institute of Medical Sciences, Raichur, Karnataka, India
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Mazzai L, Anglani M, Giraudo C, Martucci M, Cester G, Causin F. Imaging features of rhinocerebral mucormycosis: from onset to vascular complications. Acta Radiol 2022; 63:232-244. [PMID: 33615823 DOI: 10.1177/0284185120988828] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Rhinocerebral mucormycosis (RCM) may result in severe intracranial ischemic and hemorrhagic lesions. Both computed tomography (CT) and magnetic resonance imaging (MRI) play an essential role in the diagnosis of RCM, but whereas CT is better for assessing bone erosion, MRI is superior in evaluating soft tissue, intraorbital extension, and in assessing intracranial and vascular invasion. Specific CT and MRI techniques, such as CT angiography or enhanced MR angiography, and more advanced MRI sequences such as gadolinium-3D Black Blood imaging, contribute to the assessment of the extension of vascular invasion.In this pictorial review, we describe specific CT and MRI signs of RCM, mainly focusing on its life-threatening complications due to vascular involvement.
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Affiliation(s)
- Linda Mazzai
- Neuroradiology UOC, Department of Diagnostics, San Bortolo Vicenza Hospital, Vicenza, Italy
| | - Mariagiulia Anglani
- Neuroradiology UOC, Neuroscience Department, Padova University Hospital, Padova, Italy
| | - Chiara Giraudo
- Institute of Radiology, Department of Medicine (DiMED), University of Padova, Padova, Italy
| | - Matia Martucci
- Neuroradiology UOC, Neuroscience Department, Padova University Hospital, Padova, Italy
| | - Giacomo Cester
- Neuroradiology UOC, Neuroscience Department, Padova University Hospital, Padova, Italy
| | - Francesco Causin
- Neuroradiology UOC, Neuroscience Department, Padova University Hospital, Padova, Italy
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Tunç O, Yazıcı A, Aytaç İ, Tümüklü K, Akşamoğlu M. Value of Hounsfield Units in the Evaluation of Isolated Sphenoid Sinus Lesions. Allergy Rhinol (Providence) 2021; 12:21526567211032560. [PMID: 34457372 PMCID: PMC8387604 DOI: 10.1177/21526567211032560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Radiologic findings of fungal sinus disease are generally opacification in paranasal computed tomography (CT) images. The Hounsfield unit (HU) is a standardized objective unit that is also suitable for measuring remodeling and opacifications on CT scans of bone sections of patients with chronic rhinosinusitis. We hypothesized that HU values could provide valuable information in isolated sphenoid sinus lesions before surgery. Between 2012 and 2019, 35 patients underwent functional endoscopic sinus surgery for sphenoid sinus lesions. Tissues obtained from the sphenoid sinus were divided into two groups, fungal and nonfungal, according to the findings of histopathologic examinations. HU values were measured in sphenoid sinus sections on paranasal CT scans of these two groups. Differences in mean and maximum HU values between the two groups were statistically significant (p < .05). The maximum HU values calculated from the sphenoid sinus were 435.08 and 196.23 (p ≤ .05) in the fungal group and nonfungal group, respectively. The mean HU values calculated from the sphenoid sinus were 64.31 and 29 (p ≤ .05) in the fungal and nonfungal groups, respectively. At the maximum cutoff value of 241, the sensitivity and specificity of the HU maximum were 84.6% and 77.3%, respectively. At the mean cutoff value of 41.5, the sensitivity and specificity of the HU mean were 76.9% and 86.4%, respectively. HU is an objective value used in radiographic density measurement. The HU values were higher in fungal lesions than in nonfungal inflammations, and they are useful in preoperative measurement.
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Shipman P, Highland J, Witt B, Alt J. Non-invasive Fungal Sinusitis as a Complication of a Steroid-Eluting Stent Following Endoscopic Sinus Surgery: A Case Report. Ann Otol Rhinol Laryngol 2021; 131:678-682. [PMID: 34350789 DOI: 10.1177/00034894211036844] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Steroid eluting stents have proven to be a highly useful adjunctive therapy for chronic rhinosinusitis (CRS) and play an important role in the treatment of many inflammatory diseases of the sinuses. Few reports of adverse events were reported in clinical trials and are described in the literature. However, we describe the first known case of an immunocompetent patient developing non-invasive fungal tissue infection as a sequelae of stent-related tissue necrosis requiring surgical debridement. METHODS A 69-year-old immunocompetent male with CRS had Propel™ stents placed in the bilateral frontal sinus outflow tracts during revision endoscopic sinus surgery. He presented 2 weeks post-operatively with severe facial pain without vision changes, fevers, mental status changes, or evidence of cranial neuropathies. On rigid nasal endoscopy, necrotic tissue and gross fungal elements were visualized in the left frontal sinus outflow tract at the area of previous steroid stent position. RESULTS The patient was taken for urgent endoscopic sinus surgery and debridement given significant symptoms and concern for invasive fungal infection. A revision left maxillectomy, ethmoidectomy, and draf 2b frontal sinus drillout were performed, with healthy bleeding tissue encountered beneath necrotic tissue. Pathology revealed tissue necrosis, exudative lumenal debris, and extensive fungal elements with no evidence of tissue invasion, and cultures yielded growth of aspergillus niger. The patient's symptoms improved significantly on post-operative day 1, he had normal post-operative changes at 2 weeks following debridement, and had no recurrence of fungal infection with complete healing at 4 months. CONCLUSION While likely rare, steroid-eluting stents may pose a risk of saprophytic tissue infection as a result of tissue necrosis and local immunosuppression. Caution should be taken in using these devices in immunocompromised patients.
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Affiliation(s)
- Paige Shipman
- Division of Otolaryngology, Department of Surgery, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Julie Highland
- Division of Otolaryngology, Department of Surgery, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Benjamin Witt
- Department of Pathology, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Jeremiah Alt
- Division of Otolaryngology, Department of Surgery, University of Utah School of Medicine, Salt Lake City, UT, USA
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12
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Nair AG, Adulkar NG, D'Cunha L, Rao PR, Bradoo RA, Bapaye MM, Kothari A, Dave TV, Shinde CA. Rhino-orbital mucormycosis following COVID-19 in previously non-diabetic, immunocompetent patients. Orbit 2021; 40:499-504. [PMID: 34338124 DOI: 10.1080/01676830.2021.1960382] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
PURPOSE To report a series of 13 immunocompetent patients who developed new-onset uncontrolled diabetes mellitus (DM) following COVID-19 infection and presented as rhino-orbital mucormycosis (ROM). METHOD Retrospective study. RESULTS A total of 127 patients of COVID-19 Associated Mucormycosis (CAM) were evaluated at four centres in India. All patients underwent endoscopic sinus debridement surgery and received systemic amphotericin-B therapy. Five patients (5/13; 38.4%) received retrobulbar amphotericin-B injections. Orbital exenteration was performed in advanced orbital involvement or progression of orbital disease in spite of maximal medical therapy. In his cohort, 13/127 (10.2%) patients presented with new onset DM, where one patient had bilateral disease. The mean age was 35.9 years (range: 20-51 years) and the mean duration from diagnosis of COVID-19 to the diagnosis of mucormycosis was 14.2 days. While 7/13 (53.8%) of the patients received systemic corticosteroids during the course of their treatment for COVID-19, six patients received no steroids or immunomodulators. The mean follow-up period was 9.2 weeks (range: 3-18 weeks) following discharge. Life salvage was possible in 100% of the cases. While overall globe salvage was possible in 42.8% (6/14 eyes), the globe could be preserved in 4/5 patients who received retrobulbar amphotericin-B injections. CONCLUSIONS Those involved in the care of COVID-19 patients should be aware about the possibility of recent-onset DM, even in patients without a history of corticosteroid therapy. Rarely, recent-onset DM following COVID-19 may present as rhino-orbital mucormycosis, which requires aggressive surgical and medical intervention.
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Affiliation(s)
- Akshay Gopinathan Nair
- Department of Ophthalmology, Lokmanya Tilak Municipal Medical College & General Hospital, Sion, Mumbai, India.,Ophthalmic Plastic Surgery and Ocular Oncology Services, Aditya Jyot Eye Hospital, Wadala, Mumbai, India.,Ophthalmic Plastic Surgery and Ocular Oncology Services, Advanced Eye Hospital & Institute, Navi Mumbai, India.,Oculoplastics and Orbital Surgery, R Jhunjhunwala Sankara Eye Hospital, Panvel, India
| | | | - Lynn D'Cunha
- Department of Ophthalmology, Lokmanya Tilak Municipal Medical College & General Hospital, Sion, Mumbai, India
| | - Priyanka R Rao
- Department of Ophthalmology, Lokmanya Tilak Municipal Medical College & General Hospital, Sion, Mumbai, India
| | - Renuka A Bradoo
- Department of Otorhinolaryngology, Lokmanya Tilak Municipal Medical College & General Hospital, Sion, Mumbai, India
| | | | | | - Tarjani V Dave
- Ophthalmic Plastic Surgery and Ocular Oncology Services, L V Prasad Eye Institute, Hyderabad, India
| | - Chhaya A Shinde
- Department of Ophthalmology, Lokmanya Tilak Municipal Medical College & General Hospital, Sion, Mumbai, India
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13
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Almazrouei A, Sabri AM. Nasal-type T-cell lymphoma referred as fungal rhinosinusitis: Case report. Clin Case Rep 2021; 9:e04669. [PMID: 34457291 PMCID: PMC8380123 DOI: 10.1002/ccr3.4669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 06/26/2021] [Accepted: 07/06/2021] [Indexed: 11/08/2022] Open
Abstract
NKTCL is a rare and destructive midline tumor that can be easily misdiagnosed as other more common inflammatory processes. The differential diagnosis of NKTCL should always be kept in mind for any lesion of the paranasal sinuses with atypical presentation and nonresponsive to conventional treatments.
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Affiliation(s)
- Aaesha Almazrouei
- Department of OtorhinolaryngologySheikh Shakhbout Medical City Affiliated with Mayo ClinicAbu DhabiUAE
- SSMC HospitalAbu DhabiUAE
| | - Alain Michel Sabri
- Department of OtorhinolaryngologySheikh Shakhbout Medical City Affiliated with Mayo ClinicAbu DhabiUAE
- SSMC HospitalAbu DhabiUAE
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14
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Park WB, Kim YJ, Park JS, Han JY, Lim HC. Complication and Salvage of Sinus Floor Elevation in the Maxillary Sinus With Asymptomatic and Noncalcified Fungus Colonization: A Case Report. J ORAL IMPLANTOL 2021; 47:242-248. [PMID: 32663302 DOI: 10.1563/aaid-joi-d-20-00127] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The present study aimed to report (1) the sequela of sinus floor elevation (SFE) in the posterior maxilla with severe sinus membrane thickening and an undiagnosed fungal colonization but a patent ostium and (2) a treatment course without implant removal. A 73-year-old woman underwent dental implant placement in the left posterior maxillary area. Although the patient was asymptomatic, severe sinus membrane thickening with Haller cells was observed on a radiographic examination, but the ostium was patent. After SFE and simultaneous implant placement, the patient developed acute sinusitis and was referred to an otolaryngologist. Functional endoscopic sinus surgery (FESS) was performed, resulting in resolution of the infection and salvage of the augmentation and the implant. The histopathologic examination revealed the fungal ball that could not be diagnosed on preoperative dental radiography. During the 2 years after the delivery of the final prosthesis, a significant reduction in membrane thickness was observed. The implants were functioning well. Clinicians should recognize fungal colonization as an etiology of sinus membrane thickening and provide proper pre- and postoperative management, including FESS.
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Affiliation(s)
- Won-Bae Park
- Department of Periodontology, School of Dentistry, Kyung Hee University, Private Practice in Periodontics and Implant Dentistry, Seoul, Korea
| | - Young-Jin Kim
- Nowon Eulji Medical Center, Eulji University, Private Practice in Otorhinolaryngology Clinic, Seoul, Korea
| | - Jung Soo Park
- Department of Periodontology, Korea University Anam Hospital, Seoul, Korea
| | - Ji-Young Han
- Department of Periodontology, Division of Dentistry, Hanyang University, College of Medicine, Seoul, Korea
| | - Hyun-Chang Lim
- Department of Periodontology, Periodontal-Implant Clinical Research Institute, School of Dentistry, Kyung Hee University, Seoul, Republic of Korea
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15
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Thakar A, Lal D. "Black fungus": a perspective on the coronavirus disease 2019 (COVID-19)-associated rhino-orbital mucormycosis epidemic in India. Int Forum Allergy Rhinol 2021; 11:1278-1279. [PMID: 34185968 PMCID: PMC8426824 DOI: 10.1002/alr.22855] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 06/02/2021] [Indexed: 11/12/2022]
Affiliation(s)
- Alok Thakar
- All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Devyani Lal
- Department of Otorhinolaryngology-Head and Neck Surgery, Mayo Clinic, Phoenix, Arizona, USA
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16
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Tyler MA, Lam K, Marino MJ, Yao WC, Schmale I, Citardi MJ, Luong AU. Revisiting the controversy: The role of fungi in chronic rhinosinusitis. Int Forum Allergy Rhinol 2021; 11:1577-1587. [PMID: 34076362 DOI: 10.1002/alr.22826] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 04/26/2021] [Accepted: 05/09/2021] [Indexed: 12/19/2022]
Abstract
In the last two decades, the development of culture-independent genomic techniques has facilitated an increased appreciation of the microbiota-immunity interactions and their role in a multitude of chronic inflammatory diseases such as chronic rhinosinusitis (CRS), asthma, inflammatory bowel disease and dermatitis. While the pathologic role of bacteria in chronic inflammatory diseases is generally accepted, the understanding of the role of fungi remains controversial. Chronic rhinosinusitis, specifically the phenotype linked to nasal polyps, represents a spectrum of chronic inflammatory diseases typically characterized by a type 2 immune response. Studies on the microbiota within sinus cavities from healthy and diseased patients have focused on the bacterial community, mainly highlighting the loss of diversity associated with sinus inflammation. Within the various CRS with nasal polyps (CRSwNP) phenotypes, allergic fungal rhinosinusitis presents an opportunity to investigate the role of fungi in chronic type 2 immune responses as well as the antifungal immune pathways designed to prevent invasive fungal diseases. In this review, we examine the spectrum of fungi-associated sinus diseases highlighting the interaction between fungal species and host immune status on disease presentation. With a focus on fungi and type 2 immune response, we highlight the current knowledge and its limitations of the sinus mycobiota along with cellular interactions and activated molecular pathways linked to fungi.
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Affiliation(s)
- Matthew A Tyler
- Department of Otolaryngology-Head and Neck Surgery, University of Minnesota School of Medicine, Minnesota, Minneapolis, USA
| | - Kent Lam
- Department of Otolaryngology-Head and Neck Surgery, Eastern Virginia Medical School, Virginia, Norfolk, USA
| | - Michael J Marino
- Department of Otorhinolaryngology, Mayo Clinic, Phoenix, Arizona, USA
| | - William C Yao
- Department of Otorhinolaryngology-Head and Neck Surgery, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Isaac Schmale
- Department of Otolaryngology-Head and Neck Surgery, University of Rochester, Rochester, New York, USA
| | - Martin J Citardi
- Department of Otorhinolaryngology-Head and Neck Surgery, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Amber U Luong
- Department of Otorhinolaryngology-Head and Neck Surgery, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas, USA.,Center for Immunology and Autoimmune Diseases, Institute of Molecular Medicine, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas, USA
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17
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Durand ML, Kitt TM, Song Y, Marty FM. Isavuconazole treatment of invasive fungal sinusitis: a post hoc analysis of the SECURE and VITAL trials. Clin Infect Dis 2021; 73:e1380-e1383. [PMID: 33914864 DOI: 10.1093/cid/ciab386] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Indexed: 12/26/2022] Open
Abstract
This post-hoc analysis of international phase III isavuconazole trials identified 50 patients (90% immunocompromised or diabetic) with invasive fungal sinusitis (88% mucormycetes, Aspergillus) who received isavuconazole as primary (33) or salvage (17) therapy for median 82 days (range 2-882). Overall survival was 82% at day 42, 70% at day 84.
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Affiliation(s)
- Marlene L Durand
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA
| | | | - Yi Song
- Astellas Pharma Global Development, Inc, Northbrook, IL
| | - Francisco M Marty
- Division of Infectious Diseases, Brigham and Women's Hospital, Boston, MA
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18
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Abstract
OBJECTIVES The most common type of noninvasive fungal rhinosinusitis is fungus ball (FB), which usually involves a solitary paranasal sinus. Multiple fungus balls (MFBs) are rarely reported in literature. The purpose of this study was to analyze and compare the clinical features of MFBs and solitary fungus ball (SFB). METHODS We retrospectively investigated consecutive cases of FB between 2001 and 2018 and compared the clinical records of SFB with MFBs with respect to demographics, clinical features, location, radiological findings, and operative outcome. RESULTS A total of 440 SFB and 43 MFBs cases were included in the study. The mean age was 55.3 ± 13.3 and 60.6 ± 10.9 years, respectively (P = .011). The incidence of MFBs obviously increased from 2001 to 2018. The clinical symptoms and laboratory examination were similar. On computed tomography images, complete opacification, septal deviation, Haller cells, and obstruction of ostiomeatal complex were more common (P < .05). The incidence of SFB on the left and right sides was similar, while MFBs were seen to involve both sides in 74.4%. CONCLUSIONS Compared with SFB, MFBs showed some special characteristics. The MFBs affected older patients showed wide range of lesions and complex anatomy. Surgical technique is very important. Much more attention should be paid to this not so uncommon disease during the perioperative period.
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Affiliation(s)
- Hui Li
- Department of Otorhinolaryngology Head and Neck Surgery, 71185Peking University People's Hospital, Beijing, People's Republic of China
| | - Yu-Xiao Wu
- Department of Otorhinolaryngology Head and Neck Surgery, 71185Peking University People's Hospital, Beijing, People's Republic of China
| | - Min Wang
- Department of Otorhinolaryngology Head and Neck Surgery, 71185Peking University People's Hospital, Beijing, People's Republic of China
| | - Zhi-Min Xing
- Department of Otorhinolaryngology Head and Neck Surgery, 71185Peking University People's Hospital, Beijing, People's Republic of China
| | - Lin Han
- Department of Otorhinolaryngology Head and Neck Surgery, 71185Peking University People's Hospital, Beijing, People's Republic of China
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Bhatkar S, Mahesh KV, Sachdeva J, Goel A, Goyal MK, Takkar A, Ray S, Shree R, Balaini N, Singh P, Singh R, Patnaik SN, Prabhat N, Lal V. Magnetic resonance imaging (MRI) versus computed tomographic scan (CT scan) of brain in evaluation of suspected cavernous sinus syndrome. Neuroradiol J 2020; 33:501-507. [PMID: 33283671 DOI: 10.1177/1971400920970921] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND AND PURPOSE The cavernous sinus is a unique region owing to anatomical factors and the pathologies affecting it. The diagnosis of cavernous sinus syndrome (CSS) predominantly relies on clinicoradiological correlation. We studied the utility of computed tomographic (CT) scan versus magnetic resonance imaging (MRI) in the diagnosis of CSS. METHODS A prospective observational study was conducted in a tertiary care center in north India. All patients presenting with a clinical syndrome of cavernous sinus involvement with radiologically confirmed lesions were enrolled in the study. MRI and CT scan with cavernous sinus cuts were done and reviewed by experienced neuroradiologists for cavernous sinus lesions and compared with the final diagnosis. Sensitivity and specificity were calculated. RESULTS We included 48 patients in our study. A final diagnosis was achieved in 41 out of 48 (85.6%) patients. Fungal infections (16 (33.3%)) constituted the commonest cause of CSS, followed by neoplastic involvement (13 (27.1%)) and Tolosa-Hunt syndrome (12 (25%)). Vascular involvement was seen in three (6.3%) patients. Other rare causes were seen in four (8.3%) patients. CT scan had an overall sensitivity of 14.6% in achieving a final diagnosis, whereas MRI had an overall sensitivity of 70.7%, with a statistically significant difference (p < 0.001). CONCLUSIONS Although CT scan is a relatively cheap and accessible resource, its role in CSS diagnosis and management is limited because of poor yield. Hence, it is prudent to do an MRI as an initial investigation in cases of CSS.
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Affiliation(s)
- Sanath Bhatkar
- Department of Neurology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Karthik Vinay Mahesh
- Department of Neurology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Julie Sachdeva
- Department of Neurology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Abeer Goel
- Department of Neurology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Manoj K Goyal
- Department of Neurology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Aastha Takkar
- Department of Neurology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sucharita Ray
- Department of Neurology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Ritu Shree
- Department of Neurology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Neeraj Balaini
- Department of Neurology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Paramjit Singh
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Ramandeep Singh
- Department of Ophthalmology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Shiv Narayan Patnaik
- Department of Neurology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Nandita Prabhat
- Department of Neurology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Vivek Lal
- Department of Neurology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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20
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Salamah MA, Alsarraj M, Alsolami N, Hanbazazah K, Alharbi AM, Khalifah W. Clinical, Radiological, and Histopathological Patterns of Allergic Fungal Sinusitis: A Single-Center Retrospective Study. Cureus 2020; 12:e9233. [PMID: 32821581 PMCID: PMC7430688 DOI: 10.7759/cureus.9233] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Objectives To explore the clinical, pathological, and imaging characteristics of allergic fungal sinusitis (AFS) and to analyze the correlation of disease duration with imaging and histopathology findings. Methods We reviewed all cases of AFS managed at the otorhinolaryngology department of King Fahad Armed Forces Hospital, Jeddah, Saudi Arabia. Demographic and clinical features were collected, as well as imaging and histopathological findings, which were analyzed by time from onset. Results Forty-six patients were diagnosed AFS, representing 11.8% of total sinusitis cases; 25 (54.3%) were female, with mean (SD) age=33.57 (11.76). Patients presented with multiple symptoms of chronic rhinosinusitis (43, 93.5%), chronic headache (14, 30.4%), and hyposmia (2, 4.3%), and 36 (78.3%) were diagnosed late (≥5 years after onset). AFS involved all four sinuses in 32 (69.6%) patients and was bilateral in >53.5% of infected sinuses. Imaging showed increased intrasinus attenuation (88.2%-95.3%), complete opacification (74.4%-85.3%), sinus expansion (35.3%-51.2%), remodeling (20.6%-37.2%), wall thinning (41.2%-58.1%), and involvement of adjacent soft tissue (11.8%-25.6%), depending on the sinus type. Histology evidenced eosinophilic mucin (45.7%), eosinophils (91.3%), fungal hyphae (93.5%), and Charcot-Leyden crystals (6.5%). Patients who were diagnosed late had a higher percentage of imaging and pathological lesions, principally, the expansion and wall thinning of involved sinuses (p<0.050). Conclusion AFS represents a significant proportion of chronic sinusitis cases treated in the otorhinolaryngology department and is often diagnosed late with extensive forms. Major efforts should be made to improve the early diagnosis and management of such disease, including raising awareness about this entity among general practitioners and family physicians to enhance clinical suspicion and detection rate.
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Affiliation(s)
- Marzouqi A Salamah
- Otolaryngology-Head and Neck Surgery, Ohud Hospital, Al-Madinah Al-Munawarah, SAU
| | - Mazin Alsarraj
- Otolaryngology-Head and Neck Surgery, King Fahad General Hospital, Jeddah, SAU
| | - Nawaf Alsolami
- Otolaryngology-Head and Neck Surgery, King Fahad Armed Forces Hospital, Jeddah, SAU
| | - Kamal Hanbazazah
- Otolaryngology-Head and Neck Surgery, King Fahad Armed Forces Hospital, Jeddah, SAU
| | - Abdulmajeed M Alharbi
- Otolaryngology-Head and Neck Surgery, King Abdulaziz University Hospital, Jeddah, SAU
| | - Wael Khalifah
- Otolaryngology-Head and Neck Surgery, Jeddah University, Jeddah, SAU
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21
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Fong A, Ahmed S, Ramalingam S, Brown RM, Harper L, Mollan SP. Eosinophilic Granulomatosis with Polyangiitis Presenting as Unilateral Acute Anterior Ischaemic Optic Neuropathy. Neuroophthalmology 2020; 45:109-116. [PMID: 34108782 PMCID: PMC8158048 DOI: 10.1080/01658107.2020.1761402] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 04/18/2020] [Accepted: 04/23/2020] [Indexed: 10/24/2022] Open
Abstract
Eosinophilic granulomatosis with polyangiitis (eGPA) is a rare vasculitis of small-medium sized vessels that can cause both anterior and posterior ischaemic optic neuropathies. Herein, the authors present a rare case of eGPA presenting initially as an acute unilateral anterior ischaemic optic neuropathy from short posterior ciliary artery vasculitis. The diagnosis presented a challenge as clinical and histopathological evidence suggested allergic rhinosinusitis, and no invasive fungal sinusitis was found. The high serum eosinophilia, asthma, optic neuropathy and paranasal sinus abnormalities fulfilled the criteria for a diagnosis of eGPA. Furthermore serum was positive for myeloperoxidase antibodies. Subsequently the case was successfully treated with oral glucocorticoids and intravenous rituximab.
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Affiliation(s)
- Anthony Fong
- Birmingham Neuro-Ophthalmology, Queen Elizabeth Hospital, Birmingham, UK
- Associate Lecturer Medicine, The University of Queensland, Level 6 Oral Health Centre, Herston, QLD, Australia
| | - Shahzada Ahmed
- Department of Ear Nose and Throat, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital, Birmingham, UK
| | - Satheesh Ramalingam
- Department of Neuroradiology, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital, Birmingham, UK
| | - Rachel M. Brown
- Department of Histopathology, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital, Birmingham, UK
| | - Lorraine Harper
- Department of Renal Medicine, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital, Birmingham, UK
| | - Susan P. Mollan
- Birmingham Neuro-Ophthalmology, Queen Elizabeth Hospital, Birmingham, UK
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22
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Humphreys IM, Wandell GM, Miller C, Rathor A, Schmidt RA, Turner JH, Hwang PH, Davis GE. A multi-institutional review of outcomes in biopsy-proven chronic invasive fungal sinusitis. Int Forum Allergy Rhinol 2020; 10:738-747. [PMID: 32282122 DOI: 10.1002/alr.22547] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2019] [Revised: 01/16/2020] [Accepted: 01/21/2020] [Indexed: 12/31/2022]
Abstract
BACKGROUND Chronic invasive fungal sinusitis (CIFS) is a rare, life-threatening infection of the nose and sinuses. This study aims to identify factors that impact survival in 1 of the largest cohorts to date. METHODS Pathology records were reviewed for biopsy-proven CIFS from 3 tertiary academic institutions from 1995 to 2016. Variables were analyzed using log-rank survival analysis. Univariate Cox regression was performed at 1 and 12 months. RESULTS Thirty-eight patients were included. Hematologic malignancy and diabetes were the most common underlying diseases (32% each). Aspergillus was the most common fungus (63%). Greater than 75% of the patients had an absolute neutrophil count (ANC) >1000 at the time of diagnosis. Overall survival at 1, 6, and 12 months was 89%, 68%, and 48%, respectively. In univariate analysis, factors associated with worse survival included: ANC <500 at 12 months (hazard ratio [HR] 4.8; p = 0.01), ANC <1000 at 12 months (HR 5.8; p = 0.001), and recent chemotherapy (HR 4; p = 0.01). The following factor was associated with improved survival in univariate analysis: ANC as a linear variable in the entire cohort (HR 0.7; p = 0.005). CONCLUSION We present a multi-institutional case-series of CIFS and long-term follow-up. ANC <1000 at time of diagnosis and recent chemotherapy (within 1 month of diagnosis) are associated with poorer survival, whereas a rising ANC >1000 is associated with improved survival at 12 months. Further prospective studies are needed to further define factors that affect outcomes.
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Affiliation(s)
- Ian M Humphreys
- Department of Otolaryngology, University of Washington, Seattle, WA
| | - Grace M Wandell
- Department of Otolaryngology, University of Washington, Seattle, WA
| | - Craig Miller
- Department of Otolaryngology, University of Washington, Seattle, WA
| | | | | | - Justin H Turner
- Department of Otolaryngology, Vanderbilt University, Nashville, TN
| | - Peter H Hwang
- Department of Otolaryngology, Stanford University, Stanford, CA
| | - Greg E Davis
- Department of Otolaryngology, University of Washington, Seattle, WA
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Deutsch PG, Whittaker J, Prasad S. Invasive and Non-Invasive Fungal Rhinosinusitis-A Review and Update of the Evidence. ACTA ACUST UNITED AC 2019; 55:E319. [PMID: 31261788 DOI: 10.3390/medicina55070319] [Citation(s) in RCA: 89] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Revised: 06/24/2019] [Accepted: 06/25/2019] [Indexed: 12/15/2022]
Abstract
Fungal infections are a subset of infectious processes that an otolaryngologist is required to be familiar with. They can be encountered in otology, rhinology and head and neck surgery. The presence of fungal rhinosinusitis is well recognised by otolaryngologists, but the classifications and appropriate management are not so well understood. The prevalence of fungal sinus disease is thought to be have been increasing in recent decades There is speculation that this may be due to increased awareness, antibiotic overuse and increased use of immunosuppressant medications. Added to this, there has been a large amount published on the role of fungi as a causative organism in chronic rhinosinusitis. Given the importance of fungal rhinosinusitis in clinical practice, we aim to review the classification and current management strategies based on up-to-date literature.
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24
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Leszczyńska J, Stryjewska-Makuch G, Lisowska G, Kolebacz B, Michalak-Kolarz M. Fungal sinusitis among patients with chronic rhinosinusitis who underwent endoscopic sinus surgery. Otolaryngol Pol 2019; 72:35-41. [PMID: 30190445 DOI: 10.5604/01.3001.0012.1263] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
INTRODUCTION Fungal paranasal sinusitis can be either invasive or non-invasive. Saprophytic infections, fungus balls (FB) and allergic fungal rhinosinusitis are non-invasive (AFR). MATERIALS AND METHODS The present study examined 521 patients who underwent endoscopic sinus surgery between January 2016 and April 2017 due to chronic paranasal sinusitis at the Department of Laryngology and Laryngological Oncology of the Upper Silesian Medical Centre in Katowice. The aim of the study was to analyse the histopathological and microbiological material collected intraoperatively and to determine the incidence and type of fungal infections among patients treated for chronic sinusitis. RESULTS Chronic fungal sinusitis was confirmed in 10 of 521 operated patients. The study group consisted of 9 females and 1 male. Histopathological examination revealed dead mycelium in 5 patients and colonies of Aspergillus spp. in 4, while microbiological examination revealed Candida albicans infection in 1 case. Allergy to inhalant allergens of fungal spores of Alternaria and Penicillinum was confirmed in a 73-year-old patient, which, based on the whole clinical presentation, enabled to diagnose chronic allergic fungal sinusitis. The most common location of mycelium was the maxillary sinus, followed by the sphenoid sinus. DISCUSSION The most common form of non-invasive fungal sinusitis is the so-called fungus ball, which was also confirmed in our report (95% of the test subjects). AFRS is more likely to occur in warm, moist climates that favour the growth of fungi.
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Affiliation(s)
- Joanna Leszczyńska
- Samodzielny Publiczny Szpital Kliniczny nr 7 Śląskiego Uniwersytetu Medycznego w Katowicach Górnośląskie Centrum Medyczne im. prof. Leszka Gieca. Oddział Laryngologii i Onkologii Laryngologicznej
| | - Grażyna Stryjewska-Makuch
- Independent Public Research Hospital No. 7 of Silesian Medical University in Katowice, Upper Silesian Medical Centre, Department of Laryngology and Laryngological Oncology, ul. Ziołowa 45/47, 40-635 Katowice, Poland
| | - Grażyna Lisowska
- Szpital Specjalistyczny w Zabrzu Kliniczny Oddział Laryngologii i Onkologii Laryngologicznej Śląski Uniwersytet Medyczny w Katowicach
| | - Bogdan Kolebacz
- Samodzielny Publiczny Szpital Kliniczny nr 7 Śląskiego Uniwersytetu Medycznego w Katowicach Górnośląskie Centrum Medyczne im. prof. Leszka Gieca., Oddział Laryngologii i Onkologii Laryngologicznej
| | - Marta Michalak-Kolarz
- Samodzielny Publiczny Szpital Kliniczny nr 7 Śląskiego Uniwersytetu Medycznego w Katowicach Górnośląskie Centrum Medyczne im. prof. Leszka Gieca Oddział Laryngologii i Onkologii Laryngologicznej
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25
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Jiang RS, Huang WC, Liang KL. Characteristics of Sinus Fungus Ball: A Unique Form of Rhinosinusitis. Clin Med Insights Ear Nose 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] [What about the content of this article? (0)] [Affiliation(s)] [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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26
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Abstract
Allergic fungal rhinosinusitis (AFRS) is a unique variety of chronic polypoid rhinosinusitis usually in atopic individuals, characterized by presence of eosinophilic mucin and fungal hyphae in paranasal sinuses without invasion into surrounding mucosa. It has emerged as an important disease involving a large population across the world with geographic variation in incidence and epidemiology. The disease is surrounded by controversies regarding its definition and etiopathogenesis. A working group on "Fungal Sinusitis" under the International Society for Human and Animal Mycology (ISHAM) addressed some of those issues, but many questions remain unanswered. The descriptions of "eosinophilic fungal rhinosinusitis" (EFRS), "eosinophilic mucin rhinosinusitis" (EMRS) and mucosal invasion by hyphae in few patients have increased the problem to delineate the disease. Various hypotheses exist for etiopathogenesis of AFRS with considerable overlap, though recent extensive studies have made certain in depth understanding. The diagnosis of AFRS is a multi-disciplinary approach including the imaging, histopathology, mycology and immunological investigations. Though there is no uniform management protocol for AFRS, surgical clearing of the sinuses with steroid therapy are commonly practiced. The role of antifungal agents, leukotriene antagonists and immunomodulators is still questionable. The present review covers the controversies, recent advances in pathogenesis, diagnosis, and management of AFRS.
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Affiliation(s)
- Arunaloke Chakrabarti
- Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh 160012, India.
| | - Harsimran Kaur
- Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh 160012, India.
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27
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Rodrigues J, Caruthers C, Azmeh R, Dykewicz MS, Slavin RG, Knutsen AP. The spectrum of allergic fungal diseases of the upper and lower airways. Expert Rev Clin Immunol 2016; 12:531-50. [PMID: 26776889 DOI: 10.1586/1744666x.2016.1142874] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Fungi cause a wide spectrum of fungal diseases of the upper and lower airways. There are three main phyla involved in allergic fungal disease: (1) Ascomycota (2) Basidiomycota (3) Zygomycota. Allergic fungal rhinosinusitis (AFRS) causes chronic rhinosinusitis symptoms and is caused predominantly by Aspergillus fumigatus in India and Bipolaris in the United States. The recommended treatment approach for AFRS is surgical intervention and systemic steroids. Allergic bronchopulmonary aspergillosis (APBA) is most commonly diagnosed in patients with asthma or cystic fibrosis. Long term systemic steroids are the mainstay treatment option for ABPA with the addition of an antifungal medication. Fungal sensitization or exposure increases a patient's risk of developing severe asthma and has been termed severe asthma associated with fungal sensitivity (SAFS). Investigating for triggers and causes of a patient's asthma should be sought to decrease worsening progression of the disease.
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Affiliation(s)
| | - Carrie Caruthers
- a Allergy & Immunology , Saint Louis University , St. Louis , MO , USA
| | - Roua Azmeh
- a Allergy & Immunology , Saint Louis University , St. Louis , MO , USA
| | - Mark S Dykewicz
- a Allergy & Immunology , Saint Louis University , St. Louis , MO , USA
| | - Raymond G Slavin
- a Allergy & Immunology , Saint Louis University , St. Louis , MO , USA
| | - Alan P Knutsen
- a Allergy & Immunology , Saint Louis University , St. Louis , MO , USA
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28
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Shinya Y, Miyawaki S, Nakatomi H, Okano A, Imai H, Shin M, Sato K, Tsuchida T, Hayashi T, Terao Y, Numakura S, Morikawa T, Shibahara J, Kikuta S, Kondo K, Tatsuno K, Mori H, Kunimatsu A, Tsuji S, Saito N. Recurrent cerebral aneurysm formation and rupture within a short period due to invasive aspergillosis of the nasal sinus; pathological analysis of the catastrophic clinical course. Int J Clin Exp Pathol 2015; 8:13510-13522. [PMID: 26722566 PMCID: PMC4680511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 08/26/2015] [Accepted: 09/28/2015] [Indexed: 06/05/2023]
Abstract
Destructive infiltration of invasive fungal sinusitis can easily occur into the central nervous system (CNS). Cerebral aneurysms associated with fungal infection are highly vulnerable to rupture, and can frequently and rapidly take a serious clinical course. We experienced a patient who twice developed cerebral aneurysm followed by rupture due to invasive fugal sinusitis. This 77-year-old man was admitted for progressive bilateral visual disturbance, which was initially treated as idiopathic hypertrophic pachymeningitis. The patient subsequently suffered subarachnoid hemorrhage (SAH) twice in only 12 days. Both SAH originated from different newly formed cerebral aneurysms. Trapping was performed for both ruptured aneurysms. Pathological examination of the resected aneurysms indicated the presence of fungi determined to be Aspergillus. This Aspergillus infection was also discovered inside the frontal sinus by endoscopic biopsy, so a regimen of antifungal agents was instituted. Prolonged antifungal therapy caused renal impairment, which ultimately led to the patient's death. Autopsy detected no mycotic infiltration of the major cerebral arteries, except for the 2 ruptured cerebral aneurysms. However, prolonged mycosis of the CNS, such as in the deep part in the falx cerebri and in the small veins proximal to the tentorium cerebelli, was observed, indicating that mycosis invading the cranium is refractory even to long-term administration of antifungal agents. The present case strongly suggests that urgent and proactive definitive diagnosis is essential to successfully treat invasive paranasal sinus aspergillosis. If infiltration of the CNS is suspected, early surgical resection and antifungal therapy must be initiated immediately.
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Affiliation(s)
- Yuki Shinya
- Department of Neurosurgery, Faculty of Medicine, The University of TokyoTokyo, Japan
| | - Satoru Miyawaki
- Department of Neurosurgery, Faculty of Medicine, The University of TokyoTokyo, Japan
| | - Hirofumi Nakatomi
- Department of Neurosurgery, Faculty of Medicine, The University of TokyoTokyo, Japan
| | - Atsushi Okano
- Department of Neurosurgery, Faculty of Medicine, The University of TokyoTokyo, Japan
| | - Hideaki Imai
- Department of Neurosurgery, Faculty of Medicine, The University of TokyoTokyo, Japan
| | - Masahiro Shin
- Department of Neurosurgery, Faculty of Medicine, The University of TokyoTokyo, Japan
| | - Kazuya Sato
- Department of Neurology, Faculty of Medicine, The University of TokyoTokyo, Japan
| | - Takeyuki Tsuchida
- Department of Neurology, Faculty of Medicine, The University of TokyoTokyo, Japan
| | - Toshihiro Hayashi
- Department of Neurology, Faculty of Medicine, The University of TokyoTokyo, Japan
| | - Yasuo Terao
- Department of Neurology, Faculty of Medicine, The University of TokyoTokyo, Japan
| | - Satoe Numakura
- Department of Pathology, Faculty of Medicine, The University of TokyoTokyo, Japan
| | - Teppei Morikawa
- Department of Pathology, Faculty of Medicine, The University of TokyoTokyo, Japan
| | - Junji Shibahara
- Department of Pathology, Faculty of Medicine, The University of TokyoTokyo, Japan
| | - Shu Kikuta
- Department of Otolaryngology, Faculty of Medicine, The University of TokyoTokyo, Japan
| | - Kenji Kondo
- Department of Otolaryngology, Faculty of Medicine, The University of TokyoTokyo, Japan
| | - Keita Tatsuno
- Department of Infectious Diseases, Faculty of Medicine, The University of TokyoTokyo, Japan
| | - Harushi Mori
- Department of Radiology, Faculty of Medicine, The University of TokyoTokyo, Japan
| | - Akira Kunimatsu
- Department of Radiology, Faculty of Medicine, The University of TokyoTokyo, Japan
| | - Shoji Tsuji
- Department of Neurology, Faculty of Medicine, The University of TokyoTokyo, Japan
| | - Nobuhito Saito
- Department of Neurosurgery, Faculty of Medicine, The University of TokyoTokyo, Japan
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29
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Saibene AM, Vassena C, Pipolo C, Trimboli M, De Vecchi E, Felisati G, Drago L. Odontogenic and rhinogenic chronic sinusitis: a modern microbiological comparison. Int Forum Allergy Rhinol 2015; 6:41-5. [PMID: 26345711 DOI: 10.1002/alr.21629] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2015] [Revised: 07/06/2015] [Accepted: 07/21/2015] [Indexed: 11/07/2022]
Abstract
BACKGROUND Odontogenic sinusitis and sinonasal complications of dental disease or treatment (SCDDT) play a relevant, often underappreciated role in paranasal sinus infections. Treating SCDDT patients requires tailored medical and surgical approaches in order to achieve acceptable success rates. These approaches differ from common rhinogenic sinusitis treatment protocols mostly because of the different etiopathogenesis. Our study comprehensively evaluated microbiology and antibiotic resistance in SCDDT patients and compared findings with a control group of patients affected by rhinogenic sinusitis. METHODS We performed microbiological sampling during surgery on 28 patients with SCDDT and 16 patients with chronic rhinosinusitis with nasal polyps (CRSwNP). Colonies were isolated, Gram-stained, and the species identified using classic biochemical methods. These results were confirmed by DNA pyrosequencing, and then the resistance profile of each SCDDT isolate to various antibiotics was tested. RESULTS Microbial growth was observed in all SCDDT patients, whereas samples from 60% of patients in the control group failed to yield any bacterial growth (p < 0.001). Anaerobes grew in 14% of SCDDT patients as compared to 7% of CRSwNP patients (p = 0.42). Of the isolates from SCDDT patients, 70% were susceptible to amoxicillin/clavulanate, whereas all isolates were susceptible to levofloxacin, teicoplanin, and vancomycin. Of the staphylococci identified, 80% were capable of producing beta-lactamase. CONCLUSION Given the extent of microbiological contamination within the maxillary sinus of SCDDT patients, these infections should be regarded as a different class of conditions from rhinogenic sinusitis. Our findings support the need for different approaches in the treatment of SCDDT patients.
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Affiliation(s)
- Alberto Maria Saibene
- Department of Otolaryngology-Head and Neck, San Paolo Hospital, University of Milan, Milan, Italy
| | - Christian Vassena
- Laboratory of Clinical Chemistry and Microbiology, National Institute for Research and Treatment (IRCCS) Galeazzi Orthopaedic Institute, Milan, Italy
| | - Carlotta Pipolo
- Department of Otolaryngology-Head and Neck, San Paolo Hospital, University of Milan, Milan, Italy
| | - Mariele Trimboli
- Department of Otolaryngology-Head and Neck, San Paolo Hospital, University of Milan, Milan, Italy
| | - Elena De Vecchi
- Laboratory of Clinical Chemistry and Microbiology, National Institute for Research and Treatment (IRCCS) Galeazzi Orthopaedic Institute, Milan, Italy
| | - Giovanni Felisati
- Department of Otolaryngology-Head and Neck, San Paolo Hospital, University of Milan, Milan, Italy
| | - Lorenzo Drago
- Laboratory of Clinical Chemistry and Microbiology, National Institute for Research and Treatment (IRCCS) Galeazzi Orthopaedic Institute, Milan, Italy.,Laboratory of Technical Science for Laboratory Medicine, Department of Biomedical Science for Health, University of Milan, Milan, Italy
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30
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Vosler PS, Ferguson BJ, Contreras JI, Wang EW, Schaitkin BM, Lee S. Clinical and pathologic characteristics of intranasal abuse of combined opioid-acetaminophen medications. Int Forum Allergy Rhinol 2014; 4:839-44. [PMID: 25137346 DOI: 10.1002/alr.21355] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2014] [Revised: 04/22/2014] [Accepted: 04/29/2014] [Indexed: 12/16/2022]
Abstract
BACKGROUND The nonmedical abuse of prescription opioids via intranasal administration is a growing problem. The objective of this study is to investigate of the typical presentation of intranasal opioid-acetaminophen abuse and outline optimal therapy. METHODS This study was a retrospective chart review. Patients with intranasal pathology from inhalation of combined opioid-acetaminophen medications (COAMs) from 3 academic otolaryngology practices in western Pennsylvania from January 2012 to October 2012 were included in the review. RESULTS Seven adults ranging in age from 23 to 46 years were identified with nasal complaints from the intranasal inhalation of COAMs. All patients presented with nasal pain and were found to have fibrinous necrotic nasal mucosa involving the posterior nasal cavity and nasopharynx. Of the 7 patients, 6 (85.7%) presented with a septal perforation. Pathology and culture revealed fungus in 85.7% of the patients; however, no invasive fungal disease was noted in any of the specimens. Patients did not improve with either systemic or topical antifungal therapy. Polarizable material characteristic of talc used as a tablet binder was present in the histopathology of 4 of 7 (57.1%) patients. Patients who abstained from intranasal drug use along with serial debridement demonstrated the greatest improvement. CONCLUSION Intranasal COAM abuse causes nasal pain, tissue necrosis with potential septal and palatal perforation, and noninvasive fungal colonization. Antifungal therapy was of no benefit in the current series of patients. Current therapy should focus on recognition of the etiology of patients' pathology and encourage abstinence from intranasal use of these drugs along with serial debridements.
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Affiliation(s)
- Peter S Vosler
- Division of Sinonasal Disorders and Allergy, University of Pittsburgh Medical Center (UPMC), Pittsburgh, PA
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31
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FANUCCI E, NEZZO M, NERONI L, MONTESANI L, OTTRIA L, GARGARI M. Diagnosis and treatment of paranasal sinus fungus ball of odontogenic origin: case report. Oral Implantol (Rome) 2013; 6:63-66. [PMID: 24772263 PMCID: PMC3982303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
In recent years the incidence of fungal sinusitis has increased considerably, due both to increased survival of patients at risk and to improved diagnostic equipment. The pathogen responsible in most cases is the Aspergillus in its forms Fumigatus, Flavus and Niger. The diagnosis is often delayed because the symptoms, characterized by headache, cough, and facial algia, are generally similar to that of chronic bacterial rhinosinusitis. It can be divided into invasive and non-invasive forms based on the clinical evolution and extent of the lesion. We report a case of non-invasive fungal rhinosinusitis in a patient with recurrent sinusitis and pain in the left maxillary region, resistant to antibiotic therapy.
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Affiliation(s)
- E. FANUCCI
- Department of Diagnostic Radiology - Ospedale San Pietro F.B.F., Rome, Italy
| | - M. NEZZO
- Department of Diagnostic Radiology - Ospedale San Pietro F.B.F., Rome, Italy
| | - L. NERONI
- Department of Diagnostic Radiology - Ospedale San Pietro F.B.F., Rome, Italy
| | - L. MONTESANI
- Department of Clinical Sciences and Translational Medicine - University of Rome “Tor Vergata”, Rome, Italy
| | - L. OTTRIA
- Department of Clinical Sciences and Translational Medicine - University of Rome “Tor Vergata”, Rome, Italy
| | - M. GARGARI
- Department of Dentistry “Fra G.B. Orsenigo” - Ospedale San Pietro F.B.F., Rome, Italy
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32
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Sharma D, Mahajan N, Rao S, Khurana N, Jain S. Invasive maxillary aspergillosis masquerading as malignancy in two cases: Utility of cytology as a rapid diagnostic tool. J Cytol 2012; 29:194-6. [PMID: 23112462 PMCID: PMC3480770 DOI: 10.4103/0970-9371.101171] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Fungi have emerged as important etiological agents for chronic sinusitis. Invasive aspergillosis has been reported in immunocompromised individuals or diabetics; however, it is uncommonly seen in immunocompetent patients. Definitive diagnosis of these lesions is based on histological examination and fungal culture. We report two cases of invasive maxillary lesions in immunocompetent patients, clinically suspected of malignancy; however, fine needle aspiration cytology showed fungal hyphae, morphologically suggestive of Aspergillus, which was later confirmed on histopathology. Aspiration cytology thus plays a crucial role in the early and definitive diagnosis of fungal sinusitis in cases clinico-radiologically suspected of malignancy. An early diagnosis will help the clinician for early and appropriate management and follow-up in order to decrease the high morbidity and mortality associated with it.
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Affiliation(s)
- Divya Sharma
- Department of Pathology, Maulana Azad Medical College, New Delhi, India
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33
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Chakrabarti A, Denning DW, Ferguson BJ, Ponikau J, Buzina W, Kita H, Marple B, Panda N, Vlaminck S, Kauffmann-Lacroix C, Das A, Singh P, Taj-Aldeen SJ, Kantarcioglu AS, Handa KK, Gupta A, Thungabathra M, Shivaprakash MR, Bal A, Fothergill A, Radotra BD. Fungal rhinosinusitis: a categorization and definitional schema addressing current controversies. Laryngoscope 2009; 119:1809-18. [PMID: 19544383 PMCID: PMC2741302 DOI: 10.1002/lary.20520] [Citation(s) in RCA: 274] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Fungal (rhino-) sinusitis encompasses a wide spectrum of immune and pathological responses, including invasive, chronic, granulomatous, and allergic disease. However, consensus on terminology, pathogenesis, and optimal management is lacking. The International Society for Human and Animal Mycology convened a working group to attempt consensus on terminology and disease classification. DISCUSSION Key conclusions reached were: rhinosinusitis is preferred to sinusitis; acute invasive fungal rhinosinusitis is preferred to fulminant, or necrotizing and should refer to disease of <4 weeks duration in immunocompromised patients; both chronic invasive rhinosinusitis and granulomatous rhinosinusitis were useful terms encompassing locally invasive disease over at least 3 months duration, with differing pathology and clinical settings; fungal ball of the sinus is preferred to either mycetoma or aspergilloma of the sinuses; localized fungal colonization of nasal or paranasal mucosa should be introduced to refer to localized infection visualized endoscopically; eosinophilic mucin is preferred to allergic mucin; and allergic fungal rhinosinusitis (AFRS), eosinophilic fungal rhinosinusitis, and eosinophilic mucin rhinosinusitis (EMRS) are imprecise and require better definition. In particular, to implicate fungi (as in AFRS and EMRS), hyphae must be visualized in eosinophilic mucin, but this is often not processed or examined carefully enough by histologists, reducing the universality of the disease classification. A schema for subclassifying these entities, including aspirin-exacerbated rhinosinusitis, is proposed allowing an overlap in histopathological features, and with granulomatous, chronic invasive, and other forms of rhinosinusitis. Recommendations for future research avenues were also identified.
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Affiliation(s)
- Arunaloke Chakrabarti
- Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
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