Abstract
BackgroundFungus 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.FindingsFive 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).ConclusionsAll 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.
Highlights
Aspergillus fumigatus is a filamentous fungus of the Ascomycetes class, which represents the most common Aspergillus species causing disease in immunocompromised hosts
The surface plot representation (Fig. 1c) displayed some differences in the density of the superficial layer, which looked rather wispy in the biofilm formed on Synthetic nanohydroxyapatite (NHA) and allograft compared to that detected on the other samples
This property was confirmed by scanning electron microscope (SEM) analysis that, besides the filamentous hyphae detected in all samples, revealed the presence of conidiophora only on the surface of NHA and allograft (Fig. 1d)
Summary
Aspergillus fumigatus is a filamentous fungus of the Ascomycetes class, which represents the most common Aspergillus species causing disease in immunocompromised hosts. It is widespread in nature and very common in the environment, in soil, and in decaying organic matter. 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. 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
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