Aspergillus Granuloma Research Articles

A Rare Case of Aspergillus Granuloma in the Cavernous Sinus of an Immunocompetent Patient

Aspergillosis is an invasive fungal disease that commonly infects immunocompromised hosts. Among the Aspergillus group, A. fumigatus is responsible for most cases of invasive Aspergillosis, mostly occurring in immunocompromised individuals, as well as chronic Aspergillosis and allergic syndromes. Prolonged exposure to Aspergillus is said to cause disease even in immunocompetent host.Hereby discussing a case of a 42-year-old male with headache, drooping of right eyelid and right ophthalmoplegia, right facial pain along the V1 and V2 region with features indicative of cranial nerve palsies involved in cavernous sinus syndrome. With radioimaging not giving clues toward the etiology, an open biopsy was done, was suggestive of fungal Aspergillus granuloma. Hence, the patient was started on voriconazole and clinically improved over time. This emphasizes that although rare with diagnostic barriers such as nonspecific clinical manifestations, deep anatomical location, and completely depending on pathological diagnosis, timely intervention saves the patient.

Scleral buckle infection with Aspergillus and pyogenic granuloma: A case report

Scleral buckle infection with Aspergillus and pyogenic granuloma: A case report

Intracranial Aspergillus Granuloma

Intracranial fungal granulomas are rare and of the histologically verified granulomas, Aspergillus spp. is the commonest causative fungal pathogen. Most of the reported large series of aspergillus granulomas are from countries with temperate climate like India, Pakistan, Sudan, and Saudi Arabia. In contrast to disseminated aspergillosis that occurs in immunosuppressed individuals, most of the intracranial aspergillus granulomas are reported in immunocompetent individuals. The temperature, humidity, high spore content in the atmosphere during ploughing, and occupation as agricultural worker are implicated in the pathogenesis. The sinocranial spread is the most common route of intracranial extension. Extracerebral firm fibrotic lesions and skull base lesions are common. Extensive fibrosis and large number of multinucleated giant cells are the characteristic histological features and these pathological features have therapeutic relevance.

Characteristics of Isolated Sphenoid Sinus Aspergilloma: Report of Twelve Cases and Literature Review

Isolated sphenoid sinus aspergilloma (ISSA) is a form of fungal sinus infection that is distinct from allergic fungal sinusitis, invasive fungal disease, and Aspergillus granulomas. In this study, we identify the characteristics of patients with ISSA to achieve timelier intervention for this easily neglected disease. In a retrospective study of patients with ISSA in our institution (1995 to 2006), 12 were identified. Sixty-seven percent of our patients were more than 50 years of age, and a female preponderance was noted. Headache and postnasal drip were the two most common symptoms, and the samples from 78% of our patients with postnasal drip were blood-tinged. Computed tomographic scanning provided a sensitivity of 64%, whereas endoscopic examination failed to identify abnormalities in any patients. Four characteristics were identified in the diagnosis of ISSA: female; usually above 50 years of age; with postnasal drip (especially blood-tinged); and headache (particularly periorbital or retro-orbital).

Successful treatment of Aspergillus granuloma involving the cavernous sinus and the middle fossa by using surgery and voriconazole

"Successful treatment of Aspergillus granuloma involving the cavernous sinus and the middle fossa by using surgery and voriconazole" published on Mar 2007 by American Association of Neurological Surgeons.

Isolated cerebral <i> Aspergillus</i> granuloma with no obvious source of infection

Intracranial fungal granulomas occur by extension from contiguous structures or by hematogenous dissemination from lungs. Isolated granulomas without any obvious source of infection are extremely uncommon. To describe isolated intracerebral Aspergillus spp. granuloma without any obvious source of infection. We analyzed clinical, radiological and pathological features of isolated intracerebral aspergillus granulomas diagnosed in our institution between 1986 and 2006. The chest X-ray and paranasal sinus (PNS) X-rays were reviewed. Fungal stainings were done on histological sections. We identified eight patients with Aspergillus spp. intracerebral granulomas (six males, two females). There were no predisposing risk factors. The chest and PNS X-rays were normal. On computerized tomography all were heterogeneously enhancing lesions with perilesional edema. Pre or perioperative diagnosis was never made. Histological studies revealed granulomas with minimal fibrosis and giant cells and septate hyphae of Aspergillus spp. on fungal stains. Two patients died of postoperative complications and two patients relapsed. Isolated intracerebral aspergillus granulomas are rare and pose a diagnostic challenge. Fungal granulomas should be considered in the differential diagnosis of intracerebral inflammatory pathologies.

Aspergillus granuloma of the cavernous sinus: magnetic resonance imaging with pathologic correlation

This case illustrates the correlation between Magnetic Resonance Imaging (MRI) and the pathological findings in a case of cavernous sinus (CS) aspergilloma.

Primary Paranasal Aspergillus Granuloma: Case Report and Review of the Literature

Primary paranasal aspergillus granuloma (PPAG) is a slowly progressive chronic infection of the sinus extending beyond the confines of the sinus. It has been reported only in patients from the Sudan and India. Microscopically, it differs from chronic invasive fungal sinusitis in that there are pseudotubercles containing giant cells, histiocytes, lymphocytes, plasma cells, newly formed capillaries, eosinophils, and Aspergillus fungal elements. We describe the first case of PPAG in the United States in an immunocompetent nonatopic woman who had never left Missouri.

625 Primary paranasal aspergillus granuloma (PPAG) of St Louis, the first endemic case in the US

625 Primary paranasal aspergillus granuloma (PPAG) of St Louis, the first endemic case in the US

Paranasal sinus fungus balls

Background Paranasal sinus fungus balls (mycetomas) are a form of fungal sinus infection distinct from allergic fungal sinusitis, fulminant invasive fungal disease, and paranasal aspergillus granulomas. Methods The Mayo Clinic surgical pathology files of inflammatory sinus specimens from 1984 to 1994 were examined. Twenty-nine paranasal sinus fungus balls were identified. Cases of allergic fungal sinusitis and invasive fungal disease were excluded. Results The fungus balls occurred in 11 men and 18 women, with an age range of 28 to 86 years, mean 64 years. Sinuses involved included maxillary (20 cases), sphenoid (10 cases), ethmoid (9 cases), and frontal (6 cases). In 12 patients, multiple sinuses were involved in a variety of combinations. By culture the most common pathogens were Aspergillus fumigatus and Aspergillus flavus. Treatment was by a variety of surgical procedures. Follow-up in 28 patients showed two recurrences and three deaths due to intracerebral bleed as a complication of surgery. These deaths occurred in patients with sphenoid sinus fungus balls. Conclusions Paranasal sinus fungus balls occur in an elderly population and have a female predominance. They have a low morbidity and recurrence rate. Death can occur in sphenoid sinus lesions as a complication of surgery. © 1997 John Wiley & Sons, Inc. Head Neck 19:481–486, 1997.

Parasellar Aspergillus granuloma extending from the sphenoid sinus: Report of two cases

Sphenoid sinus aspergillosis is a rare disease known to show an aggressive course with high mortality. Early diagnosis, though difficult, is required to prevent lethal fungal meningoencephalitis. We describe two cases of parasellar Aspergillus granuloma extending from the sphenoid sinus clinically indistinguishable from intracranial neoplasms. In the first patient, the fungus colony was visualized by computed tomography (CT) and magnetic resonance imaging (MRI) as a calcified concretion and total removal was curative. In the second patient, partial removal and subsequent antifungal therapy had minimal effect. The prognosis of the patients with this disease depends on prompt surgical treatment before intradural invasion occurs, and CT and MRI are useful diagnostic maneuvers for detecting calcified Aspergillus colonies.

Aspergillus Sinusitis: A Radiologic Study

Aspergillus Sinusitis: A Radiologic Study

Intracranial aspergillus granuloma

Intracranial aspergillus granulomas over a 12-year period were studied retrospectively. Three distinctive types of presentations were seen, namely nine patients had the rhinocerebral form with primary involvement of the air sinuses and secondary involvement of the skull base, cranial nerves and brain, three patients with the apparently purely intracranial form presented like any other space occupying lesion and one patient who had a 'stroke-like' presentation had a parasellar lesion. None of these patients were immunocompromised. The clinical features, and the medical and surgical options are discussed together with outcome.

Post-operative responses of paranasal Aspergillus granuloma to itraconazole

Paranasal Aspergillus granuloma is an invasive infection, seen mainly in tropical countries, involving the paranasal sinuses, orbit and brain. Previously surgical excision has been followed by a high relapse rate, 80% in some series, and mortality. This study involved the use of post-operative therapy with oral itraconazole in doses of 200–300 mg daily. Twenty-two patients were treated for a mean period of 19·7 weeks. Of 19 patients for whom follow-up data were available, 12 (62%) were rated as being in complete remission in a mean period of 17·2 months after the end of therapy. Only one patient developed progressive disease during itraconazole therapy. No serious adverse effect was seen. Use of itraconazole shows promise as a means of preventing relapse after surgery in this progressive infection.

Aspergillus Granuloma Presenting as Recurrent Nasal Polypi

Aspergillus Granuloma Presenting as Recurrent Nasal Polypi

Aspergillosis of the Central Nervous System Causing Subarachnoid Hemorrhage from Mycotic Aneurysm of the Basilar Artery

The authors present an extremely rare case of aspergillosis of the central nervous system (CNS) causing subarachnoid hemorrhage (SAH). A 78-year-old female developed facial pain, progressive deterioration in left visual acuity, and left total ophthalmoplegia. Computed tomography demonstrated a heterogeneously enhanced mass extending from the sphenoid sinus to the left cavernous sinus and left orbit, and angiography showed luminal narrowing and irregularity of the left internal carotid artery at its siphon. Biopsy of the left orbital and sphenoid sinus mass resulted in the diagnosis of Aspergillus granuloma. Despite combined administration of amphotericin-B and 5-FC, she became comatose from brainstem infarction and finally, suddenly died. Postmortem examination revealed massive SAH due to a ruptured mycotic aneurysm of the basilar artery. Aspergillosis of the CNS is a growing problem with the wider use of immunosuppressants and antibiotics. To the authors' knowledge, however, only 13 cases of CNS aspergillosis causing SAH have been reported. The prognosis is absolutely bad, with all patients dying from rupture of major intracranial arteries such as the internal carotid artery and basilar artery. Early diagnosis and vigorous chemotherapy are important.

Intracranial Aspergillus Granuloma Originating in the Sphenoidal Sinus

We report a case of intracranial Aspergillus granuloma that originated in and extended from the sphenoidal sinus. The patient, a 68-year-old male gardener, had no predisposing medical condition, such as cancer or immunosuppression. His symptoms, in order of appearance, were visual disturbance, headache, and ophthalmoparesis. A review of the literature concerning this rare disorder disclosed that these three symptoms, along with inflammation of the face, are common. On magnetic resonance (MR) imaging, the lesion appeared as an isointense mass extending from the sphenoidal sinus. Differentiation from malignant nasopharyngeal tumors is difficult, however, because the MR images are similar. Radical excision followed by aggressive antimycotic chemotherapy can result in a good outcome if a correct, early diagnosis is made.

IMMUNOHISTOCHEMICAL OBSERVATION OF LYSOZYME IN MACROPHAGES AND GIANT CELLS IN HUMAN GRANULOMAS

Lysozyme activity of macrophages and giant cells in various human granulomas were examined with immunoperoxidase bridge method in tissue sections. Various numbers of epithelioid cells and giant cells of epithelioid cell granulomas of tuberculosis, sarcoidosis and Crohn's disease exhibited intense granular cytoplasmic lysozyme activity. Foreign body granulomas induced with various substances showed negative or faintly positive lysozyme stain. Macrophages and giant cells of aspergillus granuloma associated with thymus hypoplasia and T-cell depression contained no lysozyme. The results suggest that cell-mediated immunology plays an important role for the lysozyme synthesis of macrophages in granuloma.

Mycoses of the Sudan

Mycoses in the Sudan are still significant and, as well as mycetoma, there are a number of other fungal diseases: paranasal aspergillus granuloma, which came into eminence in 1966; actinomycosis; subcutaneous phycomycosis; systemic phycomycosis; post-operative opportunistic infection of the eye with Trichosporon cutaneum and rhinosporidiosis. Mycetoma and paranasal aspergillus granuloma are discussed in detail.

Further observations on the primary paranasal aspergillus granuloma in the Sudan: a morphological study of 46 cases.

The morphological changes in 46 cases of primary paranasal aspergillus granuloma seen in the Sudan are described. Histologically, three groups can be differentiated: 1) a proliferative type, characterized by the presence of pseudotubercles in a fibrous tissue stroma; 2) an exudative-necrotizing type, consisting of large foci of edematous necrosis; and 3) a mixed group, where proliferation and necrosis exist side by side. Fungal hyphae are seen both within the giant cells and lying free in the stroma. Three factors seem to play a part in the pathogenesis of this disease: a) the climatic conditions, inducing recurrent inflammation of the nasal sinuses; b) the ability of the fungus and its toxic metabolites to cause damage; and c) an immunological process produced by the fungal antigens. The latter is supported by the finding of fibrinoid necrosis of collagen, vascular alterations, and formation of pseudotubercles.