Cases Of Fungal Sinusitis Research Articles

Pathological Role of Fungal Biofilms in Fungal Rhinosinusitis: A Case-Control Study

Objective: This case-control study aimed to detect the presence of fungal biofilms in cases of fungal sinusitis, trying to find its role in recurrence of fungal sinus infection and resistance to medical treatment. Patients and Methods: This study was conducted at Ain-Shams University from June-2017 to June-2018 upon 20 patients as the fungal cases are not much in Egypt. All patients were subjected to functional endoscopic sinus surgery and taking specimens. Examination of specimens by scanning electron microscope was made. Results: The prevalence of fungal biofilms was 7 (70%) in cases and 0 (0%) in controls (p-value = 0.001). There is higher risk of fungal biofilms in cases of fungal sinusitis, the odds of biofilms is higher in the study group 2.33 than in the control group 0. The lower is the invasiveness, the higher is the fungal biofilms (OR = 0.94, 95% CI 0.46 - 4.05). Also, the analysis showed that the lower is the recurrence the lower is the fungal biofilms (OR = 2.25, 95% CI 0.15 - 7.93). Conclusion: This study showed the presence of fungal biofilms in different cases of fungal sinusitis whether primary or recurrent, also whether invasive or non-invasive. Studies with large sample size are recommended to get a strong evidence.

Pathological Role of Biofilm in Fungal Rhinosinusitis

Abstract Background The first case of fungal sinusitis was reported in 1885. This fungal disease occurred rarely until the past decade, when a worldwide increase in its incidence occurred. Till one decade back bacteria was implicated as pathogen in most form of chronic rhinosinusitis (CRS). Fungi were thought to be responsible for few specific forms, sine 1999, when ponikau and associates claimed that fungi were responsible for nearly all cases of CRS. Their study demonstrated the presence of fungi & eosinophils from nose & paranasal sinuses from ∼96 % cases of CRS. Aim of the Work The aim of the work was to detect the presence of fungal biofilm, in patients with fungal sinusitis trying to find its role in recurrence of fungal sinus infection, resistance to medical treatment and occurrence of intra orbital and intracranial complications. Patients and Methods The study consisted of 20 different cases of fungal sinusitis controlled by 10 cases of non fungal sinusitis. Control cases were divided into 5 cases of chronic sinusitis with nasal polyposis and 5 cases of deviated septum with no evidence of sinusitis undergoing nasal surgery. Results Using statistical analysis, there was evidence of pressure of fungal biofilm in different cases of fungal sinusitis whether primary or recurrent, also whether invasive or non invasive. Comparing cases with controls, There was statistically significant difference between them as regard Biofilm (p-value: < 0.001) with incidence reaching (70 %) in cases while (0%) in controls. By applying risk analysis for biofilm, we used relative risk (p value = 0.0001) which is statistically significant indicating higher risk of positive biofilm in cases of fungal sinusitis, also by Using odds ratio (p value= 0.0002) which is statistically significant indicating higher risk of positive biofilm in cases of fungal sinusitis. Conclusion The study showed the presence of fungal biofilm in different cases of fungal siunsitis whether primary or recurrent, also whether invasive or non invasive.

Chronic rhinofacial basidiobolomycosis caused by Basidiobolus ranarum: Report of a case from Aseer Region, Kingdom of Saudi Arabia

We present a caseof fungal sinusitis caused by Basidiobolus ranarum in a 22-year-old male patient with chronic rhinosinusitis in Aseer region, Kingdom of Saudi Arabia. The patient was admitted with nasal obstruction accompanied by itching, sneezing, rhinorrhea, epistaxis and recurrent headache. Axial computed tomography (CT) scan of the paranasal sinuses showed a clear left facial swelling chronic inflammation and granulomata. Basidiobolus ranarum fungus was isolated on Sabouraud dextrose agar from a biopsy specimen. The organism was characterized by flat, yellowish-grey, glabrous, becoming radially folded fungus that under the microscope showed broad vegetative hyaline hyphae that bear zygospores with protuberances. The patient made good recovery and was discharged home with no recurrences after receiving oral itraconazole and removal of the polyps surgically.

A Rare Cause of Headache: Aspergillus Sinusitis

Ad dress for Cor res pon den ce/Ya z›fl ma Ad re si: Sehnaz Arici MD, Katip Celebi University, Ataturk Training and Research Hospital, Clinic of Neurology, Izmir, Turkey Phone: +90 232 245 45 45-2867 E-mail: sarici35@hotmail.com Re cei ved/Ge lifl Ta ri hi: 04.03.2014 Ac cep ted/Ka bul Ta ri hi: 28.08.2014 Fungal sinusitis is a frequently observed entity in immunosuppressed individuals and can be fatal. Surgical debridement, sinus aeration, and medical treatment are recommended in its management. Herein, a case of fungal sinusitis is reported in a patient who presented with headache.

Invasive Fungal Granuloma of the Brain in an Immunocompetent Patient

Aspergillus species is a fungus that causes invasive diseases with high mortality in immunosuppressed patients. We present a case of the central nervous system aspergillosis in an immunocompetent patient. A 27-year-old man was admitted to the hospital with complaints of headache and visual disturbance. He was a known case of fungal sinusitis and used to inhale opium. In cranial magnetic resonance imaging, a mass lesion in the right frontal lobe was observed. The pathology result was in favor of the aspergillus infection. The substance abuse by inhalation is considered a possible route of fungal entry, especially in the immunocompetent patient.

Accidental placement of central venous catheter tip into internal mammary vein.

Sir, Central venous catheter (CVC) plays an important role in the management of critically ill patients in terms of central venous pressure (CVP) monitoring, administration of vasopressors, inotropes, blood products, and parenteral nutrition. The ultrasound guided central venous cannulation has become a routine practice in recent years due to its lower complication rates and lesser errors during insertion. The ultrasound-guided catheter insertion does not prevent or help in the detection of misplaced catheter tips. We present a case of a 25-year-old male, known case of fungal sinusitis and mycotic aneurysm of right internal carotid artery admitted to our tertiary care Intensive Care Unit following surgery (craniotomy) at an outside hospital. He was shifted for evaluation and management of shortness of breath and sepsis. It was decided to remove his old left subclavian central line in view of sepsis and replace it with a new left internal jugular vein (IJV) cannulation with the help of ultrasound guidance. Left internal jugular site was selected as all other sites were cannulated previously. The CVC on chest X-ray looked as if the catheter was entering the left atrium [Figure 1]. Flush tests on two-dimensional echo with agitated saline through the left jugular catheter showed that the catheter was draining into right atrium [Figure 2]. When patient was taken for computed tomography cerebral angiography, the neck vessel angiography was also done which on venous reconstruction showed that there were no anomalies in the venous system, but the catheter tip was seen entering the left internal mammary vein (IMV) [Figure 3]. Later the central line was removed and replaced at a different location (since it was not showing CVP trace, and there was no backflow of blood through the port). Figure 1 Central venous catheter in the left internal jugular vein appears to be entering left atrium Figure 2 Agitated saline flush through the central port of the catheter showing bubbles in the right atrium Figure 3 Angiogram of neck showing left central venous catheter entering into left internal mammary vein The incidence of CVC malposition during IJV cannulation is around 2%.[1] There have been very few reported cases of accidental left IMV cannulation in the past.[2] CVC, which are misdirected into tributaries of central veins, are more common during central venous cannulation of the left side.[3] Reason may be due to the left brachiocephalic vein, which is anatomically longer and left smaller tributaries anastomose with the brachiocephalic vein opposite to the orifice of the left jugular vein.[4] Internal mammary vein receives the anterior intercostal veins and some abdominal branches, later drain into the brachiocephalic vein behind the sternal end of the clavicle and the first costal cartilage. Portal hypertension and portal to systemic collateral circulation dilates the IMV causing a higher risk of malpositioning of the catheter, which in our patient did not have any of these complaints. Complication related to IMV placement includes laceration of IMV with massive hemothorax and altered patency of the vein.[2,5] Ultrasound might reduce the complications associated with insertion, but chest X-ray would be needed to confirm the tip of catheter positioning.

Fungal Rhinosinusitis: Report of uncommon Aspergillus species as etiological agents

Rhinosinusitis caused by the usual Aspergillus spp. is very common. However, rare isolates of Aspergillus causing fungal sinusitis is also on the rise. Case Series: We hereby report three cases of fungal sinusitis caused by uncommon Aspergillus such as A. versicolor and A. sydowii. Case 1 was a 40-year-old female came with complaints of nasal block and nasal discharge for past one and a half years with history of previous nasal surgery. Her computed tomography (CT) scan of paranasal sinus (PNS) showed bilateral ethmoidal sinusitis. Case 2 was a 43-year-old male known asthmatic presented with complaints of nasal block for last five years, was diagnosed to have bilateral sinonasal polyposis by anterior rhinoscopy. Case 3 was a 17-year-old female known asthmatic presented with headache, nasal discharge and frequent sneezing for last six months. Her CT PNS showed left side deviated nasal septum with left side pan sinusitis along with right frontal sinusitis. All the three patients underwent functional endoscopic sinus surgery (FESS). The material was sent to the microbiology laboratory for fungal culture and potassium hydroxide mount. Speciation by slide culture was not conclusive. Hence, molecular methods were opted for speciation. Conclusion: Reporting of these cases will ensure awareness among the microbiologists about the not so common Aspergilli as a cause of fungal sinusitis. The need of molecular methods for speciation has also been emphasized here as it is difficult to speciate these Aspergilli using routine conventional methods.

건강한 성인에서 발생한 진균성 부비동염과 동반된 양측성 비중격 농양

건강한 성인에서 발생한 진균성 부비동염과 동반된 양측성 비중격 농양

Expression and significance of IgG4 in inflammatory disease of nasal cavity and paranasal sinuses

To study the prevalence of IgG4-positive plasma cells in inflammatory disease of nasal cavity and paranasal sinuses and its association with IgG4-related sclerosing disease (IgG4-SD). The expression of IgG4 and IgG in plasma cells of 103 cases diagnosed as inflammatory disease of nasal cavity and paranasal sinuses with dense lymphoplasmacytic infiltrate was studied by immunohistochemistry (EnVision) and quantitatively analyzed by medical image analysis system. Immunohistochemical study showed marked infiltration by IgG4-positive plasma cells (>50 per high-power field) in 28 cases, moderate infiltration (30 to 50 per high-power field) in 23 cases, mild (10 to 29 per high-power field) in 30 cases and negative (<10 per high-power field) in 22 cases (P < 0.05). Twenty-two cases studied fulfilled the diagnostic criteria of IgG4-SD (>50 IgG4-positive plasma cells per high-power field and IgG4-to-IgG ratio > 40%), including 3 cases of chronic sinusitis (3/20), 3 cases of nasal polyps (3/18), 3 cases of inflammatory pseudotumor (3/17), 4 cases of fungal sinusitis (4/20), 1 case of rhinoscleroma (1/12), 7 cases of Wegener's granulomatosis (7/11) and 1 case of Rosai-Dorfman disease (1/2). Inflammatory disease of nasal cavity and paranasal sinuses fulfilling the diagnostic criteria IgG4-SD is not uncommon. Definitive diagnosis of IgG4-SD requires correlation with other clinical and laboratory findings. Some cases of unexplained inflammatory disease of nasal cavity and paranasal sinus may represent a member of the IgG4-SD spectrum. IgG4 carries diagnostic value in differential diagnosis of inflammatory disease occurring in nasal cavity and paranasal sinuses.

Clinical Management of Invasive Fungal Sinisitis

Objective: Invasive fungal sinusitis (IFS) has increased in recent years with the use of steroids and onset of diabetes mellitus. The most frequently observed fungal sinusitis infections are typically associated with Aspergillus. Although most cases of fungal sinusitis are noninvasive, the infection occasionally develops into an invasive type, particularly in immunocompromised patients. Method: Because of its progressive nature, IFS is a potentially fatal disease with a relatively high overall mortality rate. Once manifested, the fungus frequently involves the orbit of the eye and intracranial area. Although optimum treatment methodologies are still controversial, early diagnosis and treatment of the disease is generally accepted as essential to achieving a positive patient outcome. Several recent reports have claimed successful management of IFS by systemic administration of new anti-fungal agents such as voriconazole, or combination therapy using debridement and anti-fungal agents. Results: Here, we report on the clinical features and outcomes of 4 patients with IFS involving the cavernous sinus and orbit. Prognostic factors facilitating an early diagnosis are described, and the usefulness of combination therapy involving systemic administration of anti fungal agents and surgical intervention is discussed. Strategic treatment employing both surgery and systemic administration of antifungal agents was performed in all patients. One patient with invasion into the cavernous sinus died of brain infarction. The remaining three patients are still alive. Conclusion: Observations of patients in the present case study suggest that early diagnosis and strategic treatment may contribute to improvement in the prognosis of IFS.

Fine‐needle aspiration biopsy as an initial diagnostic modality in a clinically unsuspected case of invasive maxillary fungal sinusitis: A case report

Cases of invasive fungal lesions involving the paranasal sinuses are generally diagnosed either on histologic examination or on fungal culture. Here, we report a case of invasive fungal sinusitis diagnosed primarily by a fine-needle aspiration biopsy (FNAB).Our patient was a 36-year-old male who presented with a history of slowly progressive, painless swelling over the left cheek. The only positive clinical finding was a bony hard swelling in the left maxillary region, which was clinically interpreted as "fibrous dysplasia." A computed tomographic (CT) examination of the paranasal sinuses showed a soft tissue attenuation lesion involving the bilateral maxillae, with the destruction of multiple bones and involvement of multiple sinuses and the bilateral orbits. FNAB of the maxillary swelling showed several giant cells, many of them exhibiting ingested organisms with a morphologic resemblance to the Aspergillus species of fungi. Strikingly, no significant inflammatory cells were seen on cytologic smears. Unfortunately, owing to a lack of initial clinical suspicion, as well as the patient's loss to further follow-up, a culture/histopathologic examination could not be carried out.This case is presented chiefly to highlight the clinical utility of a simple FNAB procedure, as an initial diagnostic modality in cases of fungal sinusitis, which can masquerade clinically as a neoplastic lesion. In addition, if radiologic findings are also available at the time of cytologic examination, a pretherapeutic comment on the invasive nature of the lesion can also be made.

Significance of MUC5B antibody in differential diagnosis between Aspergillus species and Mucorales of fungal sinusitis

To differentiate between Aspergillus species and Mucorales of fungal sinusitis by immunohistochemistry. Formalin-fixed paraffin-embedded tissue blocks of 66 cases of fungal sinusitis were retrieved from the archival files of Department of Pathology of Beijing Tongren Hospital during the period from 2001 to 2006. The samples included 29 cases of fungal balls, 12 cases of allergic fungal sinusitis, 24 cases of chronic invasive fungal sinusitis and 1 case of acute invasive fungal sinusitis. The types of fungi were 44 Aspergillus species (31 cases of A. fumigatus, 7 cases of A. flavus and 6 cases of A. terreus) and 22 Mucorales (14 cases of Mucor species and 8 cases of Rhizopus species). Immunohistochemistry was performed with MUC2, MUC5AC and MUC5B antibodies. The results were compared with histochemical study for periodic acid-Schiff (PAS) and Grocott methenamine silver (GMS) stains. Immunohistochemical study for MUC5B showed that the positive rate of Aspergillus species was 90.9%, in contrast to 4.5% in Mucorales (P < 0.001). The expression of MUC2 and MUC5AC was completely negative, whereas PAS and GMS stains were positive in all cases. MUC5B antibody appears to be a useful immunohistochemical marker for identifying fungal types in tissue sections, especially in distinguishing between Aspergillus species and Mucorales in fungal sinusitis.

副鼻腔真菌症症例の検討

Fungal paranasal sinusitis is included in the differential diagnosis of unilateral paranasl lesion. Recently the incidence of fungal paranasal sinusitis has been increasing. We reviewed 24 patients (9 males and 15 females) with fungal paranasal sinusitis treated at Muroran City Hospital between January 2001 and May 2006, and clinical presentation and CT findings with those of 56 patients (36 males and 20 females) with chronic unilateral sinusitis. Fungal sinusitis patients ranged in age from 45 to 87, and the average age was 65.9 years old. In contrast, the age of chronic sinusitis patients ranged from 24 to 83, and the average age was 54.4 years old. The chief complaint of both fungal sinusitis and chronic sinusitis included rhinorrhea, nasal obstruction and post nasal discharge.CT exam was performed in all patients. In 23 cases of paranasal fungal sinusitis and 54 cases of chronic sinusitis the findings involved the maxillary sinus. The most common observation (69.6%) was bone density within the affected sinus in fungal sinusitis. However, only 2 cases of chronic sinusitis (3.9%) showed calcification.All cases of fungal sinusitis were diagnosed by pathological examinations. Most cases were proved to be aspergillus, while only one case was mucor. We treated all cases surgically, 18 cases underwent Caldwell-Luc's procedure and 5 cases underwent endoscopic sinus surgery under local anesthesia.

Primary and secondary fungal infections of the paranasal sinuses: Clinical features and treatment outcomes

Conclusion. In a retrospective study of 239 cases of fungal sinusitis, noninvasive paranasal sinus aspergillosis was most common and successfully treated by endoscopic sinus surgery (ESS) with postoperative sinus irrigation. For the treatment of fungal sinusitis, ESS with or without antifungal agents and control of predisposing factors for secondary cases are recommended. Objective. The aim of this study was to investigate the clinical characteristics of fungal sinusitis and evaluate the treatment outcomes of primary and secondary fungal infections of the paranasal sinuses. Materials and methods. Two hundred thirty-nine cases of fungal infection of the paranasal sinuses seen between January 1997 and December 2006 were retrospectively analyzed by reviewing their medical records. There were 200 cases of primary fungal infection and 39 cases of secondary fungal infection. Results. The symptoms of chronic rhinosinusitis such as nasal obstruction, purulent rhinorrhea, and postnasal drip were commonly present in both primary and secondary infections, and the sphenoid sinus was commonly involved in secondary infection. The radiological findings in fungal sinusitis included haziness, calcification, and bone destruction of the involved sinuses. CT scans in 80% of the primary and 69% of the secondary cases revealed calcific densities in a paranasal soft tissue mass. Twenty-eight of 38 cases which had MR showed decreased signal intensities on T1-weighted images and markedly reduced signal intensities surrounded by bright signal on T2-weighted images. In secondary cases, the most common concomitant disease was diabetes mellitus. All patients received surgery including biopsy, ESS, and Caldwell-Luc's operation. Mucosal hypertrophy with fungus ball, which was the most common finding in both types, was found in 124 cases (62%) with primary and in 26 cases (67%) with secondary cases, and aspergillosis was most common, followed by unidentifiable colony, and mucormycosis. Eleven cases received amphotericin-B postoperatively. Two hundred thirty-eight cases showed no recurrence during the mean follow-up period of 11 months.

Classification of etiologic agents in fungal sinusitis by immunohistochemistry, histology and culture

In the invasive forms of fungal sinusitis rapid identification of etiologic agent is of vital importance because of the different reaction of the fungi to various antifungal agents. In the non-invasive forms it is of interest for epidemiologic reasons and because of the potential transition to invasive and generalized mycoses in case of additional immunodeficiency. A diagnosis of fungal genus in histologic slides is desirable since up to 70% of the fungal cultures remain without result.In the present study 77 cases of fungal sinusitis were examined with the comercially available antibodies Anti-Aspergillus and Anti-Rhizomucor. The results of the histological examination and fungal cultures were added. The immunohistochemical examination permitted in 64 cases a classification as Aspergillus/Penicillium. Two cases caused by Zygomyzetes alone or in combination could be confirmed immunohistochemically. Four fungus balls showed no significant immunoreaction with both antibodies. If these where caused by other Hyphomycetes p.e. Pseudallescheria or if it where Aspergillus fungus balls that did not react because of extreme regressive change can not be decided.

Fungal Sinusitis Presenting as an Ethmoid Mucocele

Fungal sinusitis was first reported in the late 1880s and was due to Aspergillus. Since this initial report, scattered case reports of fungal sinusitis have appeared in the medical literature, with the majority of these cases being due to Aspergillus and Mucormycosis. These case reports have also demonstrated multiple presentations of fungal sinusitis; however, our review of the literature did not demonstrate any previous case reports presenting as an ethmoid sinus mucocele. We now describe what we believe to be the first case of fungal sinusitis that presented as an ethmoid sinus mucocele.

Proptosis as the Initial Presentation of Fungal Sinusitis in Immunocompetent Patients

Fungal sinusitis typically occurs in immunocompromised patients. The authors report four cases of fungal sinusitis in immunocompetent young adults, all of whom had proptosis. The diagnosis in all four patients was determined after orbital imaging and sinus biopsies. All four patients required surgical removal of the fungal source and anti-fungal chemotherapy postoperatively. Patients with proptosis, ocular pain, or other symptoms suggestive of orbital cellulitis unresponsive to antibiotic treatment should undergo radiographic imaging. If sinus disease is present, biopsy and culture may lead to the diagnosis of fungal disease. Surgical debridement and the appropriate systemic antifungal therapy usually lead to cure.