Non-invasive Aspergillosis Research Articles

Coexistence of Pituitary Adenoma With Sphenoid Sinus Fungus Ball

Fungus ball in sphenoid sinus, together with functioning or nonfunctioning pituitary adenomas, are a rare event. Our case is of an old woman presented with sudden-onset headache. In brain MRI, sellar tumor as well as a noninvasive mass in sphenoid sinus were detected. The patient underwent a transsphenoidal approach for excision of the mass. Pathologic study of the resected tumor confirmed the diagnosis of pituitary adenoma. The histologic finding of sinus lesion was in favor of a noninvasive aspergillosis, with many septated fungal hyphae.

Histopathological Implications ofAspergillusInfection in Lung

This paper opens with a discussion on the significance of invasive fungal infections in advanced contemporary medicine, with an emphasis on the intractability of disease management and the difficulties of diagnosis. This is followed by a discussion concerning classification, histopathological features, and pathophysiology. While it has been largely accepted that Aspergillus species is recognized by cellular receptors and attacked by neutrophils, the radiological and macroscopic findings linking infection with neutropenia remain unconfirmed. In an effort to gain a better understanding of the pathophysiology and pathogenesis of invasive aspergillosis, we wish to emphasize the utility of radiological and histopathological examinations since these can provide detailed information on the extremely complex interaction between the causative microbes and tissue responses. A review of noninvasive or semi-invasive aspergillosis is also provided, with particular emphasis on chronic necrotizing pulmonary aspergillosis, which is recognized as a transition form of simple pulmonary aspergilloma and invasive pulmonary aspergillosis, although few findings have been reported in this area.

Clinical features and outcome of sphenoid sinus aspergillosis: A retrospective series of 15 cases

Sphenoid sinusitis is uncommon, and aspergillus infections represent a minority of these cases. This study was designed to describe the characteristics of this disease and present a review of the literature. Retrospective study from 2004 to 2010 based on 15 patients managed at Nantes University Hospital. Risk factors and history, symptoms, intranasal examination, imaging, histological and mycological results as well as analysis of the response to treatment and outcome were analysed. Patients were aged between 14 to 78 years, almost 75% of patients were older than 50 and 73% of patients were women. The most common symptoms were headache [80%], nasal blockage or discharge [33%], and recurrent mild epistaxis [20%]. Predisposing factors were immunodepression in three patients, with no cases of diabetes. Two patients had a history of intranasal surgery and one had a history of facial trauma. Nasal endoscopy was normal in 40% of cases. CT was suggestive of sphenoid sinus aspergillosis in more than one half of cases [8/15] and demonstrated osteolysis in four patients. An incorrect preoperative diagnosis of mucocele was proposed in three patients. Histological examination demonstrated spore-forming structures in every case, but culture was positive in only four cases. Only two patients required antifungal therapy, including one patient with invasive aspergillosis. Chronic noninvasive sphenoid sinus aspergillosis appears to be a benign disease, essentially affecting women and patients over the age of 50 years. Symptoms are fairly non-specific. Imaging and histological examination are essential for management. The invasive form is a serious disease requiring rapid, multidisciplinary management.

Evaluation of a Recombinant Antigen-Based Enzyme Immunoassay for the Diagnosis of Noninvasive Aspergillosis

Antibody detection is a key diagnostic tool for noninvasive aspergillosis (NIA) such as allergic bronchopulmonary aspergillosis and chronic pulmonary aspergillosis. Specific immunoprecipitin detection (IPD) is considered as the reference but lacks standardization and is time-consuming. To evaluate the performance of a new anti-Aspergillus fumigatus IgG enzyme immunoassay (EIA) kit using a recombinant A. fumigatus antigen (Bio-Rad), a retrospective study was performed on 551 sera collected from patients with a definite diagnosis of NIA (group 1; n = 64), bronchial Aspergillus colonization (group 2; n = 26), and probable aerial Aspergillus contamination (group 3; n = 44); from patients suspected of NIA with negative serological and mycological investigations (group 4; n = 49); and from a group of 222 patients not suspected of NIA (group 5). The EIA exhibited excellent reproducibility with coefficients of variation below 10%. Agreement with IPD was calculated between 62.5 and 84.4% according to the group of patients with Cohen's kappa coefficient at 0.6196 ± 0.077. Taking as reference a composite status including clinical, radiological, mycological, and serological data, sensitivity (group 1) and specificity (other groups) were calculated between 90.2 and 93.8% and 54.3 and 100%, respectively. Lower specificity was observed for patients with Aspergillus colonization. However, Yule Q coefficients estimating the correlation between EIA result and the definite diagnosis of NIA were calculated between 0.97 and 0.98. The method is a highly useful screening tool for the diagnosis of NIA, reducing the need for confirmatory IPD tests.

Comparative estimation of mucous membrane of maxillary sinus ultrastructural changes at aspergillosis different forms

Research objective was establishment of ultrastructural changes of mucous membrane maxillary sinus (MM MS) at noninvasive and chronic invasive aspergillosis. By methods of light, electronic microscopy and morphometry it is established, that the basic signs of endocellular reorganisation of epithelial cells at noninvasive form are decrease in squirrels-synthetic and plastic functions. On separate sites of epithelium there are the cages characterised small changes by cytoplasmatic organells. As a whole, the revealed changes testify to loss of epithelium protective and barrier properties, and as consequence, its defective participation in mucocilliar clearance. At invasive form of aspergillosis sinusitis, despite revealed single-layered metaplasia, in epithelial cells was observed fiber-synthetic and plastic processes that can specify on high reparative possibilities of epithelium.

Clinical analysis of 45 non-invasive aspergillosis of the paranasal sinuses

Objective To explore the pathogeny, diagnosis and treatment of non-invasive aspergillosis of the paranasal sinuses thus improve the initial diagnosis accuracy. Methods 45 cases of non-invasive aspergillosis of the paranasal sinuses treated with ESS from 2001 to 2008 were analyzed retrospectively. Results All of patients' symptoms had been disappeared, and the entrance to paranasal sinuses were patent with smooth sinus wall and no secretion in sinus cavity. 45 cases had been followed up for 6 months to 2 years and no recurrence occurred. Conclusion There is no specificity with non-invasive aspergillosis of the paranasal sinuses. Preoperation diagnosis rate can be improved with the help of CT or MRI. Nasal sinus surgery with nasal endoscope may be the first choice for treatment. Key words: Paranasal Sinus; Aspergillosis; Endoscopic surgery

Aspergillosis Involving the Maxillary Sinus-A Report of Two Cases and A Brief literature Review

Aspergillosis is a fungal infection characterized by invasive and noninvasive forms. Noninvasive aspergillosis usually affects a healthy host, appearing either as an allergy or a cluster of fungal hyphae. Localized invasive infection of damaged tissue may be seen in a healthy host, but more extensive infection is often evident in immunocompromised patients. Its incidence in recent years has shown a marked increase and it is believed to account for many cases of nonspecific sinusitis. The purpose of this paper is to report two cases of aspergillosis involving the maxillary sinus in immunocompetent patients with an emphasis on early diagnosis because delay in the initiation of treatment can be life-threatening due to the propensity of fungi to invade adjacent blood vessels and embolize to distant organs.

A case of invasive paranasal aspergillosis that developed from a non-invasive form during 5-year follow-up

Invasive paranasal aspergillosis has been previously reported, but there have been no case reports of non-invasive paranasal aspergillosis that progressed to the invasive form during follow-up. A case of non-invasive aspergillosis of the maxillary sinus that appeared to become invasive during 5-year follow-up is reported. The patient was diagnosed as having non-invasive aspergillosis at the first visit because CT images revealed only mucosal thickening and calcifications in the right maxillary sinus. Five years later, CT images showed an invasive mass lesion in the orbit and large bone destruction of the posterior wall of the maxillary sinus. The patient was rescued by total removal of the orbital contents with zygomatic ostectomy followed by appropriate antifungal chemotherapy irrespective of residual tissue invasion. We would propose that appropriate surgical treatment and antifungal agents are necessary to improve the prognosis of invasive aspergillosis.

Sphenoid sinus aspergillosis simulating pituitary tumor in immunocompetent patient

Aspergillosis of the sphenoid sinus is rare in immunocompetent patients. It may be mistaken for a sellar region tumor. A 65-year-old, human immunodeficiency virus-negative man presented with a 3-week history of cranial nerve III paresis and visual deterioration. The patient had a long-term history of tobacco snuff abuse. CT scans and MRI demonstrated a space-occupying lesion of the sellar and sphenoid sinus region. Presumptive diagnosis of pituitary macroadenoma was made and the patient was operated on via a transnasal–transsphenoidal approach. After the sphenoid sinus was opened, a yellow-brownish gluey material with crumbly debris extruded and was aspirated. The dura was intact. Histopathology revealed numerous Aspergillus hyphae without tissue invasion. Postoperatively, the cranial nerve III paresis resolved in a few days and visual acuity improved. Sphenoid sinus aspergillosis should be included in the differential diagnosis of sellar region processes, even in immunocompetent patients. Early diagnosis and transsphenoidal removal provides good results without the need for systemic antifungal therapy in non-invasive aspergillosis.

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.

Imaging of Rhinosinusitis and Its Complications: Plain Film, CT, and MRI

Conventional plain-film radiography may be used as a screening method for various pathological conditions of the sinonasal cavities. However, CT scanning remains the study of choice for the imaging evaluation of acute and chronic inflammatory diseases of sinonasal cavities. MRI is superior to CT in differentiating inflammatory conditions from neoplastic processes. The most common complications of rhinosinusitis in children occur in the orbit. The information obtained from the CT scan and MRI, together with clinical findings, may be the best guidelines for clinical management and the mode of treatment. Although intracranial complications of sinusitis are relatively rare, prompt recognition of these disease states is important to prevent permanent neurological deficit or fatality. It is prudent to obtain MRI of the sinuses, orbits, and brain whenever extensive or multiple complications of sinusitis are suspected, in addition to CT scanning. Chronic rhinosinusitis is a clinical diagnosis, confirmed and staged with the CT scan of sinonasal cavities. Chronic inflammatory disease is often associated with mucosal thickening and sclerosis of the bone, particularly within the sinuses. Chronic extramucosal fungal sinusitis develops as a saprophytic growth in retained secretions in a sinus cavity. The imaging manifestations of chronic mycotic rhinosinusitis may be nonspecific or highly suggestive of the presence of fungal infection. The presence of diffuse increased attenuation within the paranasal sinuses and nasal cavity should be considered as chronic allergic hypersensitivity aspergillosis (chronic noninvasive aspergillosis) or chronic hyperplastic sinusitis and polyposis associated with desiccated, retained mucosal secretions. The MRI characteristics of fungal sinusitis depend on the stage of the disease.

Aspergillosis of the Maxillary Sinus: Review and Case Report

A case of non-invasive aspergillosis affecting the maxillary sinus is presented. Reference is made to its possible aetiology (spores introduced to the antrum at the time of a root canal overfilling with a zinc oxide paste). A review is presented and the management of the case is described.

両側上顎洞に発症したアスペルギルス症の１例

A 47-year-old man was refered to us because of maxillary sinusitis associated with homogenous radiopague images in both maxillary sinuses on panoramic X-ray film obtained at another hospital. Computed tomography suggested that the high density images in the maxillary sinus were calcification associated with aspergillosis infection. As aspergillosis was detected on direct microscopy and fungal culture of specimens taken at sinus surgery and studied by histopathological staining, the lesion was diagnosed as non-invasive aspergillosis of both maxillary sinuses. The route of infection was suspected to be animal feed.

Aggressive surgical management in localized pulmonary mycotic and nonmycotic infections for neutropenic patients with acute leukemia: Report of eighteen cases

Objective: To prevent hemoptysis and relapse during subsequent chemotherapy-induced neutropenia in patients with localized forms of invasive pulmonary aspergillosis, we adopted an aggressive surgical approach. Methods: From 1988 to 1996, 18 patients with hematologic diseases were referred with the diagnosis of localized invasive pulmonary aspergillosis. The diagnosis was based on clinical features, failure to respond to antibiotic therapy, an air crescent sign suggestive of aspergillosis on the computed tomographic scan (39%), and retrieval of fungi by bronchoalveolar lavage (44%). Results: The following procedures were done: one pneumonectomy, four bilobectomies, seven lobectomies, six wedge resections, and one lobectomy with wedge resection (one patient had two procedures). No perioperative deaths or complications occurred. The histologic examination confirmed the diagnosis of invasive pulmonary aspergillosis in 12 patients. The six other diagnoses were as follows: one case of classic aspergilloma, one case of pneumonia, and four cases of pulmonary abscess. According to univariate analysis, thoracic pain was less common in the group with noninvasive pulmonary aspergillosis (1/6) than in the group with invasive pulmonary aspergillosis (8/12) ( p < 0.05). Sixteen patients required subsequent hematologic treatments. Sixty-six percent of the patients are alive with a mean follow-up of 29.1 ± 27.8 months (range 2 to 103 months), with no statistically significant difference between the invasive and the noninvasive pulmonary aspergillosis groups. Five patients died of a recurrence of their malignant disease at a mean of 17.2 ± 12.5 months (range 2 to 30 months), and one had a cerebral recurrence of Aspergillus infection during a bone marrow transplantation 3 months later. Conclusion: Aggressive surgical management radically improves the prognosis of invasive pulmonary aspergillosis, even if the surgical indications include some nonmycotic infections because of the difficulty in establishing the clinical diagnosis. (J Thorac Cardiovasc Surg 1997;115:63-9)

Influence of zinc oxide on Aspergillus species: a possible cause of local, non-invasive aspergillosis of the maxillary sinus.

Recently the appearance of radiopaque 'concrements' in the maxillary sinus was reported. These radiodense objects could be identified as root-filling material for teeth of the upper jaw containing zinc oxide. This suggested that excess root-filling material containing zinc oxide in the maxillary sinus could favour the formation of a local, non-invasive aspergillosis. To verify this hypothesis in vitro, we tested the influence of zinc oxide on Aspergillus fumigatus, A. flavus, A. terreus, A. nidulans, A. niger and A. niveus. A geometric series of zinc oxide diluted in 0.1 N H2SO4 was used. Czapek-Dox agar was inoculated with the six Aspergillus species. Circular cavities stamped into the centre of each agar plate were filled with an equal amount of the dilutions and all plates were then incubated for 7 days at 37 degrees C. Readings were taken on days 3, 5 and 7. Soluble zinc oxide promoted the growth of all the tested Aspergillus species, the effect diminishing with decreasing concentration. This effect could be observed on all days of measurement. Only with A. niger was stimulation of growth minimal, probably because this species already exhibits a high growth rate on Czapek-Dox agar. Therefore, overfilling of maxillary teeth with a zinc oxide-containing root-filling material may favour the formation of local aspergillosis.

Variation in virulence of Aspergillus fumigatus strains in a murine model of invasive pulmonary aspergillosis.

The diversity in virulence of different Aspergillus fumigatus strains was studied in an experimental murine model of invasive pulmonary aspergillosis (IPA) and the results were correlated with possession of a putative molecular marker of virulence. Seven strains from different patients with non-invasive or invasive aspergillosis and four environmental strains were typed by PCR with specific primers and scored as positive or negative, according to whether or not a 0.95-kb DNA fragment was amplified. Immunosuppressed mice were inoculated intranasally with A. fumigatus conidia from these different strains. The mortality curves revealed differences in virulence between the strains. The environmental strains produced a weaker infection than the strains from patients and the 0.95-kb-positive patient strains caused significantly higher mortality rates in mice than the 0.95-kb-negative patient strains. These findings support the hypothesis that certain isolates of A. fumigatus are more virulent than others and that their virulence appears to be associated with the 0.95-kb molecular marker.

Diagnosis of pulmonary aspergillosis in cases with cavity as sequela of tuberculosis

Non-invasive pulmonary aspergillosis is frequently seen in cases with cavity as sequela of tuberculosis. Diagnosis of non-invasive pulmonary aspergillosis is not easy except for cases whose chest X-ray findings show a typical fungus ball. How to diagnose pulmonary aspergillosis was studied in 21 patients who showed changes in the radiological findings of cavity as sequela of tuberculosis. We made sputum culture of Aspergillus, measurement of precipitin antibody titer to Aspergillus fumigatus and measurement of PASTOREX ASPERGILLUS in serum and sputum on the 21 patients (group A). PASTOREX ASPERGILLUS in sputum was evaluated in three grades: 1+ approximately 3+. We diagnosed 14 patients as pulmonary aspergillosis (PA group) among the 21 patients taking into account the chest X-ray findings and the results of the above-stated investigations. The types of chest X-ray findings of these 14 patients were fungus ball type (FB) in 2 patients, productive aspergilloma on the inner wall of a cavity (PAIC) in 8, mixed type with FB and PAIC in 2 and non-specific change in 2. However, there were 3 patients with the chest X-ray findings suggestive of PAIC in 7 patients (non-PA group) who were not diagnosed as pulmonary aspergillosis. Sputum culture were positive in 11 patients of PA group (79%) and negative in all patients of non-PA group. Precipitin antibody were positive in 8 patients of PA group (67%) and negative in all patients of non-PA group. PASTOREX ASPERGILLUS in serum were negative in all 21 patients. PASTOREX ASPERGILLUS in sputum were 3+ (+3) in all 14 patients of PA group and in 2 patients of non-PA group and 2+ (+2) in 2 patients of non-PA group. 12 patients of PA group were treated by antifungal agents and 11 patients responded well to the treatment. We also made sputum culture of Aspergillus and measurement of PASTOREX ASPERGILLUS in sputum on 14 patients (group B) who had respiratory diseases with stable cavities and 17 patients (group C) who had respiratory diseases without a cavity. In group B, sputum culture were positive in 1 patient and PASTOREX ASPERGILLUS in sputum were 3+ (+3) in 2 patients, 2+ (+2) in 1 and 1+ (+) in 2. In group C, sputum culture were negative in all patients and PASTOREX ASPERGILLUS in sputum were 3+ (+3) in 1 patient, 2+ (+2) in 3 and 1+ (+) in 2. Measurement of PASTOREX in sputum was a useful tool to diagnose non-invasive aspergillosis in addition to sputum culture and measurement of precipitin antibody titer. The sensitivity of PASTOREX in sputum was high but its specificity was low, however, its specificity could be raised by applying semi-quantitative analysis of PASTOREX in sputum.

Non-invasive aspergillosis of the paranasal sinuses: CT and MRI findings

Aspergillosis is the most common fungal infection of the paranasal sinuses, and needs to be recognized because it requires surgical removal. Twenty proven cases of aspergillosis of the paranasal sinuses are reported here. CT was performed in all the cases and MRI in 2 cases. The maxillary sinus was affected in 19 patients and the sphenoid sinus in 1. Mycosis was unilateral in all but 1 of the cases. Foci of increased attenuation at CT were observed in 18 cases, with calcification in 10 cases and/or dental material in 13 cases. An increased bony wall thickness was observed in 16 cases. All the patients but 1 had at least one of the signs. At MRI the fungal mass displayed a hypointense signal on T1- and T2-weighted images. No enhancement was noted on post-contrast T1-weighted images. The diagnosis of paranasal sinus aspergillosis is suggested by the CT findings, when a hyperdense mass with calcifications and/or dental material is noted with thickening of the sinus wall. MRI may have a complementary diagnostic role in doubtful cases.

Virulence of Aspergillus fumigatus strains investigated by random amplified polymorphic DNA analysis

A possible relationship between the ability of Aspergillus fumigatus strains to invade tissues and genetic polymorphism was studied by random amplified polymorphic DNA (RAPD) analysis. One hundred randomly designed oligonucleotide decamers were examined with DNA of three reference strains, eight environmental isolates and 21 isolates from two distinct clinical situations: non-invasive aspergillosis (predominantly aspergilloma) and invasive aspergillosis. One primer (OPQ 6) was found to generate a reproducible amplification product that enabled distinction between the two groups according to the presence or absence of a 0.95-kb fragment that correlated with the nature of the infection (non-invasive or invasive) and immune status of the patient. The results indicated that the pathogenicity of A. fumigatus was related not only to the host's immune status but also to the virulence of the strain of A. fumigatus.

Non-invasive aspergillosis of the paranasal sinuses: CT and MRI findings

Non-invasive aspergillosis of the paranasal sinuses: CT and MRI findings