Orbital Aspergillosis Research Articles

Right inferior rectus palsy – An unusual initial presentation of a case of disseminated fungal infection

Orbital Aspergillosis is a rare life-threatening fungal infection that is often misdiagnosed due to its nonspecific clinical and radiological appearance. In this case report, we present a case of disseminated aspergillus infection initially presenting as right inferior rectus palsy.

Invasive Optic Nerve Aspergillosis with Intracranial Extension in an Immunocompetent Patient (P10-10.004)

<h3>Objective:</h3> To report on an uncommon case of Invasive Optic Nerve Aspergillosis in an Immunocompetent Patient <h3>Background:</h3> Orbital aspergillosis is an uncommon and life-threatening infection. It often affects immunocompromised individuals but can rarely be seen in immunocompetent patients. We present a case of invasive optic nerve aspergillosis with intracranial extension in an immunocompetent male. <h3>Design/Methods:</h3> Case Report <h3>Results:</h3> 59-year-old man presented with a 6-week history of complete left vision loss and left sided facial pain. He was initially diagnosed with optic neuritis and treated with oral prednisone without resolution of symptoms. Initial work including computed tomography (CT) of the head, magnetic resonance imaging (MRI) of the brain, digital subtraction angiography of the head, fluorescence angiography of the left eye, and temporal artery biopsy were all unremarkable. Optical coherence tomography (OCT) demonstrated mild left optic nerve edema. Due to persistent symptoms, an MRI of the orbits was obtained and revealed left optic nerve diffusion restriction with enhancement along the optic tract, suggesting an abscess. Interval OCT revealed worsening left optic nerve layer thinning. The patient was treated initially treated with ceftriaxone, metronidazole, and vancomycin. The optic nerve abscess was surgically decompressed. Cultures grew Aspergillus fumigatus. He was transitioned to oral isavuconazole for a total of 6 months of antifungal therapy. Repeat head CT one month later revealed skull base osteomyelitis with intracranial extension requiring further surgical debridement. The patient was kept on antifungal therapy. Repeat neuroimaging has been stable but there has been no improvement in his vision. <h3>Conclusions:</h3> Orbital aspergillus is a rare entity and as such is a diagnostic challenge. Multiple surgical debridements in addition to appropriate antifungal therapy may be required as recurrent infections are common. Close interval imaging should be obtained to aid in the initial diagnosis and monitoring of orbital fungal infections. <b>Disclosure:</b> Dr. Gill has nothing to disclose. Dr. Whiting has nothing to disclose. Dr. Malik has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Genetech . Dr. Malik has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Jansen . Dr. Malik has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for EMD serono. The institution of Dr. Malik has received research support from National MS Society .

Voriconazole in the treatment of invasive aspergillosis of orbit

BackgroundThe aim of the study was to evaluate the outcomes of voriconazole in terms of functional recovery and response on imaging in the management of invasive aspergillosis of orbit. MethodsThis was a prospective non-comparative interventional study. Diagnosed cases of invasive orbital aspergillosis were studied in a tertiary care hospital. Intravenous voriconazole followed by oral treatment was given. Sinus debridement was done, where needed. The response to treatment was assessed clinically and on radiology. ResultsA total of 10 diagnosed cases of invasive orbital aspergillosis were studied. Nine cases (90%) occurred in immunocompetent patients. Predisposing sinus infection was seen in 8 patients (80%). The most common presenting complaint was the protrusion of eye. On voriconazole treatment, there was a statistically significant improvement in vision and extraocular movements from first week onwards (p = 0.01 and p = 0.02, respectively) and reduction in proptosis from second week onwards (p = 0.003). Imaging was done at three months follow-up which revealed a good response to treatment in 90% of patients. All patients tolerated the drug well except one who had transient hepatic dysfunction. The mean follow-up was 5.8 months (range: 3–12 months). There was no recurrence of disease till the last follow-up. ConclusionInvasive orbital aspergillosis commonly presents as sino-orbital disease, mostly in immunocompetent adult patients. Voriconazole is a safe and effective drug with good short-term clinical outcome.

Invasive fungal sinusitis-A neglected but important association with COVID 19 infection and a ticking bomb

A retrospective analysis of severe acute respiratory syndrome (SARS) and influenza data worldwide has concluded that fungal coinfections associated with global SARS-coronavirus 2 (CoV-2) are likely to be missed or misdiagnosed. The coronavirus disease-2019 (COVID)-19 patients, especially those who are severely ill or immunocompromised, are more likely to suffer from invasive mycoses which require early detection and treatment. We report two such cases, one of which is a case of aspergillosis of unilateral orbit and maxilla and another case is of mucormycosis infection of the paranasal sinuses and bilateral orbits.

COMPLICATIONS OF ZYGOMATIC IMPLANTS: A REVIEW OF SCIENTIFIC EVIDENCE

Background: Despite the technological advances the zygomatic implants (ZI) and its proven success, this rehabilitation option is sensitive, not a routine in dental practice, requiring technical mastery, surgical experience, and in-depth anatomical knowledge, which makes it quite susceptible to complications. In addition, little is discussed about these disorders, whether immediate or late, although they are essential knowledge for the surgeons who perform this procedure. Aim: The objective of the study was to answer the question through literature review: "Are there surgical complications in zygomatic implants?" As well as to argue the main intercurrences found. Material and Methods: The review of the literature was conducted on PubMed/Medline, Cochrane and SciELO using the descriptors: “Complications” or “Failure” and “Zygomatic Implants”. The included articles were observational studies that related ZI and complications. The initial research identified 448 articles, but 42 of them that mentioned complications associated with ZI were considered in this study. Results: The most common complication is sinusitis followed by peri-implantitis, problems with the prosthetic connection, fistula towards the implant, paresthesia, hematoma, lip laceration, ecchymosis, penetration of the orbital cavity, aspergillosis, intracranial penetration, and intraorbital hemorrhage. 44 out of 2835 ZIs placed in immediate or late loading were lost (1.5%). There were 223 minor or major complications in the 2827 implants (7.86%). Conclusions: The low morbidity of this treatment for maxillary atrophy, there are some immediate and late complications to be considered in the choice of rehabilitation treatment and that these should be reported preoperatively to the patients.

Atypical Optic Neuritis in an Immunocompetent Patient with Orbital

Aspergillosis infection in immunocompetent individuals is an uncommon entity. Non-specific presentation could delay in the diagnosis and management. We describe a case of orbital aspergillosis with cavernous sinus extension in a healthy lady. A 67-year-old lady presented with left eye decreased vision, preceded by non-specific headache for three weeks. Visual acuity deteriorated followed by ptosis and left ocular restrictions after corticosteroids therapy. Examination revealed poor left eye visual acuity with ptosis, anisocoria and total ophthalmoplegia. MRI orbit and brain demonstrated a heterogenous left orbital apex lesion extending to cavernous sinus. Transsphenoidal endoscopic biopsy revealed Aspergillus infection at the left retro-orbital space and the sphenoid sinus. Patient was treated with long duration of oral voriconazole. Ptosis and ophthalmoplegia resolved but left optic atrophy remained. In conclusion, orbital aspergillosis may carry a poor visual prognosis and intracranial spread does easily occur. Early treatment may lead to a better outcome in immunocompetent patients.

Orbital Aspergillosis Mimicking Giant Cell Arteritis

Orbital aspergillosis is a very rare, debilitating disease which can present solely with painful optic neuropathy and mimic giant cell arteritis in an elderly person. We report a case of orbital aspergillosis in a 65-year-old Malay man who presented with unilateral gradual blurring of vision and ipsilateral headache. Our initial working diagnosis was giant cell arteritis. Unfortunately, patient’s condition worsened with intravenous corticosteroid and developed into orbital apex syndrome. Imaging and biopsy results showed evidence of orbital aspergillosis. Patient lost his eyesight due to the wrong initial working diagnosis. This report is to emphasize that although giant cell arteritis is also a sight and life-threatening condition, it is rare among Asian populations. We need to take into account the epidemiology of the disease and look into any other differential diagnoses when the presentation is atypical.

Orbital aspergillosis: a case report and review of the literature

BackgroundOrbital aspergillosis is a rare sight- and life-threatening fungal infection affecting immunocompromised or otherwise healthy patients. It is often misdiagnosed due to its unspecific clinical and radiologic appearance. Therapeutic delay can have dramatic consequences. However, progress in microbiological diagnostic techniques and therapeutic experience from case series help improve the management of this disease.Case presentationA 78-year-old immunocompetent woman presented at an eye clinic for subacute swelling, reddening, and ptosis of her left upper eyelid. Based on radiologic and histologic considerations, she was treated for idiopathic orbital inflammation, but her condition worsened. After a second biopsy of the orbital mass, aspergillosis was diagnosed. Her condition improved promptly after initiation of an oral voriconazole treatment. Additionally, using a polymerase chain reaction (PCR) assay, A. fumigatus was identified on tissue of both biopsies and its azole susceptibility was examined simultaneously.ConclusionsIn the case described here, oral antifungal treatment was sufficient for the therapy of invasive orbital aspergillosis. Performing fungal PCR on orbital tissue can accelerate the diagnostic process and should be performed in ambiguous cases of slowly growing orbital mass. Finally, interdisciplinary management is the key to optimal treatment of orbital tumours and infections.

Sino-orbito-cerebral aspergillosis in an immunocompetent patient: a rare case report

&lt;p&gt;Invasive sino-orbito-cerebral aspergillosis is rarely seen in immunocompetent individuals; diagnosis and management of which is still a challenge. We report a case of invasive sino-orbito-cerebral aspergillosis in a 38 year immunocompetent male presenting with mild protrusion of right eye which was associated with no other complaint. His visual acuity was 6/6 in both eyes. There was mild proptosis of right eye of 2 mm on Hertel exophthalmometer with no restriction of the ocular movements. MRI brain, orbit and paranasal sinuses revealed soft tissue swelling in right ethmoid, frontal and sphenoidal air cells and orbit with bony destruction of lamina papyracea with intracranial extension of the mass with destruction of lamina cribrosa. The tissue biopsy was taken from the uncinate process and middle turbinate and sent for histopathological examination which revealed a fibrocollagenous soft tissue which was densely infiltrated by inflammatory cells with presence of large number of foreign body granulomas and filamentous aspergillus fungal hyphae. By radiological and histopathological findings, patient was diagnosed as a case of rhino-orbito-cerebral aspergillosis and given Tb Voriconazole 200 mg BD for 6 months after neurosurgery consultation. His proptosis was revealed at 3 months and repeat MRI showed slightly thickened mucosa of sinuses with no mass lesion seen in the orbit and brain with no evidence of any residual fungal granuloma. Orbital aspergillosis is quite challenging in terms of both diagnosis and treatment. Prolonged antifungal therapy is very effective in controlling infection, if patient is compliant.&lt;/p&gt;

Orbital aspergillosis masquerading as lymphoma diagnosed by cytology – A case report

Orbital aspergillosis is rare, more so in immunocompetant individuals. Fine needle aspiration cytology plays an important role in diagnosis of mass lesions in orbit, in spite of the fright of hemorrhagic episodes. We herein report a rare case of aspergillosis presenting as a mass lesion in orbit in a young immunocompetent female. Clinical and radiological features favored a malignant process. Fine needle aspiration cytology (FNAC) followed by culture assisted in accurate diagnosis. Keywords: Aspergillosis, FNAC, Cytology, Orbit.

Equine retrobulbar disease: Diagnoses and outcomes of 15 horses with exophthalmos (1988–2017)

SummaryRetrobulbar disease, while rare in horses, can pose a clinical challenge due to the advanced diagnostic procedures necessary to determine the underlying aetiology and extent of disease. The goal of this study was to explore definitive causes of exophthalmos within a hospital population and investigate prognoses for the various aetiologies. Retrospective medical record review was used to identify 15 horses diagnosed with a definitive cause of exophthalmos. Patient signalment, disease duration, eye affected, diagnostic procedures, therapies, and histopathological diagnosis were evaluated. Geldings (12/15, or 80%) were over‐represented (P = 0.014). Mean age at presentation (14 ± 6.7 years) was not significantly different for horses with (14 ± 8.5 years) and without (15 ± 4.4 years) a diagnosis of neoplasia. Diagnosis of a neoplastic process was made in 8/15 horses (53.3%) with neuroendocrine tumour being most common. Eight of the 15 cases were classified as primary orbital disease, and seven represented extension from paranasal sinus disease. Two novel diagnoses were identified: cystic hamartoma arising from the lacrimal gland and orbital aspergillosis secondary to sinonasal disease. In total, eight of 12 horses for which follow‐up was available were euthanised due to orbital disease, two immediately following computed tomography of the skull and six due to disease progression. One horse was euthanised following a peri‐anaesthetic complication. Three horses were lost to follow‐up. Of the 12 horses for which follow‐up was available, only four (33.3%) were alive 21 months post‐diagnosis. Considering only patients for whom a definitive diagnosis was obtained, retrobulbar disease was associated with a poor prognosis for life.

Primary Invasive Orbital Aspergillosis in an Immunocompetent Patient

Primary invasive orbital aspergillosis is a rare but fatal entity. It is commonly seen in immunocompromised patients with sinus pathology. The clinical spectrum of disease is variable which could delay in diagnosis and management of patients. Treatment includes surgical excision and systemic antifungals. Here we report a case of primary invasive orbital aspergillosis an immune-competent patient who managed successfully with surgical excision and a course of oral antifungal. The patient had not shown any recurrence in follow up period of one year.

Concomitant orbital aspergillosis and mucormycosis in a 17 months old immunocompetent child

Isolated multiple orbital fungal infection (aspergillosis & mucormycosis) is extremely rare disease in immunocompetent individuals and especially in children. Placement of prosthetic device during the surgery could be one of the risk factors. The presentation is usually masquerading other entities which make early diagnosis a challengeable. This case presenting a 17 months old immunocompetent child who is diagnosed with isolated multiple orbital fungal infection: aspergillosis & mucormycosis. The presentation was mimicking orbital cellulitis and chronic dacryocystitis. The definitive diagnosis was made by tissue biopsy. The child was managed by surgical debridement and IV amphotericin B liposomal. High index of suspicion to fungal infection should be considered after surgical intervention with insertion prosthetic materials. To the best of our knowledge, orbital aspergillosis in immunocompetent young children is exceptionally rare.

Invasive Orbital Apex Aspergillosis with Mycotic Aneurysm Formation and Subarachnoid Hemorrhage in Immunocompetent Patients.

Invasive orbital apex aspergillosis (IOAA) is an aggressive form of aspergillus infection that usually affects immunocompromised patients. It can cause orbital apex syndrome and, if not treated promptly, may progress rapidly causing fatal complications. Subarachnoid hemorrhage (SAH) secondary to ruptured mycotic aneurysms is a very rare complication of invasive aspergillosis. We aim to describe our management and the outcome of six immunocompetent patients with IOAA with subsequent SAH secondary to ruptured mycotic aneurysms. A retrospective review was undertaken of charts of patients treated for orbital involvement with aspergillosis between January 2003 and December 2015 at King Abdulaziz University Hospital, Jeddah, Saudi Arabia. We identified all immunocompetent patients with IOAA who developed vascular complications. Six immunocompetent patients with IOAA complicated by SAH secondary to ruptured mycotic aneurysms were identified in the study period. Four patients were female, and patients' age ranged between 14 and 53 years (mean, 33.7 ± 13.4 years). All patients presented with progressive retro-orbital headache, visual impairment, and ophthalmoplegia; four had proptosis. Two patients had vasospasm and brain infarction. Antifungal therapy was used in all patients, and 4 underwent emergency craniotomy and clipping of an aneurysm. Five patients died as a consequence of SAH and infarction. IOAA is a serious disease that commonly causes catastrophic and fatal vascular complications.

Isolated Orbital Aspergillosis in Immunocompetent Patients: A Multicenter Study

To report clinicopathologic features, radiologic findings, and treatment outcomes of isolated, orbital aspergillosis. Multicenter, retrospective case series. setting: Multicenter. There were 8 lesions in 8 eyes of 8 patients with isolated, orbital aspergillosis. Review of medical records and histopathology slides. Disease control. Of 34 patients with orbital aspergillosis, 8 (23.5%) had isolated orbital involvement at presentation. The mean age at presentation was 34.5 years (median, 43 years: range, 0.5-72 years). Gradually progressive proptosis and eyelid swelling were the most common presenting features (each 4/8). Proptosis ranged from 4mm to 9mm (median, 5.5mm; mean, 5.75mm). Restriction of ocular motility was seen in all 8 patients. Other examination findings included palpable mass (2/8), conjunctival chemosis (2/8), hyperglobus (1/8), hypoglobus (1/8), and resistance to retropulsion (1/8). Microbial culture results were available in 1 patient and showed Aspergillus fumigatus. Two patients were treated with complete surgical excision alone while 6 were treated with antifungal medications. Complete resolution of proptosis and restoration of ocular motility were seen in all patients following treatment. Visual disturbances present in 1 were corrected following treatment. Recurrence was observed in 1 patient. Isolated orbital aspergillosis, though rare, should be considered in the differential diagnosis of a patient presenting with a gradually progressive orbital mass, especially in Asian individuals. Early recognition will help reduce the morbidity and mortality associated with this disease.

A Case of the Third, Fourth, and Sixth Nerve Palsy in a Patient with Cerebral Aspergillosis

Purpose: To report a case of cerebral aspergillosis with third, fourth, and sixth nerve palsy. Case summary: A 66-year-old female presented with ocular pain, diplopia, ptosis, and limited ocular movement of the right eye. The patient had experienced rhinorrhea and headache in the right temporal area 3 weeks prior and was treated with oral antibiotics for 1 week. Marginal reflex distance 1 was -4 mm in the right eye and +4 mm in the left eye. Upward, downward, medial, and lateral gaze limitation (-4/-4/-3.5/-2.5) was evaluated. Magnetic resonance imaging (MRI) revealed a mass originating from the nasopharynx and passing through the petrous apex, foramen lacerum, carvernous sinus, sphenoid sinus, orbital apex, and inferior orbital fissure. The mass had high signals on T2-weighted imaging. After 5 days, the mass was removed by endoscopic surgery and aspergillus was detected histopathologically. The patient was given intravenous voriconazole for 11 days and oral voriconazole for 11 weeks. Ptosis and ocular movement limitation began to improve after 6 weeks postoperatively. After 4 months, ocular movement was not limited and there was no recurrence during the 1 year follow-up period. Conclusions: The present case showed that orbital aspergillosis can invade the intracranial area and third, fourth, and sixth nerve palsy can develop without exophthalmos. Thus, when ocular movement disorders, ptosis and symptoms of sinusitis are present in orbital aspergillosis patients, use of appropriate diagnostic tools such as MRI and active treatment are important. J Korean Ophthalmol Soc 2015;56(3):471-476

Orbital aspergillosis in immunocompetent patients

PurposeTo describe clinical, ultrasonographic, radiological and histopathological features of orbital aspergillosis in immunocompetent patients.MethodsMedical records of immunocompetant individuals with orbital aspergillosis between November 1995 and November 2010 were reviewed.ResultsThirty-five cases...

A Case of the Third Nerve Palsy in a Patient with Orbital Aspergillosis

A Case of the Third Nerve Palsy in a Patient with Orbital Aspergillosis

Orbital Aspergillosis or Giant Cell Arteritis — A Diagnostic Dilemma

Orbital aspergillosis is an uncommon but potentially fatal disease. Its initial clinical presentation can be nonspecific and may be easily confused with other systemic diseases (such as neoplasms, other orbital infections which could include bacterial, mycobacterium and fungal infections), systemic vasculitis and other inflammatory conditions. Use of systemic corticosteroid may result in transient symptom relief further delaying the diagnosis. We describe its occurrence in a 76-year-old Chinese female with underlying rheumatoid arthritis who presented with a four-week history of left fronto-temporal headache, and ipsilateral blurring of vision with an elevated erythrocyte sedimentation rate (ESR). Although temporal artery biopsy was negative for giant cell arteritis (GCA), high-dose corticosteroids were initially started for presumptive GCA. There was an initial transient improvement in headache and in her left eye's visual acuity. However, this was followed by a worsening headache and complete visual loss in her left eye. Magnetic resonance imaging (MRI) revealed a new orbital apical mass-like lesion extending from the sphenoid sinus which was diagnosed as aspergillus infection on biopsy. Her condition improved and remained stable after the institution of appropriate anti-fungal therapy.

Two Cases of Feline Orbital Aspergillosis Due to &lt;i&gt;Aspergillus udagawae&lt;/i&gt; and &lt;i&gt;A. viridinutans&lt;/i&gt;

Aspergillus udagawae and A. viridinutans are members of the section Fumigati; both cause invasive aspergillosis in humans. These two Aspergillus species are discriminated from A. fumigatus by molecular methods. Herein, we report two cases of feline orbital aspergillosis, one caused by A. udagawae and the other by A. viridinutans. To our knowledge, Case 1 represents the first reported case of treatment of A. udagawae with a high dosage of itraconazole, and Case 2 represents the first reported case of A. viridinutans infection associated with sarcoma. Identification of the etiologic agents of these cases was confirmed by comparative analyses of the sequences of β-tubulin-encoding genes. With the spread of non-fumigatus aspergillosis, increasing emphasis should be placed on molecular identification of the infecting Aspergillus species and the use of in vitro drug susceptibility tests to ensure the selection of appropriate antibiotics.