Infection Of Paranasal Sinuses Research Articles

Orbital complications of infected mucocele in the paranasal sinuses

ObjectiveInfected mucocele of the paranasal sinuses can induce orbital infection, including orbital subperiosteal abscess, which may lead to life-threatening intracranial complications. Effective diagnosis is important, and treatment should be aggressive. This paper presents our experiences in endoscopic surgical management of orbital complications secondary to infected paranasal sinus mucoceles. MethodsFrom our retrospective review of the medical charts for 82 patients with 92 sides diagnosed with paranasal sinus mucoceles, we present 7 sides in 7 adult patients with orbital complications secondary to infected mucoceles. The collected data include the suggested etiology, side of sinus involvement, localization of abscess in the orbit, orbital wall bone defects caused by mucocele compression, ophthalmic symptoms, duration between symptom onset and initial visit, operation date, type of surgery performed, and follow-up. ResultsThe mucocele was located in the ethmoid-frontal region in 9.8% of the sides (9/92), in the frontal sinus in 7.6% (7/92), in the ethmoidal sinus in 9.8% (9/92), in the maxillary sinus in 67.4% (62/92), in the maxillary-ethmoidal sinus in 3.3% (3/92), and in the sphenoid sinus in 2.2% (2/92). The patients with ethmoid-frontal mucoceles had a significantly higher incidence of orbital complications (6/9) as compared with the other sub-types of mucoceles (frontal, 0/7; ethmoidal, 0/9; maxillary, 1/62; maxillary-ethmoidal, 0/3; sphenoid, 0/2). Chandler's classification showed Type I in one, Type II in three, and Type III in three. Sinus involvement was observed at the ethmoid-frontal sinuses in six cases and the maxillary sinus in one case. All seven cases had a partial defect of the orbital wall bone (lamina papyracea, or inferior orbital wall bone) by mucocele compression, and the patients underwent endoscopic marsupialization. For the cases with subperiosteal abscess, the lamina papyracea was also removed partially for draining the abscess. In all cases, symptoms were resolved without any recurrence of the mucocele. ConclusionsInfected ethmoid-frontal mucoceles with a defect of the lamina papyracea tend to induce orbital infection, so prompt surgery for the infected mucoceles should be considered early even with Types I and II, before visual acuity is impaired, because surgery is the only curative treatment for the mucoceles.

Imaging of Paranasal Sinus Infections in Children: A Review.

Paranasal sinuses (PNS) infections are common in children. They may cause common and well-known complications, but also, unusual and potentially devastating complications. Diagnosing PNS infections and complications in children requires knowledge of the unique anatomy of the nasal cavity and the PNS. In fetal life, nasal mucosa evaginations into the lateral nasal walls initiate the development of the PNS. The PNS continue to develop after birth and complete their maturation and pneumatization at different ages during childhood which makes the pattern of PNS infections determined by patient age. Complications are caused by direct spread of the infection to the orbit, face, intracranial or osseous structures or hematogenous spread of the infection to the intracranial structures. Emergent imaging studies are often necessary in the evaluation of the complications in pediatric patients when the symptoms persist for 10 days and/or if there is evidence of intracranial or orbital complications. In addition, immunocompromised children are especially vulnerable to developing unusual complications. Computed tomography (CT) is excellent for determining whether there is intraorbital extension of PNS disease. However, when the infection approaches the orbital apex, a magnetic resonance imaging (MRI) study with contrast is necessary to assess spread into the cavernous sinus and the intracranial compartment. The goal of this manuscript is to review and characterize imaging findings of PNS infections using CT and MRI allowing determination of the extent of PNS infections and their common and unusual complications in children. In addition, a summary of the development of the normal PNS is provided.

Fungal Pneumonia in The Immunocompetent Host: A Possible Statistical Connection Between Allergic Fungal Sinusitis with Polyposis and Recurrent Pulmonary Infection Detected by Gastroesophageal Reflux Disease Scintigraphy.

Objectives:Fungal pneumonia in the immune competent host is a rarity with few reported cases in the literature. We present a series of 7 cases of recurrent fungal pneumonia in association with allergic fungal rhinosinusitis and gastroesophageal reflux disease (GERD). We hypothesised that recurrent infection may have been transported from the infected paranasal sinuses into the lung by GERD as the process was terminated by surgical fundoplication in 2 of these patients.Methods:Patients were recruited into the study if they were immune competent and had recurrent fungal pneumonia and GERD. Allergic fungal rhinosinusitis was proven by biopsy. GERD was investigated by a scintigraphic test that assessed local oesophageal disease, lung aspiration and head and neck involvement with a hybrid gamma camera and X-ray computed tomography.Results:All patients were shown to have GERD with 5/7 showing paranasal sinus contamination and 7/7 showing laryngopharyngeal involvement and 6/7 lung aspiration. One patient had characteristics strongly predictive of aspiration. Fundoplication led to cessation of fungal lung infection in two patients.Conclusion:Recurrent fungal pneumonia in the immune competent host should raise the possibility of re-infection from the paranasal sinuses, especially in patients with GERD.

Characteristics of Atypical Orbital Complications of Sinusitis.

Orbital complications of rhinosinusitis in adults are scarcely discussed in the literature. We defined atypical orbital complications as those without typical orbital invasion and not classified by the Chandler classification. These complications present as visual loss of diplopia without soft tissue swelling, pain, or computed tomography images of an orbital abscess. The objective of this study was to review our experience with the management of atypical orbital complications of rhinosinusitis and to identify key factors in the characteristics of these patients. A retrospective case series review was conducted from 2015 to 2019 in a tertiary referral center, which included all patients with rhinosinusitis and orbital complications. Five patients were identified with atypical complications in the orbital area. Two of the 5 patients exhibited vision loss without any other symptoms. Two patients showed diplopia with or without ptosis. One patient had a headache and ptosis. Complete recovery was noted in 4 of the 5 patients after endoscopic sinus surgery. With future studies, new surgical criteria, including retinal destruction, location of the sinusitis, the onset of ophthalmological symptoms, and culture results may be added to the classical surgical criteria to manage orbital complications of paranasal sinus infection cases.

Intracranial Abscesses: An Institutional Study

Background: Brain abscess is defined as a focal intracranial infection that is initiated as an area of cerebritis and evolves into a collection of pus surrounded by a vascularized capsule. These are complications of head trauma, neurosurgical operations, meningitis, and otogenic, mastoid, and paranasal air sinus infections. Management involves both medical and surgical treatment. Surgical management includes either aspiration or excision of lesions larger than 2.5 cm in diameter, depending on brain location. However, literature on surgical treatment is replete with several procedures which, on their own, may not determine outcome. Aim: Aim is to study the epidemiology, management and outcome of various treatment modalities of brain abscess in our institute. Material and Methods: We conducted a retrospective study of demographic data as well as indications, treatment modalities, and outcomes of various surgical procedures for evacuation of intracranial abscesses in patients admitted to our Neuro-intensive care unit at R.N.T. Medical College, Udaipur, Rajasthan, India from January 2013 to June 2019. Results: We carried out 53 procedures in 43 (30 male and 13 female) patients with various intracranial abscesses. Most abscesses [16, i.e. 37%] occurred in the second decade and second most common in the first decade [15, i.e. 34%]. In infants 4 (9%) cases of intracranial abscesses were present. None of the infants had features of congenital heart disease. The predisposing factors were mostly otolaryngologic (15) or posttraumatic (8). Most commonly abscesses were located in frontal 13 (30%) followed by cerebellar 9 (21%). Burr hole evacuation was done in 74% of cases. 3 patients (7% of cases) died. Prognosis appears to worsen with ventriculitis, multiple abscesses especially in infants, and immunosuppression. Conclusion: In conclusion, brain abscess still continues to be a formidable challenge, with prognosis that dramatically improved over the last decades due to advances in brain imaging, neurosurgical techniques and better use of old and more recent antibacterial agents. Mortality is improved compared with historical series; however, long-term morbidity is significant particularly in the infant population. Further researches must be conducted to clarify specific aspects, such as anticonvulsant prophylaxis/therapy, and also for the improvement of microbiological diagnosis.

Primary Central Nervous System Mucormycosis Mimicking Like a High Grade Glioma - A Rare Case Report

Mucormycosis is an invasive fungal infection caused by fungi of Mucoraceae family in immunocompromised individuals. CNS (Central Nervous System) Mucormycosis commonly arises from an adjacent para nasal sinus infection (Rhino cerebral), but isolated CNS Mucormycosis is a rare presentation as in our case. Presented as raised intra cranial pressure and no focal neurological deficit on evaluation found to have left temporal space occupying lesion with significant mass effect looking like high grade glioma. Operated on emergency basis, histopathology suggestive of invasive fungal infection managed accordingly. Results: As per literature primary CNS Mucormycosis has high mortality and morbidity even after best possible management. Our case was managed as per treatment protocol and after discharge patient got readmitted with surgical site infection and uncontrolled blood sugars and worsened medical condition, and finally died due to cardiac event after 28 days of diagnosis. Conclusion: Mucormycosis is an aggressive infection which can cause significant morbidity and mortality, thus needs high index of suspicion for early diagnosis and treatment.

Comparison of nasal and olfactory functions between two surgical approaches for the treatment of concha bullosa: a randomised clinical trial.

Concha bullosa may be associated with paranasal sinus infections and nasal obstruction. Middle concha mucosa membranes have olfactory neurofibrils. This study investigated the impact of routinely used concha bullosa surgery techniques - crushing and lateral laminectomy - on nasal and olfactory functions. Forty-three adult patients who had undergone surgery for a symptomatic concha bullosa completed the odour test, nasal obstruction visual analogue scale, 22-item Sino-Nasal Outcome Test, and peak nasal inspiratory flow test, pre-operatively and three months post-operatively. The pre- and post-operative results within and between the two treatment groups were compared. Intragroup comparison of mean pre- versus post-treatment changes revealed statistically significant findings for the nasal obstruction visual analogue scale, Sino-Nasal Outcome Test, peak nasal inspiratory flow and olfaction tests (all p < 0.05). However, there were no statistically significant changes when comparing the scores between the groups (intergroup comparison). Lateral laminectomy and crushing in concha bullosa surgery have no negative effects on olfactory function. Concha bullosa surgery provides positive outcomes regarding nasal complaints in symptomatic patients.

Mucormycosis of the Central Nervous System.

Mucormycosis involves the central nervous system by direct extension from infected paranasal sinuses or hematogenous dissemination from the lungs. Incidence rates of this rare disease seem to be rising, with a shift from the rhino-orbital-cerebral syndrome typical of patients with diabetes mellitus and ketoacidosis, to disseminated disease in patients with hematological malignancies. We present our current understanding of the pathobiology, clinical features, and diagnostic and treatment strategies of cerebral mucormycosis. Despite advances in imaging and the availability of novel drugs, cerebral mucormycosis continues to be associated with high rates of death and disability. Emerging molecular diagnostics, advances in experimental systems and the establishment of large patient registries are key components of ongoing efforts to provide a timely diagnosis and effective treatment to patients with cerebral mucormycosis.

Successful Treatment of Scedosporium Sinusitis in Two Lung Transplant Recipients: Review of the Literature and Recommendations for Management.

BackgroundScedosporium fungal infection is an emerging disease which is difficult to diagnose and treat. Patients undergoing lung transplant may be colonized prior to transplantation and are at risk for lethal allograft infection after transplantation.ObjectivesTo identify and evaluate treatment options.MethodsThis study is a retrospective review of patients treated at a tertiary academic medical center from 2007 to 2017 with positive sinonasal cultures. A review of the literature was also performed to identify additional cases.ResultsTwo lung transplant patients had a positive culture for Scedosporium. The literature search resulted in 37 citations, which yielded only 2 prior cases of Scedosporium paranasal sinus colonization or infection in lung transplant recipients. Three of the 4 patients had cystic fibrosis. Two of the patients were colonized before initial transplant, while 1 patient was colonized before subsequent transplant. Three of the 4 patients survived, and all 3 had disease isolated to their sinuses and lungs treated with sinus surgery, while the fourth had disseminated disease and did not undergo sinus surgery. All patients were treated with multiple antifungals due to resistance patterns. One surviving patient cleared both sinus and lung cultures in less than 1 month, while the other 2 surviving patients achieved negative cultures after a minimum of 6 months.ConclusionsSurgery may be especially important in patients with fungal sinus colonization or infection before or after lung transplantation. Chronic sinusitis is an important source for persistent fungal colonization and reinfection of the allograft which could be removed with surgical debridement before causing highly morbid pulmonary disease.

Study on management of fungal infections of nose and parnasal sinuses

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; From last few years, the fungal infection has been increasing due to greatly enhanced international traffic and as opportunistic infections in consequence of use of powerful cytotoxic drugs. The disease invariably occurs in diabetics, usually with ketoacidosis, immune compromised patients. Hence, we planned to undertake the present study to evaluate a standard method of management of fungal infections of nose and paranasal sinuses.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; A detailed examination of the nose and pranasal sinuses was carried out in the department of ENT. The patients were continuously monitored with pulse oximetry and ECG monitor. In all patients, nasal endoscopy was performed. &lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; In this study, fungal infections of the nose and paranasal sinuses were found to be common between 20 and 50 years of age. Aspergillosis was the commonest sinonasal fungal infection followed by allergic fungal sinusitis, rhinosporidiosis and mucormycosis.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Early detection, proper and adequate dose of antifungal agents, timely surgical intervention in the form of debridement and sphenoethmoidectomy and orbital exenteration improve the survival rate in the disease of sinonasal fungal infections.&lt;/p&gt;&lt;p&gt; &lt;/p&gt;

A Rare Complication of Frequent Sphenoid Sinusitis Is Subdural Empyema: Case Report

Subdural empyema is a fluid collection between dura and arachnoid layers and can develop secondary to states like meningitis, middle ear infection, paranasal sinus infection, trauma or cranial surgery. It can develop secondary to paranasal sinus infections which are rare observed and lead to a life-threatening situation. Early diagnosis and treatment cause a decrease in mortality and morbidity. As well as nonspecific symptoms and signs might cause, the most common symptom triad of fever, headaches and vomiting. Computerized tomography is the first choice for the diagnosis; however Magnetic Resonance İmaging is more efficient and useful. Broad spectrum antibiotherapy is chosen for the treatment, in most cases surgical drainage becomes necessary. In this paper, we aimed to present a rarely seen subdural empyema case secondary to frequently seen sphenoid sinusitis.

Role of CT in the Diagnosis and Follow up of Pediatric Oncology Patients with Fungal Infection

Background: invasive fungal infections are rare in pediatric population, but have a high morbidity and mortality rates despite the development of antifungal treatment. It ranges from superficial, mucosal to invasive infection. Aim of the Work: to assess the value of CT in the diagnosis of invasive fungal infection and differentiating it from other causes of infection or metastatic deposits in patients with childhood cancer and persistent fever in spite of antibacterial treatment and to assess the radiological response after treatment with antifungal drugs. Patients and Methods: our study was done over period from October 2017 to June 2018, included 22 immunocompromised pediatric patients from El -Demerdash tertiary hospital, included (8 male, and 14 female) with age range (14m- 16 yrs.). We identified immunocompromised patient of having underlying malignancy or auto-immune deficiency. We included all patients with fever, neutropenia and high CRP, in whom we suspected chest or paranasal sinus infection. Results: in our case group; the most common underlying disease was ALL-B cell (n=6, 40%), followed by ALL-T cell (n=2, 13.3%), AML (n=2, 13.3%), aplastic (n=3, 20%), hepatobalstoma (n=1, 6.7%) and auto-immunodeficiency (n=1, 6.7%).Analysis of the radiological data showed that macronodules was the most significant finding to suggest fungal rather than bacterial infection (53.3% vs. 0% respectively, p=0.015), followed by consolidation (40% vs. 57.1%, p=0.45) and ground glassing (26.7% vs. 14.3%.Cavitary lesions, pleural effusion and lung abscess were associated only with fungal disease, yet it is not considered significant enough in our study as a reliable sign to suggest fungal infection Conclusion: increase number of hospitalized pediatric patients with fungal infection is a rising problem, with no specific criteria for early diagnosis among this population causing delay of the proper treatment. In our study hematological malignancy was the most common underlying disease with macronodules being the most specific finding to suggest fungal infection in pediatrics.

Role of CT in the Diagnosis and Follow up of Pediatric Oncology Patients with Fungal Infection

Background: invasive fungal infections are rare in pediatric population, but have a high morbidity and mortality rates despite the development of antifungal treatment. It ranges from superficial, mucosal to invasive infection. Aim of the Work: to assess the value of CT in the diagnosis of invasive fungal infection and differentiating it from other causes of infection or metastatic deposits in patients with childhood cancer and persistent fever in spite of antibacterial treatment and to assess the radiological response after treatment with antifungal drugs. Patients and Methods: our study was done over period from October 2017 to June 2018, included 22 immunocompromised pediatric patients from El -Demerdash tertiary hospital, included (8 male, and 14 female) with age range (14m- 16 yrs.). We identified immunocompromised patient of having underlying malignancy or auto-immune deficiency. We included all patients with fever, neutropenia and high CRP, in whom we suspected chest or paranasal sinus infection. Results: in our case group; the most common underlying disease was ALL-B cell (n=6, 40%), followed by ALL-T cell (n=2, 13.3%), AML (n=2, 13.3%), aplastic (n=3, 20%), hepatobalstoma (n=1, 6.7%) and auto-immunodeficiency (n=1, 6.7%).Analysis of the radiological data showed that macronodules was the most significant finding to suggest fungal rather than bacterial infection (53.3% vs. 0% respectively, p=0.015), followed by consolidation (40% vs. 57.1%, p=0.45) and ground glassing (26.7% vs. 14.3%.Cavitary lesions, pleural effusion and lung abscess were associated only with fungal disease, yet it is not considered significant enough in our study as a reliable sign to suggest fungal infection Conclusion: increase number of hospitalized pediatric patients with fungal infection is a rising problem, with no specific criteria for early diagnosis among this population causing delay of the proper treatment. In our study hematological malignancy was the most common underlying disease with macronodules being the most specific finding to suggest fungal infection in pediatrics.

Surgical Treatment of Rhinosinusitis-Related Orbital Complications: Factors Affecting Irreversible Blindness.

If left untreated, rhinosinusitis can rarely cause a devastating complication irreversible blindness (IB). Despite new technologies in endoscopic sinus surgery and use of new broad-spectrum antibiotics, IB outcome is still a problem for surgically treated orbital complication of paranasal sinus infection (OCPSI) patients, and factors leading to IB outcome are not actually known. The aim of this study was to assess the factors leading to the IB outcome for surgically treated OCPSI patients. Results of 25 surgically treated OCPSI patients in our clinic were combined with surgically treated OCPSI patients reported through the PubMed database search from the year 2007. Patients were divided into 2 groups: IB group and recovery group. Patients having at least 1 immune status-related additional risk factor (ARF) were more common in the IB group, having an at least 1 ARF had 1.683 risk value of IB outcome (RR: 1.683, P = 0.006). IB patients had statistically significant higher mean (21.87 ± 40.35, P = 0.005) time interval (days) (TI) between onset of ophthalmological symptoms and surgical intervention compared to recovery group patients (2.92 ± 2.53). ROC curve analysis for an estimation of IB outcome according to the TI value demonstrated that a cut-off value of ≥2.5 days had the ideal sensitivity (87.5%) and specificity (71.9%) that resulted in IB outcome. (80.5% power, P = 0.008) IB and recovery group patients did not differ according to orbital complication type according to Chandler's classification (P = 0.492) and white blood cell count status (P = 0.584). In conclusion, OCPSI patients with ARFs and delayed admission after onset of orbital symptoms have a higher risk of IB outcome. These patients deserve prompt evaluation and early surgical intervention to prevent blindness. With future studies, new surgical criteria, including the ARF status and onset of ophthalmological symptoms (≥2.5 days) may be added to classical surgical criteria to prevent IB for OCPSI cases.

A rare cause of ptosis in emergency medicine practice: acute sinusitis case report

Objective: Paranasal sinus infections are one of the most frequent causes of emergency service admissions. With increased incidence, complications are often local and classified according to the effecting side. Early identification of complication leads to reduce mortality and morbidity. Case: A 22 year old male patient was admitted to our emergency department with ptosis on his right eyelid. Firstly he was admitted to the family doctor and received oral cephalosporin treatment for upper respiratory tract infection. Within three days, the ptosis was progressively occurred. No additional systemic sign was detected. The eyelid has slightly edema, not have redness, conjunctival hyperemia and loss of brow not observed. Eye movements were naturally, display pain in the outward view. For differential diagnosis central nervous system imaging was performed. Patient referred to otorhinolaryngology surgeon with prediagnosis of orbital cellulite and acute sinusitis. The patient was admitted to the otorhinolaryngology clinic for operation because of complicated sinusitis. Conclusion: In the presence of acute sinusitis, infections may enter the orbital periosteum and spread to neighboring tissues. Computed tomography is a highly effective imaging modality for the evaluation of both paranasal infections and their complications. Patients with orbital complications must be hospitalized and immediate intravenous antibiotic therapy should be started.

Clinical analysis of orbital and periorbital abscess in 17 patients

Objective: To discuss the etiology, clinical features and treatment principles of the orbital and periorbital abscess. Methods: A retrospective case series of 17 cases with orbital and periorbital abscess between July 2010 and November 2015 were conducted. All patients(,) clinical data including medical history, etiology, abscess location, paranasal sinus involvement, eye involvement, microbiological test results, imaging features, treatment and prognosis were summarized and analyzed. Results: In all 17 patients, there were 10 males and 7 females with age from 3.0 to 71.0 years (the average age was 33.9 years).Eight patients(,) bacterial cultures of the pus and secretion were positive in all 17 patients. Orbital and periorbital abscess patients could manifest decreased vision, redness and swelling of eyelid, conjunctival congestion and edema, ocular motility disorders, displacement of eyeball, increased orbital pressure, abscess rupture etc. CT showed us the soft tissue mass, accompanied with sinusitis or paranasal sinus mass. MR performed with the long T(1) and T(2) signals. The signals of the abscess cavity were not uniform. For the etiology,11 cases were secondary to sinusitis, including 1 case of diabetes; 2 cases with orbital fractures.One case was secondary to orbital fracture repairment surgery. One case was secondary to the remnant of sequestrum and foreign bodys in the wound after repairment surgery. One case was injured by the hard object. One case was secondary to paranasal sinuses large B-cell lymphoma. One case had diabetic history and the blood sugar was controlled unstablly. For the treatment, 7 cases were treated by the drainage surgery which was performed via the sinus with endoscopic and abscess resection performed via the skin.Two cases were treatment by the abscess resection only.One case was treated by the drainage surgery performed via the sinus with endoscopic only. Six cases were treated by the drainage surgery performed via the skin. One case was only administered intravenous antibiotic. Sixteen cases acquired well prognosis without serious complications except 1 case which occurred central retinal artery and vein occlusion. Conclusions: The orbital and periorbital abscess is mainly a complication of paranasal sinus infection, or secondary to trauma, surgery, tumor, etc; Orbital and periorbital abscess always manifest inflammatory neoplastic clinical features, the key of the diagnosis is to make sure the etiology; Incision and drainage of the abscess is the main treatment method when necessary. We can do the surgery with other departments to avoid the occurrence of serious complications.(Chin J Ophthalmol, 2017, 53: 588-593).

Imaging of Pediatric Paranasal Sinus and Orbital Infections

AbstractUpper respiratory tract infections are the most frequent outpatient disease processes treated by the pediatricians. Although upper respiratory tract infections are typically self-limited viral illnesses, a subset of children will develop acute bacterial sinusitis, which is differentiated from the former viral nasopharyngitis by prolonged illness, worsening course, or severe onset of symptoms. Although diagnostic imaging is not indicated in the differentiation of a viral upper respiratory tract infection from acute bacterial sinusitis, contrast-enhanced computed tomography (CT) or magnetic resonance imaging (MRI) are critical in the detection and classification of potentially serious complications of acute bacterial sinusitis resulting from intraorbital or intracranial spread of infection. Orbital infections are the most frequently associated complications of paranasal sinus inflammatory disease given the proximity of the paranasal sinuses and orbits. Imaging is essential in differentiating preseptal cellulitis from orbital cellulitis and guiding appropriate therapy. Cross-sectional imaging is also important in the characterization of noninvasive fungal sinusitis, forms of chronic sinusitis in the setting of an intact immune system, and invasive fungal sinusitis, an acute fulminant sinusitis induced by angioinvasive fungi in immunocompromised children requiring emergent surgical management.

Diagnostic Accuracy of CT Scan in Diagnosing Paranasal Fungal Infection.

To assess the diagnostic accuracy of CTscan in detecting paranasal sinus fungal infections. Cross-sectional, observational study. Department of Radiology, Ziauddin University Hospital, Karachi, from April to September 2014. Patients with clinical suspicion of fungal sinusitis were included in this study. Patients with already diagnosed or history of recurrent fungal infections were excluded. All these patients underwent CTscan examination of paranasal sinuses. Findings were recorded. Final diagnosis was based on smear analysis for fungal culture. Accuracy analysis was conducted for CTdiagnosis using smear analysis as the gold standard. Kappa analysis was conducted to determine agreement. Out of the 120 patients, 71 (59%) were male. The sensitivity, specificity, positive predictive value and negative predictive value of CTwere 96.19%, 93.33%, 99.01%, 77.77%, respectively. The diagnostic accuracy was 95.83%. Kappa statistics showed 82% agreement beyond chance. CTscan is highly accurate in diagnosing and characterizing fungal infection of paranasal sinuses. It also determines the extent of disease which eventually aids in deciding the surgical approach to be used.

Diagnosis of biofilm infections in cystic fibrosis patients.

Chronic Pseudomonas aeruginosa biofilm lung infection in cystic fibrosis patients is the best described biofilm infection in medicine. The initial focus can be the paranasal sinuses and then follows repeated colonization and infection of the lungs by aspiration. The matrix of the biofilms is dominated by alginate and the pathogenesis of tissue damage is immune complex-mediated chronic inflammation dominated by polymorphonuclear leukocytes and their products (DNA, oxygen radicals and proteases). The P.aeruginosa biofilm infection can be diagnosed by microscopy of lung tissue, sputum and mucus from the paranasal sinuses, where aggregates of the bacteria are found surrounded by the abundant alginate matrix. Specific PNA-FISH probes can be used to identify P.aeruginosa and other pathogens insitu in the biofilms. Growth of mucoid colonies from the locations mentioned above is also diagnostic for biofilm infection. Rise of specific anti-P.aeruginosa antibodies is likewise diagnostic, IgG in serum in case of lung infection, sIgA in saliva or nasal secretions in case of paranasal sinus infection. Similar approaches have been developed to diagnose chronic biofilm infections in cystic fibrosis caused by other pathogens e.g., Stenotrophomonas, Burkholderia multivorans, Achromobacter xylosoxidans and Mycobacterium abscessus complex.

Quality of life in patients with fungal infection of nose and paranasal sinuses: A study from North India

Background: Fungal infections of nose and paranasal sinuses have a protracted course with frequent relapses and recurrences. Quality of life (QOL) of such patients is severely affected. Materials and Methods: The aim of this study was to assess QOL of patients with fungal infection of nose and paranasal sinuses. The objective was to assess disease specific QOL, health-related QOL, and global QOL. Cross sectional assessment was carried out on thirty patients with the diagnosis of fungal infection of nose and paranasal sinuses. Results: The total Sino Nasal Outcome Test score was indicative of “moderate degree of problem.” Regarding generic QOL, as assessed using WHOQOL-Bref, the sample had overall moderate QOL in all domains. On the contrary, on the Short Form-36, highest scores were obtained on the individual domains of “physical functioning” and “pain” with lowest scores on the domains of “general health” and “role limitation due to physical health.” Conclusion: It can be concluded that Indian patients with fungal infection of paranasal sinuses report moderate degree of QOL on both disease specific (SNOT-20) and global (WHOQOL-Bref) scales with mild to moderate limitation on health-related QOL scale (SF-36).