Sinus Aspergillosis Research Articles

Highly effective unconventional management of aspergillosis of the left maxillary sinus in an 11-year-old girl with rhabdomyosarcoma embryonale of the frontal sinus

Invasive fungal infections are common causes of death in children treated for malignancies, and therefore present an important and growing clinical problem. Fungal invasion usually affects immunocompromised patients, but increased incidences are also associated with intensification of antineoplastic therapy and increased numbers of organ and bone marrow transplantations. Fungal infections in parameningeal and cerebral locations carry high risks of treatment failure. We describe the case of an 11-year-old female patient with rhabdomyosarcoma embryonale of the frontal sinuses with metastases to the neck lymph nodes, treated according to the CWS 2002 protocol for high-risk patients. Left maxillary sinus aspergillosis was diagnosed during chemotherapy following radiotherapy, and 56 days after surgical excision of the tumour. No effect was achieved by use of amphotericin B. Further treatment included intravenous voriconazole at 6 mg per kg body weight every 12 h for 2 weeks, followed by oral voriconazole at 4 mg per kg body weight twice daily for 6 months. Simultaneous excision of necrotic tissues from the nasal cavity, ethmoid bone, maxillary sinus and frontal recess was performed. The sinus was kept open for 3 weeks to allow voriconazole lavage every 12 h for 3 weeks. This unconventional treatment resulted in eradication of sinus aspergillosis and allowed intensive chemotherapy to be continued with no recurrence of aspergillosis.

Odontogene sinusitis maxillaris op basis van doorgeperst wortelkanaalvulmateriaal

In a 48-year-old woman and a 35-year-old man, a sinusitis maxillaris resulting from overextension of root canal filling material after an endodontic treatment ofa maxillary molar could be diagnosed through computed tomography. The woman complained of nasal congestion and in the man 2 radiopaque abnormalities in the maxillary sinus were discovered coincidentally. The corpora aliena were removed surgically. Root canal filling materials containing zinc oxide or hydrocortisone may cause aspergillosis of the maxillary sinus because they encountergrowth of Aspergillus species. In case ofmaxillary sinusitis, surgical removal of overextended root canal filling material from the maxillary sinus is indicated. No treatment consensus consists for cases without maxillary sinusitis symptoms.

Invasive Fungal Sinusitis

ABSTRACT Invasive sinus Aspergillus infection has been reported in the last decade with increased frequency, most commonly in the setting of hematologic malignancy, neutropenia, HIV infection and other states of immunosuppression. Fungal rhinosinusitis can be broadly classified into two varieties-invasive and noninvasive on the basis of tissue invasion. Invasive fungal sinusitis are acute invasive, chronic invasive (both granulomatous and nongranulomatous forms), whereas noninvasive are fungus balls and allergic fungal sinusitis. Invasive fungal sinusitis is one of the most challenging forms of sinonasal pathology to manage, most commonly presenting in immunocompromised individuals. Chronic invasive being sinus aspergillosis (CISA) is being reported in immunocompetent patients at an increasing rate while most of these cases are being reported from the India subcontinent and middle east. Invasive fungal sinusitis is on the rise worldwide and especially in north India as it is endemic in this part of the country. It is affecting immunocompetent young and middle aged population causing a great morbidity and mortality. This entity needs to be picked up early by spreading awareness among the family physicians, internists, otolaryngologists, ophthalmologists, neurosurgeons, pulmonary physicians, critical care specialists so that an early management can initiated to achieve better control over the disease. This review is an attempt to initiate an interdisciplinary approach to achieve a better outcome. How to cite this article Gupta AK, Bansal S, Rijuneeta, Gupta B. Invasive Fungal Sinusitis. Clin Rhinol An Int J 2012;5(2): 63-71.

Surgical management of stem cell transplantation‐related complications in children

HSCT is an established treatment option for some children with life-threatening diseases, but complications remain a major cause of morbidity and mortality. This retrospective data analysis addresses the surgical issues of children with HSCT-related complications. Between 2002 and 2008, HSCT was performed in 240 children for leukemias/lymphomas (n=135), solid tumors (n=59), immunodeficiencies (n=20), lipid storage diseases (n=10), autoimmune diseases (n=9), and others (n=7). HSCT-related complications requiring surgery occurred in 24 cases (10%) and most often in the leukemias/lymphomas group (18/24 cases): HC (cystoscopic irrigation, n=7), pulmonary aspergilloses (resection, n=7), bone necroses (core decompression, n=3), GvHD bowel (colostomy/PEG, n=2), ICH (drainage, n=2), bilateral kidney abscess (nephrectomies/renal transplantation, n=1), aspergillosis of the maxillary sinus (decompression, n=1), and post-traumatic wound healing disorder (meshed skin transplantation, n=1). Survival was 50% in the group with surgery and 62% in the group without (p=0.275). Even though this difference was not statistically significant, surgical intervention should be encouraged in all cases to achieve favorable results.

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.

Confirmatory diagnosis of invasive maxillary sinus aspergillosis by in situ hybridization: Report of two cases in immunocompetent subjects

Invasive maxillary sinus aspergillosis (IMSA) is uncommon in immunocompetent patients. The infection could become life-threatening due to delayed or mistaken diagnosis as it may extend into the orbit and brain. Two cases of invasive maxillary sinusitis caused by Aspergillus are described in apparently healthy subjects. Identification of the causative fungi as Aspergillus species was established by in situ hybridization of tissue samples, even though the culturing of tissue samples failed to isolate Aspergillus species. Surgical debridement of the infected sinus tissue and antifungal therapy with itraconazole resulted in a favorable outcome. For prompt and accurate diagnosis of IMSA, we highlight the usefulness of a new molecular diagnostic method, i.e., in situ hybridization in tissue samples.

Aspergillose invasive du sinus maxillaire chez un patient immunocompétent

Invasive aspergillosis of the maxillary sinus is a severe infection most commonly observed in immunocompromised patients. We report a pseudo-tumoral presentation of invasive aspergillosis of the maxillary sinus, in immunocompetent adult. A 70-year-old female patient consulted for chronic rhino-sinusitis resistant to medical treatment. Computed tomography scan revealed a hyperdense mass filling the left maxillary antrum, with erosion of sinus walls. The ethmoidal and right frontal sinuses were involved. The histological and mycological examination of the surgical resection confirmed the diagnosis of invasive aspergillosis. The patient was given voriconazole as first line treatment. The outcome was good at 18 months. Invasive aspergillosis of the maxillary sinus is a rare disease, usually observed in immunodepressed patients. It is very rarely observed in immunocompetent patients.

Sino-orbital Aspergillosis: A Case Report and Brief Review of Literature

ABSTRACT Aspergillosis of head and neck region primarily affects the nose and paranasal sinuses. Any type of paranasal aspergillosis may progress to more aggressive disease illustrating the importance of early recognition of this increasingly encountered disease. The invasive and in particular, the fulminant forms are associated with high mortality. We report a case of invasive aspergillosis of right maxillary sinus and orbit in an immunocompetent individual, along with a critical review and update of the literature. The patient underwent surgery for the debridement of right maxillary sinus through a Caldwell-Luc approach and drainage of orbital abscess as well followed by intravenous therapy of amphotericin B. Recovery with reduction of all the signs and symptoms was seen after 38 days from the appearance of first symptoms. Successful treatment of aspergillosis requires prompt diagnosis and rapid institution of therapy, because delay or nonaggressive therapy can result in the spread of infection with lethal consequences. How to cite this article Neeli AS, Kotrashetti SM, Vallavan P. Sino-orbital Aspergillosis: A Case Report and Brief Review of Literature. World J Dent 2012;3(4):363-366.

Chronic invasive aspergillosis of paranasal sinuses: A case report with review of literature

Aspergillosis of the nasal and paranasal sinuses is recognized as being second to candidiasis, among opportunistic fungal infections in immunocompromised patients. However, invasive variant in normal and mildly immunocompromised hosts is a very rare occurrence. We report one such case of aspergillosis involving paranasal sinuses in mildly immunocompromised patient.

ABPA Concomitantly Occurring with Invasive Sinus Aspergillosis: A Short Report on Two Patients

Allergic bronchopulmonary aspergillosis (ABPA) is a pulmonary disorder that is caused by hypersensitivity to Aspergillus fumigatus with resultant systemic immune activation, chronic asthma, recurrent pulmonary infiltrates, and bronchiectasis. First described by Hinson et al. (Thorax 7:317-333 [1]) in 1952, this disease occurs in 1-2% of patients with persistent asthma and in 2-15% of patients with cystic fibrosis (Greenberger, Front Biosci 8:s119-s127 [2]). Although the diagnostic criteria for ABPA have been laid down (and include bronchial asthma, immediate skin test reactivity to A. fumigatus, elevated total serum IgE level, pulmonary infiltrates, central bronchiectasis, peripheral blood eosinophilia, and positive serum precipitins [IgG] against Aspergillus antigen), none of these are specific for ABPA (Shah, Curr Opin Pulm Med 13(1):72-80 [3]). There is still no consensus on the number of criteria needed for diagnosis, and patients in different stages of ABPA may not fulfill all these criteria (Greenberger, Front Biosci 8:s119-s127 [2]; Chakrabarti et al., Mycoses 45:295-299 [4]). An high-resolution CT (HRCT) scan showing central bronchiectasis and high attenuation mucus is presently the investigation of choice for the diagnosis of bronchiectasis in patients with ABPA (Shah, Front Biosci 8:e138-e146 [5]). ABPA has also been reported in association with allergic fungal rhinosinusitis in English literature (Shah, Curr Opin Pulm Med 13(1):72-80 [3]). We are reporting two patients with invasive aspergillosis of the nose, paranasal sinuses and orbit, who were diagnose and managed successfully for ABPA, a previously unreported entity.

Long-term treatment of invasive sinus, tracheobroncheal, pulmonary and intracerebral aspergillosis in acute lymphoblastic leukaemia

A 59-year-old male with acute lymphoblastic leukemia developed sinus, tracheobroncheal, pulmonary, and intracerebral aspergillosis. All lesions except the intracerebral aspergillosis healed after combination antifungal treatment. Long-term voriconazole--but not posaconazole--therapy induced partial regression of the cerebral manifestations. At the time of writing, 3.5 years after the initial diagnosis, the patient is working half-time and suffers from a possible voriconazole-induced polyneuropathy.

Should Voriconazole be the Primary Therapy for Chronic Invasive Sinus Aspergillosis (CISA)?

ABSTRACT Introduction Invasive sinus aspergillosis infection has been reported with increasing frequency in the last decade, especially, in immunocompromised patients with chronic invasive sinus aspergillosis (CISA). The gold standard for treatment has been wide surgical debridement, intravenous administration of antifungal agents, such as amphotericin B, but the prognosis remains poor. Newer antifungal agents are being tried but no standard treatment option with new antifungal agents has yet been established for chronic invasive fungal sinusitis. Therefore, we undertook this study to evaluate the efficacy of voriconazole in patients of chronic invasive sinus aspergillosis. Materials and methods This study is a prospective randomized unblinded study with primary aim of evaluating the feasibility and effectivity of voriconazole in patients of chronic invasive sinus aspergillosis with intraorbital or intracranial extension, and secondarily to compare voriconazole with amphotericin B therapy in patients with chronic invasive sinus aspergillosis. Observations and results Thirty-three patients who fulfilled the eligibility criteria were included in this study. There were 18 patients enrolled in group I who received amphotericin therapy and 15 patients in group II who received voriconazole therapy. Out of 33 patients, 9 patients had complete response, 10 had partial response, in eight patients disease became stable and there were seven failures. Overall 50% patients had a successful outcome in group I, whereas 60% had a successful outcome in group II receiving oral voriconazole. On comparing only in extradural group, 5/10 had a successful outcome in group I receiving amphotericin B, whereas 8/12 (66.7%) had a successful outcome in group 2 receiving voriconazole. There was significant difference between adverse reactions of the two drugs, with amphotericin B having a significant renal and cardiotoxicity as compared to voriconazole; though patients on voriconazole developed skin rashes which were transient and disappeared on completion of the therapy. Conclusion The present series demonstrates that oral voriconazole can be the primary line of therapy in chronic invasive sinus aspergillosis in carefully monitored immunocompetent cases. Multicentric, randomized studies are required to define disease definition, duration and successful outcome.

Should Voriconazole be the Primary Therapy for Chronic Invasive Sinus Aspergillosis (CISA)?

ABSTRACT Introduction Invasive sinus aspergillosis infection has been reported with increasing frequency in the last decade, especially, in immunocompromised patients with chronic invasive sinus aspergillosis (CISA). The gold standard for treatment has been wide surgical debridement, intravenous administration of antifungal agents, such as amphotericin B, but the prognosis remains poor. Newer antifungal agents are being tried but no standard treatment option with new antifungal agents has yet been established for chronic invasive fungal sinusitis. Therefore, we undertook this study to evaluate the efficacy of voriconazole in patients of chronic invasive sinus aspergillosis. Materials and methods This study is a prospective randomized unblinded study with primary aim of evaluating the feasibility and effectivity of voriconazole in patients of chronic invasive sinus aspergillosis with intraorbital or intracranial extension, and secondarily to compare voriconazole with amphotericin B therapy in patients with chronic invasive sinus aspergillosis. Observations and results Thirty-three patients who fulfilled the eligibility criteria were included in this study. There were 18 patients enrolled in group I who received amphotericin therapy and 15 patients in group II who received voriconazole therapy. Out of 33 patients, 9 patients had complete response, 10 had partial response, in eight patients disease became stable and there were seven failures. Overall 50% patients had a successful outcome in group I, whereas 60% had a successful outcome in group II receiving oral voriconazole. On comparing only in extradural group, 5/10 had a successful outcome in group I receiving amphotericin B, whereas 8/12 (66.7%) had a successful outcome in group 2 receiving voriconazole. There was significant difference between adverse reactions of the two drugs, with amphotericin B having a significant renal and cardiotoxicity as compared to voriconazole; though patients on voriconazole developed skin rashes which were transient and disappeared on completion of the therapy. Conclusion The present series demonstrates that oral voriconazole can be the primary line of therapy in chronic invasive sinus aspergillosis in carefully monitored immunocompetent cases. Multicentric, randomized studies are required to define disease definition, duration and successful outcome.

Invasive sinus aspergillosis with acute myeloid leukemia: A case report

Invasive fungal sinusitis is still a life-threatening infection in immunocompromised patients. Its onset is rapid and leads to severe complications. We describe a neutropenic patient with acute myeloid leukemia who developed invasive sinus aspergillosis despite receiving prophylactic itraconazole and empirical micafungin. The patient demonstrated apparent clinical findings such as nasal discharge, nasal congestion, and skin and mucosal necrosis. Computer tomography scans strongly demonstrated invasive maxillary sinusitis. Serological examinations for (1-3)-β- d-glucan and Aspergillus galactomannan antigen were positive, suggesting Aspergillus infection. The diagnosis of invasive sinus aspergillosis was confirmed by in situ hybridization using Aspergillus-specific probe in formalin-fixed, paraffin-embedded tissue samples. The causative organism was identified as Aspergillus fumigatus by fungal culture. Despite surgical treatment with drainage and intensive antifungal administration of voriconazole and liposomal amphotericin B, the infection rapidly disseminated to the lungs, resulting in a fatal progression of the condition.

多発性脳膿瘍を合併した蝶形骨洞アスペルギルス症例

We report a case of sphenoid sinus aspergillosis with concomitant multiple brain abscesses. A 41-year-old man seen for headache, high fever, and diplopia was found in magnetic resonance imaging (MRI) to have an abnormal sphenoid sinus shadow. Computed tomography (CT) confirmed the right sphenoid sinus shadow with mixed high- and low-density areas. MRI also showed temporal and frontal lobe brain abscesses to be gradually growing, necessitating immediate endoscopic and endonasal sphenoidectomy under general anesthesia. The right sphenoid sinus contained a fungus ball in muddy green pus but now no bacteria or fungi grew from the pus. Histopathological examination showed the fungus to be a fungal-thread bolus with identifiable septa. The definitive diagnosis was invasive sphenoid sinus aspergillosis with multiple brain abscesses. Antifungal drug administration for six months postoperatively, resulting in an uneventful recovery.

Pulmonary and extra pulmonary manifestations of aspergillosis in clinical practice and potential challenges in management: An analysis of literature review

With various factors causing immunosuppression among humans and tendency towards opportunistic fungal infections such as aspergillosis, this study was therefore set up to assess the associated changing clinical presentations of the disease from the developing world. The study was based on literature search from available reports on clinical presentations of aspergillosis from literature searches for a period of 20 years (1990 - 2010). The most common forms of presentations of aspergillosis documented from the 9,743 patients in 1,222 literature reviews were invasive Pulmonary aspergillosis34.53% (3,365), allergic bronchopulmonary aspergillosis 18.13% (1,767), Pulmonary aspergillomas 15.41% (1,501) and aspergillosis of maxillary sinuses 8.05% (784). Some of the rarest presentations were aspergillus aortic embolism with stroke 0.04%, tension pneumothorax 0.07%, mycotic aneurism of descending thoracic aorta 0.06%, skull base erosion by sphenoid fungal balls 0.02%, small bowel obstruction 0.16%, perforation of large intestine 0.04%, small bowel infarction 0.03%, hypertrophic cranial pachmeningitis 0.34% and invasive generalised multi-organ aspergillosis 0.44%. Aspergillosis was found to present with various unusual surgical or medical emergencies with overall infection rates significantly higher in immunocompromised (P < 0.0001). In patients presenting with quite familiar clinical pictures in the developing world but proving difficult for treatment especially in the immunosuppressed but not exclusive and where facilities for diagnosis may be lacking, aspergillosis should not be completely ruled out. Key words: Aspergillosis, clinical presentations, rare.

Isolated Aspergillosis of the Maxillary Sinus Associated with Chronic Kidney Disease

Isolated Aspergillosis of the Maxillary Sinus Associated with Chronic Kidney Disease

Chronic Invasive Sinus Aspergillosis in Immunocompetent Hosts: A Geographic Comparison

To investigate potential differences in clinical presentation, histopathology, and outcomes of chronic invasive sinus aspergillosis (CISA) based on geographic region and species of Aspergillus isolated. A retrospective analysis of published cases of CISA with a comparison of North American and worldwide cases comprised a systematic search of the English language literature. Thirty-four articles were identified detailing 15 North American and 76 global cases of CISA with cranio-cerebral extension in clinically immunocompetent patients. North American patients with CISA were older, had a more rapidly progressive course, and appeared to have higher rates of treatment failure and mortality. Anatomic distribution and presenting symptoms were similar between the two groups. North American cases were mostly due to A. fumigatus, while A. flavus was the predominant pathogen worldwide. While granulomatous inflammation was a rare observation in North American cases, it was seen in the majority of cases worldwide. CISA due to A. fumigatus was encountered in older adults, was associated with a chronic inflammatory response, an accelerated clinical course, and a trend toward treatment failure and higher mortality. Patients with A. flavus were younger, demonstrated granulomatous inflammation, and pursued an indolent, clinically responsive course. Observed differences in clinical presentation, histopathology, and outcome might involve a complex interplay between the human host, Aspergillus species, and local climatic conditions.

Obraz radiologiczny grzybniaka kropidlakowego zatoki szczękowej

Mycotic infection of paranasal sinus could be the etiological factor of chronic sinusitis. The increase in number of fungal sinusitis cases have been reported recently among nonimmunocompromised patient after endodontic treatment of maxillary teeth. Nonspecific clinical signs and incorrect radiologic pictures interpretation as well as loss of therapeutic standards seems to be the cause of false negative diagnosis and difficulties in treatment of fungal sinusitis. Clinical and radiological picture of maxillary sinus aspergillosis was described in this paper. In the period of 2006-2009 in the Department of Maxillo-Facial Surgery 19 patient with fungal maxillary sinusitis was treated. The endodontic treatment of maxillary teeth of the related side was performed previously in 80% examined cases. In 2 cases there were immunocompromised patients with immunosuppressive treatment. In 16 cases patients were referred to our Department due to metallic foreign body of the maxillary sinus. Routine diagnostic radiological imaging was performed in each case: paranasal sinus view--Water's view and panoramic radiograph (orthopantomograph). In 4 cases imaging was extended with computer tomography (CT) visualization. The surgical treatment was performed in each case. The final diagnosis was puted on histopathological examination and fungal culture. In 16 cases of analysed group histopathological examination and fungal culture revealed aspergilosis. In 2 cases fungal culture was negative, but histopathology slices confirm presence of hyphae of Aspergillus. In 1 case the root canal sealer was found in the maxillary sinus. In none case invasive form of aspergillosis was confirmed. In all cases Water's view of paranasal sinuses and ortopantomograph showed partially or totally clouded sinus with well-defined, single or multifocal radiopaque object similar to metallic foreign body. Characteristic finding in CT imaging was well-defined radiodence concretions that have been attributed to calcium deposits in inflammatory changed mucosa, that might suggest "foreign body" picture. In 1 to 3 years follow-up control there was a recurrence of symptoms in one case. Foreign body of maxillary sinus have to be differentiated with aspergilosis. Metallic "foreign body" view in maxillary sinus seems to be characteristic sign of aspergillosis. The most often form of maxillary sinus aspergilosis is aspergilloma.

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