scholarly journals Allergen Immunotherapy in an HIV+ Patient with Allergic Fungal Rhinosinusitis

2015 ◽  
Vol 2015 ◽  
pp. 1-5 ◽  
Author(s):  
Ian A. Myles ◽  
Satyen Gada
Keyword(s):  
Allergen Immunotherapy ◽  
Severe Infection ◽  
Invasive Fungal Disease ◽  
Fungal Disease ◽  
Fungal Sinusitis ◽  
Opportunistic Pathogens ◽  
Fungal Rhinosinusitis ◽  
Allergic Fungal Rhinosinusitis ◽  
Invasive Fungal Rhinosinusitis ◽  
Chronic Invasive

Patients with HIV/AIDS can present with multiple types of fungal rhinosinusitis, fungal balls, granulomatous invasive fungal rhinosinusitis, acute or chronic invasive fungal rhinosinusitis, or allergic fungal rhinosinusitis (AFRS). Given the variable spectrum of immune status and susceptibility to severe infection from opportunistic pathogens it is extremely important that clinicians distinguish aggressive fungal invasive fungal disease from the much milder forms such as AFRS. Here we describe a patient with HIV and AFRS to both remind providers of the importance of ruling out invasive fungal disease and outline the other unique features of fungal sinusitis treatment in the HIV-positive population. Additionally we discuss the evidence for and against use of allergen immunotherapy (AIT) for fungal disease in general, as well as the evidence for AIT in the HIV population.

scholarly journals Chronic Invasive Fungal Rhinosinusitis in Immunocompetent Patients: A Retrospective Chart Review

2020 ◽  
Vol 7 ◽  
Author(s):  
Naif H. Alotaibi ◽  
Omar Abu Omar ◽  
Mays Altahan ◽  
Haifa Alsheikh ◽  
Fawziah Al Mana ◽  
...  
Keyword(s):  
Chart Review ◽  
Tertiary Care ◽  
Retrospective Chart Review ◽  
Csf Leak ◽  
Fungal Sinusitis ◽  
Invasive Fungal Sinusitis ◽  
Fungal Rhinosinusitis ◽  
Invasive Fungal Rhinosinusitis ◽  
Chronic Invasive ◽  
Immunocompetent Patients

Objective: We report cases of Chronic Invasive Fungal Sinusitis (CIFS) in patients considered as immunocompetent at tertiary care center (King Faisal Specialist Hospital), to analyze their clinical, biological, radiological features, and management.Material and methods: A retrospective chart review of CIFS in immunocompetent patients. The inclusion criteria as the following: immunocompetent patients of any age with histopathological findings of CIFS. Immunocompromised patients, acute Invasive Fungal Sinusitis (IFS), non-invasive fungal rhinosinusitis, and no positive histological findings were excluded.Results: Seventeen (17) patients were included. The species isolated included: Aspergillus (most frequent) & Mucor. Surgical treatment approaches were described. Complications reported include CSF leak, blindness, recurrence, and death.Conclusions: Early diagnosis and management of CIFS improve clinical outcomes.

scholarly journals Fungal Rhinosinusitis: A Retrospective Microbiologic and Pathologic Review of 400 Patients at a Single University Medical Center

2012 ◽  
Vol 2012 ◽  
pp. 1-9 ◽  
Author(s):  
Kathleen T. Montone ◽  
Virginia A. Livolsi ◽  
Michael D. Feldman ◽  
James Palmer ◽  
Alexander G. Chiu ◽  
...  
Keyword(s):  
Medical Center ◽  
Fungus Ball ◽  
Fungal Culture ◽  
Non Invasive ◽  
Fungal Rhinosinusitis ◽  
Allergic Fungal Rhinosinusitis ◽  
Acute Invasive Fungal Rhinosinusitis ◽  
Aspergillus Sp ◽  
Invasive Fungal Rhinosinusitis ◽  
Chronic Invasive

Fungal Rhinosinusitis (FRS) is a well known entity, but only in more recent times have the types of FRS been more fully defined. In this study, we evaluate the diagnosis of FRS in a single medical center. Cases were divided into 2 main categories, non-invasive and invasive. Non-invasive FRS included fungus ball (FB) and allergic fungal rhinosinusitis (AFRS). Invasive FRS included acute invasive fungal rhinosinusitis (AIFRS), chronic invasive fungal rhinosinusitis (CIFRS), and chronic invasive granulomatous fungal rhinosinusitis (CGFRS). Fungal culture data, if available was reviewed. 400 patients with FRS were identified. 87.25% were non-invasive (45% AFRS, 40% FB, and 2% combined AFRS and FB and 12.5% were invasive 11% AIFRS 1.2% CIFRS 0.5% CGFRS. One patient (0.25%) had combined FB/CGFRS.Aspergillus sp.or dematiaceous species were the most common fungi isolated in AFS whileAspergillus sp.was most common in FB and AIFRS. In our experience, most FRS is non-invasive. In our patient population, invasive FRS is rare with AIFRS representing >90% of cases. Culture data supports that a variety of fungal agents are responsible for FRS, butAspergillus sp.appears to be one of the most common organisms in patients with FRS.

Fungal Sinusitis

2021 ◽  
Author(s):  
Sean P McKee ◽  
Jeffrey Paul Radabaugh ◽  
Martin J Citardi ◽  
William C Yao
Keyword(s):  
Key Words ◽  
Paranasal Sinuses ◽  
Fungal Disease ◽  
Fungal Sinusitis ◽  
Invasive Fungal Sinusitis ◽  
Fungal Rhinosinusitis ◽  
Allergic Fungal Rhinosinusitis ◽  
Allergic Mucin

Fungal sinusitis encompasses a spectrum of fungal disease processes affecting the paranasal sinuses, ranging from asymptomatic colonization to rapidly progressive and fatal infections. This review contains 10 figures, 3 tables, and 30 references.  Key Words: fungal sinusitis, mycetoma, allergic fungal rhinosinusitis, invasive fungal sinusitis, mucormycosis, allergic mucin

scholarly journals Allergic fungal rhinosinusitis: an overview on pathogenesis, early diagnosis and management

2018 ◽  
Vol 4 (3) ◽  
pp. 694 ◽  
Author(s):  
Neeraj Suri ◽  
Bhavya B. M.
Keyword(s):  
Nasal Obstruction ◽  
Endoscopic Sinus Surgery ◽  
Sinus Surgery ◽  
Histological Evaluation ◽  
Nasal Discharge ◽  
Fungal Sinusitis ◽  
Surgical Specimen ◽  
Specimen Handling ◽  
Fungal Rhinosinusitis ◽  
Allergic Fungal Rhinosinusitis

<p class="abstract"><strong>Background: </strong>The objective of the study was<strong> </strong>to evaluate the criteria for diagnosing allergic fungal rhinosinusitis and to maintain permanent drainage and ventilation, while preserving the integrity of the mucosa.</p><p class="abstract"><strong>Methods:</strong> This is a prospective study of 50 patients with allergic fungal sinusitis with or without polyposis all of whom were treated with endoscopic debridement. Mucous sample collection, nasal secretion culture, surgical specimen handling, and histological evaluation of surgical specimens are described. All patients treated with endoscopic sinus surgery, debridement, post-operative use of steroids and antifungal therapy.  </p><p class="abstract"><strong>Results:</strong> Fungal mucin was found in all 50 cases, histology and fungal cultures confirmed the diagnosis. Out of 50 patients, 29 were females and 21 were males, with a mean age of 32 years. The most common symptom was nasal discharge 41 (82%) cases, nasal obstruction in 38 (76%) cases, headache and facial pain in 32 (72%) cases, 7 (14%) patients had bronchial asthma. Symptoms of nasal obstruction and nasal discharge were improved in 46 (92%) cases. All preoperative versus postoperative changes in AFRS associated complaints reached statistical significance of p value &lt;0.001 except in patients with asthma.</p><p class="abstract"><strong>Conclusions:</strong> Comprehensive management with endoscopic sinus surgery, oral steroids and antifungals reduces the recurrence or need for revision surgery. Long term follow up is very important.</p>

High Clinical Impact of Broad-Range Fungal PCR in Suspected Fungal Sinusitis

2021 ◽  
Author(s):  
Joshua A. Lieberman ◽  
Andrew Bryan ◽  
James A. Mays ◽  
Karen Stephens ◽  
Kyoko Kurosawa ◽  
...  
Keyword(s):  
Clinical Utility ◽  
Clinical Decision Making ◽  
Diagnostic Yield ◽  
Invasive Fungal Disease ◽  
Turnaround Time ◽  
Fungal Disease ◽  
Fungal Sinusitis ◽  
Anatomic Site ◽  
Fixed Tissue ◽  
Formalin Fixed

Broad-range fungal PCR is a powerful tool for identifying pathogens directly from patient specimens; however, reported estimates of clinical utility vary and costs discourage universal testing. We investigated the diagnostic and clinical utility of broad-range fungal PCR by examining 9 years of results from sinonasal specimens, hypothesizing that this anatomic location would identify immunocompromised patients at high risk for invasive fungal disease. We retrospectively identified 644 PCRs and 1446 fungal cultures from sinus sites. To determine the relative performance of each testing modality, we performed chart review on 52 patients having specimens submitted for culture and PCR on the same day. Positivity rates were significantly higher for PCR (37.1%) than culture (13.7%) but similar for formalin-fixed and fresh tissues (42.3% vs 34.6%). Relative to culture, PCR had significantly faster turnaround time to both preliminary (94.5 vs 108.8 hrs) and final positive results (137.9 vs 278.5 hrs). For chart-reviewed patients, 88% were immunocompromised, 65% had proven or probable fungal disease, and testing sensitivities for culture and PCR (67.5% and 85.0%) were not statistically different. Nevertheless, PCR identified pathogens not recovered by culture in 14.9% of cases, informed clinical decision-making in 16.7% of all reviewed cases, and sensitivity of PCR combined with culture (90.0%) was higher than culture alone. We conclude that broad-range fungal PCR is frequently informative in patients at risk of serious fungal disease, is complimentary to and has faster turnaround time than culture. Formalin-fixed tissue does not adversely affect diagnostic yield, but anatomic site may impact assay positivity rates.

Chronic Invasive Fungal Rhinosinusitis: Two New Cases and Review of the Literature

2004 ◽  
Vol 18 (4) ◽  
pp. 221-226 ◽  
Author(s):  
Xavier Dufour ◽  
Catherine Kauffmann-Lacroix ◽  
France Roblot ◽  
Jean Michel Goujon ◽  
Jean Philippe Breux ◽  
...  
Keyword(s):  
Review Of The Literature ◽  
Fungal Rhinosinusitis ◽  
Invasive Fungal Rhinosinusitis ◽  
Chronic Invasive
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