amphotericin-b and Ethmoid-Sinusitis

A phaeohyphomycotic sinusitis due to Bipolaris hawaiiensis, observed in an immunologically competent patient, is reported and a review of data from the literature is given. The patient was successfully treated by surgical drainage and amphotericin B.

Topics: Adult; Amphotericin B; Antifungal Agents; Ascomycota; Drainage; Ethmoid Sinusitis; Female; Humans; Mycoses; Sinusitis; Sphenoid Sinusitis

Zygomycosis is an opportunistic fungal infection that is increasingly reported in hematological patients. We describe 2 cases of successfully treated rhino-cerebral zygomycosis and give an overview of 120 patients from the literature with underlying hematological or oncological disorders. These data document the improved survival in sinus (15/17 patients surviving) and cutaneous (6/9 patients surviving) disease. Hematological patients with pulmonary (9/30 patients surviving) or disseminated (4/38 patients surviving) zygomycosis still have a poor prognosis. The clinical course of sinus-orbital involvement (4/11 patients surviving) follows sinus-cerebral (2/3 patients surviving) or cerebral (3/6 patients surviving) disease. Besides deoxycholate amphotericin B (AmB) (24/62 patients surviving), patients seem to benefit from liposomal amphotericin B (L-AmB) (10/16 patients surviving) or sequential AmB/L-AmB treatment (6/8 patients surviving). Alternative treatment options lead only in a few patients to success.

Topics: Adult; Aged; Amphotericin B; Antifungal Agents; Antineoplastic Combined Chemotherapy Protocols; Aspergillosis; Aspergillus fumigatus; Combined Modality Therapy; Deoxycholic Acid; Ethmoid Sinusitis; Female; Hematologic Diseases; Humans; Immunocompromised Host; Itraconazole; Ketoconazole; Liposomes; Lymphoma, Large B-Cell, Diffuse; Male; Maxillary Sinusitis; Middle Aged; Mucor; Mucormycosis; Multiple Myeloma; Nose Diseases; Opportunistic Infections; Prognosis; Treatment Outcome; Zygomycosis

Seventeen cases of infections due to Cunninghamella species have been reported worldwide in humans, and there have been only three survivors. We report a case of paranasal sinusitis due to Cunninghamella bertholletiae in an elderly patient who had diabetes mellitus and myelodysplasia. After receiving 7 weeks of therapy with deoxycholate amphotericin B (44 mg/kg or a total of 3 g) and rifampin, the patient was cured and did not have to undergo radical surgery.

Topics: Aged; Amphotericin B; Diabetes Mellitus, Type 2; Drug Therapy, Combination; Ethmoid Sinusitis; Humans; Male; Maxillary Sinusitis; Mucorales; Mucormycosis; Myelodysplastic Syndromes; Paranasal Sinuses; Rifampin; Tomography, X-Ray Computed

We present a case of rhinocerebral mucormycosis in a 47 years old woman without diabetic or immunodepression past. The diagnosis was confirmed through a histological study of the material obtained after surgery. The treatment with amphotericin B and radical surgery showed ineffective. The patient died two weeks after entrance. We make an evaluation of the etiopathological, clinical and therapeutic aspects and also a revision of the relevant literature.

Topics: Amphotericin B; Combined Modality Therapy; Ethmoid Sinus; Ethmoid Sinusitis; Female; Humans; Middle Aged; Mucormycosis; Tomography, X-Ray Computed

Topics: Amphotericin B; Animals; Antifungal Agents; Aspergillosis; Aspergillus fumigatus; Blepharoptosis; Combined Modality Therapy; Debridement; Diabetes Mellitus, Type 2; Diagnosis, Differential; Ethmoid Sinusitis; Humans; Immunocompromised Host; Male; Maxillary Sinusitis; Nasal Mucosa; Orbit; Osteolysis; Paranasal Sinus Neoplasms; Radiography

Signo del cornete negro en un caso de mucormicosis rinocerebral.

Topics: Aged; Amphotericin B; Antifungal Agents; Antineoplastic Combined Chemotherapy Protocols; Cavernous Sinus Thrombosis; Combined Modality Therapy; Cranial Nerve Diseases; Dexamethasone; Diagnosis, Differential; Disease Progression; Encephalitis; Ethmoid Sinusitis; Fatal Outcome; Humans; Interferons; Magnetic Resonance Imaging; Male; Maxillary Sinusitis; Melanoma; Mucormycosis; Opportunistic Infections; Rhizopus; Spinal Neoplasms; Tomography, X-Ray Computed; Turbinates

Schizophyllum commune is a globally distributed basidiomycete fungus that is known as a rare cause of sinusitis, for which no prompt treatment has been established. We describe the first report of S. commune sinusitis following unrelated cord blood transplantation for acute lymphoblastic leukemia. Thirteen days after transplantation, a 23-year-old female developed maxillary and ethmoid sinusitis. The sinusitis was antimicrobial-resistant, and the sinus aspirate culture revealed white wooly mold, which was identified as S. commune by nucleotide sequencing. The patient was successfully treated with intravenous administration of liposomal amphotericin B for 2 months, followed by oral voriconazole. This report suggests the effectiveness of liposomal amphotericin B and voriconazole for S. commune infection in immunocompromised patients. Given the difficulty in distinguishing S. commune infection from aspergillosis by standard culture methods, the incidence of S. commune infection following allogeneic hematopoietic stem cell transplantation may be underestimated. Nucleotide sequencing may be useful in the diagnosis of S. commune infection.

Topics: Adult; Allografts; Amphotericin B; Antifungal Agents; Cord Blood Stem Cell Transplantation; Ethmoid Sinusitis; Female; Humans; Maxillary Sinusitis; Mycoses; Precursor Cell Lymphoblastic Leukemia-Lymphoma; Schizophyllum

To present and discuss the case of a diabetic patient admitted with acidoketotic coma, with inner canthus tumefaction due to mucormycosis.. A 38-year-old diabetic man was admitted with acidoketotic coma and poor general health status. Clinical examination found right inner canthus tumefaction and mucopurulent rhinorrhea. Endoscopy of the nasal fossae found medial meatus sphaceluses. Sinus CT scan found a bilateral ethmoid infiltrating and osteolytic infectious process. Emergency endoscopic bilateral ethmoidectomy was performed. Mucormycosis was diagnosed, and liposomal amphotericin B was administered intravenously for 1 month then replaced by posaconazole. The patient was followed up monthly; the antifungal treatment was terminated after 8 months, the disease appearing to have resolved.. Mucormycosis is one of the most rapidly fatal fungal infections. Facial and cerebral CT scan is essential and is systematically abnormal in case of sinonasal mucormycosis. Emergency multidisciplinary treatment should address the diabetes and include rapid surgical debridement and effective antifungal medication. The reference antifungal is amphotericin B, to be administered at maximal dose (3 to 5 mg/kg per day). Posaconazole, available in Europe since July 2005, proved successful in the present case.

Topics: Administration, Oral; Adult; Amphotericin B; Antifungal Agents; Combined Modality Therapy; Diabetes Complications; Diabetic Ketoacidosis; Endoscopy; Ethmoid Sinusitis; Humans; Infusions, Intravenous; Male; Mucormycosis; Opportunistic Infections; Rhinitis; Tomography, X-Ray Computed; Triazoles

Topics: Amphotericin B; Combined Modality Therapy; Endoscopy; Ethmoid Sinus; Ethmoid Sinusitis; Female; Humans; Leukemia, Myeloid, Acute; Maxillary Sinusitis; Middle Aged; Nasal Mucosa; Opportunistic Infections; Orbital Diseases; Rhinitis; Tomography, X-Ray Computed

Topics: Adult; Amphotericin B; Antifungal Agents; Aspergillosis; Aspergillus fumigatus; Ethmoid Sinusitis; Humans; Immunocompromised Host; Magnetic Resonance Imaging; Male; Mucor; Mucormycosis; Triazoles

Topics: Adult; Amphotericin B; Cerebral Hemorrhage; Combined Modality Therapy; Ethmoid Sinus; Ethmoid Sinusitis; Humans; Magnetic Resonance Imaging; Male; Meningitis, Fungal; Mucormycosis

Topics: Acute Disease; Adult; Amphotericin B; Ethmoid Sinusitis; Eye Infections, Fungal; Female; Follow-Up Studies; Fundus Oculi; Humans; Mucormycosis; Orbital Diseases; Retinal Diseases

Aspergillosis belongs to the group of mycotic diseases of the paranasal sinuses. The invasive forms, and particularly the fulminant forms, are potentially fatal. Primary surgical intervention with complete removal of the mycotic mass should be performed. Additionally an antimycotic drug therapy with amphotericin B must be started. In a review of the literature, there is no case surviving an extended invasive aspergillosis after failure of the operative therapy and after failure of the postoperative amphotericin B treatment. We report an interesting case of a complete remission of an invasive, partially fulminant aspergillosis of the paranasal sinuses and frontal and basal regions. After incomplete removal of the mycotic mass by an endo- and extranasal approach, we started postoperative drug therapy with amphotericin B. Under this treatment the mycosis progressed. Additionally the patient developed severe renal side effects requiring suspension of the treatment. At this time, we started a combined antimycotic drug therapy with liposomal amphotericin B (AmBisome) and itraconazol. Within 10 weeks there was complete clinical and radiologic remission. The patient died 63 weeks after this treatment because of a fulminant bacterial pneumonia. Post mortem examination showed no aspergillosis in the skull base, the paranasal sinuses, or in the lung. The question arises as to whether this drug combination of liposomal amphotericin B (AmBisome) and itraconazol is a real alternative to high-risk surgical interventions in this region.

Topics: Amphotericin B; Antifungal Agents; Aspergillosis; Combined Modality Therapy; Drug Therapy, Combination; Ethmoid Sinus; Ethmoid Sinusitis; Female; Humans; Itraconazole; Middle Aged; Tomography, X-Ray Computed

Seventy-two cases of Aspergillus sinusitis were analyzed during a period of 14 years from January 1980 through October 1993. There were 60 cases of primary type and 12 cases of secondary type. The maxillary and ethmoid sinuses were most commonly affected in both primary and secondary types. The sphenoid sinus was commonly involved in secondary type. Fourteen (23%) cases of primary type and 4 (33%) cases of secondary type demonstrated sinus wall destruction on computed tomography or magnetic resonance images. Seventy percent of primary type and all cases of secondary type showed focal or diffuse areas of increased attenuation in the soft tissue mass on computed tomography scans. Sixteen cases assessed by magnetic resonance imaging showed decreased signal intensities on T1-weighted images and markedly reduced signal intensities on T2-weighted images. Fifty-nine (98%) of 60 cases of primary type were noninvasive, and 1 was invasive. In secondary type, 10 (83%) of 12 patients had noninvasive disease. The most common coexisting disease in secondary aspergillosis was diabetes mellitus. Thickened mucosa with necrotic brownish green material, which was the most common finding in both types, was found in 33 patients with primary type and in 5 with secondary type. Surgery was performed in most cases, among which 4 patients received chemotherapy after surgery with amphotericin B with or without flucytosine. All patients were cured without recurrence during a mean follow-up period of 13 months.

Topics: Adolescent; Adult; Aged; Amphotericin B; Antifungal Agents; Aspergillosis; Child; Diabetes Complications; Ethmoid Sinusitis; Female; Flucytosine; Humans; Magnetic Resonance Imaging; Male; Maxillary Sinusitis; Middle Aged; Necrosis; Sinusitis; Sphenoid Sinusitis; Tomography, X-Ray Computed; Treatment Outcome

A 12-year-old girl had been presenting a woody infiltration and erythema in the frontal region and on the entire left half of the face, leading to deformity of the nose and buccal fissure, and adenomegaly in a posterior cervical chain, for the last 18 months. Sinusitis was diagnosed and treated with antibiotics, and submitted to ethmoid sinusotomy, with no improvement. Several laboratory tests were made to find the correct diagnosis. An intradermal test for delayed hypersensitivity showed a positive reaction (5 mm) with necrosis for metabolic antigens for Conidiobolus. An oral mucosa biopsy showed a dense lymphohistiocytic infiltrate and focal points of necrosis. Gomori staining for fungi revealed countless wide, nonseptate hyphae. Amphotericin B was prescribed during 35 days, with no improvement. Terbinafine given orally was started in association with amphotericin B. Reduction of the lesions was observed 2 months later. No side effects were seen during 4 months of treatment.

Topics: Amphotericin B; Antifungal Agents; Antigens, Fungal; Child; Dermatomycoses; Drug Combinations; Entomophthora; Erythema; Ethmoid Sinusitis; Facial Dermatoses; Female; Humans; Lymphatic Diseases; Mouth Diseases; Naphthalenes; Nose Diseases; Terbinafine

Aspergillosis of the paranasal sinuses is a well-established clinical entity which has recently been classified into non-invasive and invasive forms with distinct sub-divisions of both types. Two cases are described, both highlighting potential serious complications of the disease as well as the importance of adequate medical and surgical treatment in effecting a favourable outcome. The disease is reviewed and the question as to whether cases necessarily fall into previously-defined clinical and pathological categories is also discussed.

Topics: Adult; Amphotericin B; Aspergillosis; Diagnosis, Differential; Diplopia; Ethmoid Sinusitis; Female; Humans; Male; Paranasal Sinus Diseases; Prednisolone; Sphenoid Sinusitis; Tomography, X-Ray Computed

Topics: Adult; Amphotericin B; Blastomycosis; Combined Modality Therapy; Ethmoid Sinusitis; Female; Humans; Maxillary Sinusitis

Topics: Amphotericin B; Debridement; Drug Carriers; Ethmoid Sinus; Ethmoid Sinusitis; Female; Humans; Infusions, Intravenous; Liposomes; Middle Aged; Mucormycosis; Orbit Evisceration; Orbital Diseases; Rhizopus

In a 70-year-old male patient with untreated diabetes a febrile orbital apex syndrome of rapid onset revealed a rhino-orbito-cerebral zygomycosis. Biopsies of the ethmoidal mucosa showed numerous colonies of the Rhizopus genus. Despite medical treatment (amphotericin B) and surgery (ethmoidectomy), the patient died within one week. Rhino-cerebral zygomycosis is a rare disease which occurs in diabetic and immunocompromised patients.

Topics: Aged; Amphotericin B; Diabetic Neuropathies; Ethmoid Bone; Ethmoid Sinusitis; Humans; Male; Mucormycosis; Orbital Diseases; Syndrome

A patient maintained on long-term immunosuppressive agents after bone marrow transplantation developed an Aspergillus abscess in the right orbit. The abscess was resected without visual compromise and the orbit was irrigated regularly with amphotericin B via an indwelling catheter. Follow-up computed tomography, surgical exploration, and histological analysis demonstrated suppression of fungal growth in the orbit. Persistent fungus was recovered from nonirrigated sinuses despite their previous surgical evacuation and continued systemic amphotericin B administration. Treatment of orbital aspergillosis should include surgical reduction of the local fungal inoculum, supplementation of intravenous antifungal agents with local delivery to minimize systemic toxicity, and attempts to reverse the immunosuppression. If the last is not possible, extensive extirpation of normal surrounding tissues will not prevent repopulation by the ubiquitous fungus.

Topics: Adult; Amphotericin B; Aspergillosis; Bone Marrow Transplantation; Catheters, Indwelling; Debridement; Ethmoid Sinusitis; Female; Humans; Immunosuppression Therapy; Injections, Intravenous; Leukemia, Myeloid, Acute; Orbital Diseases