amphotericin-b and Sinusitis

Sinusitis is a serious infectious complication of allogeneic hematopoietic stem cell transplantation. Schizophyllum commune (S commune) is a common basidiomycete fungus that is rarely involved in human disease. We report herein a case of S commune sinusitis after allogeneic bone marrow transplantation. A 66-year-old man with myelodysplastic syndrome underwent allogeneic bone marrow transplantation and developed maxillary and ethmoid sinusitis. The sinusitis did not improve with liposomal amphotericin B after neutrophil engraftment, so we considered that surgical intervention was needed for the recovery of sinusitis. Endoscopic sinus surgery was performed. In the debridement tissue of paranasal mucosa, filamentous fungal elements were observed. Moreover, genetic analysis of the tissue revealed the presence of S commune. Schizophyllum commune should be recognized as a fungal pathogen that causes sinusitis after allogeneic hematopoietic stem cell transplantation. This case suggests the effectiveness of prompt surgical intervention with liposomal amphotericin B treatment for S commune sinusitis and the usefulness of genetic diagnosis for cases under antifungal treatment. (160 words).

Topics: Aged; Amphotericin B; Antifungal Agents; Bone Marrow Transplantation; Endoscopy; Hematopoietic Stem Cell Transplantation; Humans; Male; Mycoses; Myelodysplastic Syndromes; Schizophyllum; Sinusitis

Orbital apex syndrome as a result of invasive fungal sinusitis is a disease entity most commonly found in immunocompromised patients. Infectious invasion affecting the orbital apex can have devastating visual and life-threatening consequences.

Topics: Aged; Alternaria; Alternariosis; Amphotericin B; Combined Modality Therapy; Debridement; Eye Infections, Fungal; Follow-Up Studies; Fungemia; Humans; Immunocompromised Host; Injections, Intralesional; Male; Orbital Diseases; Risk Assessment; Sinusitis; Syndrome; Tomography, X-Ray Computed; Treatment Outcome

Invasive fungal disease is a serious infectious complication of allogeneic hematopoietic stem cell transplantation (HSCT). Exserohilum rostratum is a species causing phaeohyphomycosis, which rarely causes invasive disease in humans. We treated a case of sinusitis caused by E. rostratum after cord blood transplantation (CBT). A 60-year-old man with myelodysplastic syndrome, who had a medical history of an operation to correct deviation of the nasal septum, developed sinusitis caused by E. rostratum under prolonged profound neutropenia after a second CBT because of the graft rejection of the first transplantation. Liposomal amphotericin B improved the sinusitis. A literature review revealed nine reported cases of sinusitis caused by E. rostratum, including our case. Although five cases had severe neutropenia at onset (HSCT recipients, n = 2; aplastic anemia, n = 3), the remaining four had no preexisting immunosuppressive conditions. However, three of the four patients had preexisting nasal diseases with or without a history of surgery, as in our case. Excluding our case, the outcome was fatal in five neutropenic patients, whereas the four patients without neutropenia recovered. Although sinusitis caused by E. rostratum is rare, E. rostratum should be recognized as a possible pathogen causing sinusitis in highly immunosuppressed patients such as HSCT recipients. Preexisting nasal disease and/or nasal surgery could be risks for this infection.

Topics: Adolescent; Amphotericin B; Anemia, Aplastic; Antifungal Agents; Ascomycota; Bone Marrow Transplantation; Child; Child, Preschool; Female; Fetal Blood; Hematopoietic Stem Cell Transplantation; Humans; Immunocompromised Host; Male; Middle Aged; Mycoses; Myelodysplastic Syndromes; Neutropenia; Sinusitis; Young Adult

This review adds to a series of reviews looking at primary medical management options for patients with chronic rhinosinusitis.Chronic rhinosinusitis is common and characterised by inflammation of the lining of the nose and paranasal sinuses leading to nasal blockage, nasal discharge, facial pressure/pain and loss of sense of smell. The condition can occur with or without nasal polyps. Antifungals have been suggested as a treatment for chronic rhinosinusitis.. To assess the effects of systemic and topical antifungal agents in patients with chronic rhinosinusitis, including those with allergic fungal rhinosinusitis (AFRS) and, if possible, AFRS exclusively.. The Cochrane ENT Information Specialist searched the Cochrane ENT Trials Register; Cochrane Central Register of Controlled Trials (CENTRAL); Ovid MEDLINE; Ovid Embase; CINAHL; Web of Science; ClinicalTrials.gov; ICTRP and additional sources for published and unpublished trials. The date of the search was 17 November 2017.. Randomised controlled trials (RCTs) with at least a two-week follow-up period comparing topical or systemic antifungals with (a) placebo, (b) no treatment, (c) other pharmacological interventions or (d) a different antifungal agent. We did not include post-surgical antifungal use.. We used the standard Cochrane methodological procedures. Our primary outcomes were disease-specific health-related quality of life (HRQL), patient-reported disease severity and the significant adverse effects of hepatic toxicity (systemic antifungals). Secondary outcomes included general HRQL, endoscopic nasal polyp score, computerised tomography (CT) scan score and the adverse effects of gastrointestinal disturbance (systemic antifungals) and epistaxis, headache or local discomfort (topical antifungals). We used GRADE to assess the quality of the evidence for each outcome; this is indicated in italics.. We included eight studies (490 adult participants). The presence of nasal polyps on examination was an inclusion criterion in three studies, an exclusion criterion in one study and the remaining studies included a mixed population. No studies specifically investigated the effect of antifungals in patients with AFRS.Topical antifungal treatment versus placebo or no interventionWe included seven studies (437 participants) that used amphotericin B (six studies; 383 participants) and one that used fluconazole (54 participants). Different delivery methods, volumes and concentrations were used.Four studies reported disease-specific health-related quality of life using a range of instruments. We did not meta-analyse the results due to differences in the instruments used, and measurement and reporting methods. At the end of treatment (one to six months) none of the studies reported statistically significant differences between the groups (low-quality evidence - we are uncertain about the result).Two studies reported disease severity using patient-reported symptom scores. Meta-analysis was not possible. At the end of treatment (8 to 13 weeks) one study showed no difference and the second found that patients in the placebo group had less severe symptoms (very low-quality evidence - we are very uncertain about the result).In terms of adverse effects, topical antifungals may lead to more local irritation compared with placebo (risk ratio (RR) 2.29, 95% confidence interval (CI) 0.61 to 8.62; 312 participants; 5 studies; low-quality evidence) but little or no difference in epistaxis (RR 0.97, 95% CI 0.14 to 6.63; 225 participants; 4 studies, low-quality evidence) or headache (RR 1.26, 95% CI 0.60 to 2.63; 195 participants; 3 studies; very low-quality evidence).None of the studies found a difference in generic health-related quality of life (one study) or endoscopic score (five studies) between the treatment groups. Three studies investigated CT scan; two found no difference between the groups and one found a significant decrease in the mean percentage of air space occluded, favouring the antifungal group.Systemic antifungal treatment versus placebo or no treatmentOne study (53 participants) comparing terbinafine tablets against placebo reported that there may be little or no difference between the groups in disease-specific health-related quality of life or disease severity score (both low-quality evidence). Systemic antifungals may lead to more hepatic toxicity events. Due to the very low quality of the evidence, it is uncertain whether or not the use of topical or systemic antifungals has an impact on patient outcomes in adults with chronic rhinosinusitis compared with placebo or no treatment. Studies including specific subgroups (i.e. AFRS) are lacking.

Topics: Administration, Topical; Adult; Amphotericin B; Antifungal Agents; Chronic Disease; Fluconazole; Humans; Quality of Life; Randomized Controlled Trials as Topic; Rhinitis; Sinusitis

Disseminated acanthamoebiasis is a rare, often fatal, infection most commonly affecting immunocompromised patients. We report a case involving sinuses, skin, and bone in a 60-year-old woman 5 months after heart transplantation. She improved with a combination of flucytosine, fluconazole, miltefosine, and decreased immunosuppression. To our knowledge, this is the first case of successfully treated disseminated acanthamoebiasis in a heart transplant recipient and only the second successful use of miltefosine for this infection among solid organ transplant recipients. Acanthamoeba infection should be considered in transplant recipients with evidence of skin, central nervous system, and sinus infections that are unresponsive to antibiotics. Miltefosine may represent an effective component of a multidrug therapeutic regimen for the treatment of this amoebic infection.

Topics: Acanthamoeba; Amebiasis; Amebicides; Amphotericin B; Anti-Bacterial Agents; Antilymphocyte Serum; Biopsy; Cardiomyopathies; Drugs, Investigational; Endoscopy; Female; Fluconazole; Flucytosine; Heart Transplantation; Humans; Immunocompromised Host; Immunosuppressive Agents; Magnetic Resonance Imaging; Metacarpal Bones; Metronidazole; Middle Aged; Phosphorylcholine; Polymerase Chain Reaction; Radiography; Sinusitis; Skin

Rhino-sinusal infections are serious diseases and possibly lethal. When they are invasive, we easily discuss apergilloses and mucormycoses. The confirmation of the diagnosis of mucormycosis need an extensive surgery for precise histopathological and mycological evaluation. The pathologist may be faced to other rare mycoses such as phaeohyphomycoses, which present different morphological features than mucormycoses and Aspergillus. Once the diagnosis is established, an appropriate antifungal treatment is quickly started. The aim of our work is to report two observations of phaeohyphomycoses, to describe their histopathological features, to discuss complementary diagnostic methods and to present the main differential diagnoses.

Topics: Adult; Alternaria; Alternariosis; Amphotericin B; Antifungal Agents; Combined Modality Therapy; Debridement; Diagnosis, Differential; Early Diagnosis; Fatal Outcome; Female; Humans; Liposomes; Mastoiditis; Phaeohyphomycosis; Postoperative Complications; Retrospective Studies; Rhinitis; Shock, Septic; Sinusitis

Invasive fungal sinusitis (IFS) represents an often fatal condition within the pediatric population. In an effort to characterize demographics, treatment modalities, and prognostic factors, we performed a systematic review.. We systematically reviewed EMBASE, Medline, TRIPdatabase, SCOPUS and the Cochrane database for invasive fungal nasal and sinus infections limited to individuals <18 years of age. Case series including 3 or more patients were included. Demographics, treatment and outcomes were analyzed using R Gui statistical software.. Twelve studies met inclusion criteria (103 patients). There was male preponderance of 48.5% with median age of 11 years old. Majority of patients had underlying leukemia (44.6%). Aspergillus was the predominant organism (47%). Isolated nasal findings occurred in 14% of patients and nasal findings occurred in 49% overall. Absolute neutrophil count (ANC) of immunocompromised patients was below 600 in most patients (99%). Average and median length of neutropenia was 2 weeks. All patients were prescribed amphoterocin with 50% as single medicinal therapy. Surgery occurred in 82.8% of cases. The mortality rate was 46%. Univariate analysis identified presenting with facial pain as a negative predictor of overall mortality (OR 0.296, 95% CI: 0.104-0.843, p < 0.05).. Mortality remains high in pediatric patients with IFS. An ANC of <600 occurred in the majority of immunocompromised patients at a duration of 2 weeks. Presenting with facial pain was a negative predictor of mortality. Many studies label this condition as invasive fungal sinusitis; however, approximately one seventh presented with only nasal findings and half overall had nasal involvement.

Topics: Amphotericin B; Anemia, Aplastic; Antifungal Agents; Aspergillosis; Burkitt Lymphoma; Candidiasis, Invasive; Child; Facial Pain; Female; Fusariosis; Humans; Immunocompromised Host; Leukemia; Male; Mucormycosis; Mycoses; Neutropenia; Otorhinolaryngologic Surgical Procedures; Prognosis; Retrospective Studies; Sinusitis

Chronic rhinosinusitis (CRS) is believed to be the result of an exaggerated reaction to fungi in the nasal mucosa, and topical amphotericin B (AMB) is a commonly used treatment. The purpose of this study was to perform a meta-analysis of high-quality comparative studies to examine the efficacy of topical AMB for the treatment of CRS. A search was conducted of Medline, Cochrane, EMBASE, and ISI Web of Knowledge until December 31, 2013 using combinations of the search terms chronic rhinosinusitis, human, treatment, antibiotics, nasal irrigation, nebulized, nasal lavage, sinonasal rinses, and antimicrobials. Inclusion criteria were (1) comparative studies, (2) a diagnosis of CRS or chronic sinusitis, and (3) the intervention was a topical antifungal. The primary outcome measure was quality of life (QOL), and the secondary was nasal endoscopy score. Of 235 article initially identified, five randomized controlled trials were included in the meta-analysis. Analysis of four studies with complete QOL data found no difference between treatment and placebo groups [standard difference in means 0.78, 95 % confidence interval (CI) -0.25 to 1.81, P = 0.138]. Analysis of four studies with complete nasal endoscopy score data found no difference between the treatment and placebo groups (standard difference in means 0.34, 95 % CI -0.08 to 0.76, P = 0.117). AMB is not more effective than placebo in improving QOL or nasal endoscopy scores in patients with CRS.

Topics: Administration, Topical; Adult; Amphotericin B; Antifungal Agents; Chronic Disease; Endoscopy; Humans; Nasal Lavage; Nasal Mucosa; Quality of Life; Rhinitis; Sinusitis; Treatment Outcome

Histoplasma capsulatum has not typically been associated with sinusitis in either immunocompetent or immunocompromised hosts. We report a case of sinusitis caused by H. capsulatum in a patient with chronic lymphocytic leukemia and discuss the reported cases of this rare clinical manifestation of histoplasmosis in the medical literature.

Topics: Aged; Amphotericin B; Antifungal Agents; Deoxycholic Acid; Drug Combinations; Histoplasma; Histoplasmosis; Humans; Immunocompromised Host; Itraconazole; Leukemia, Lymphocytic, Chronic, B-Cell; Male; Sinusitis; Treatment Outcome

Topics: Administration, Topical; Amphotericin B; Antifungal Agents; Chronic Disease; Humans; Randomized Controlled Trials as Topic; Rhinitis; Sinusitis

Zygomycoses are severe angio-invasive fungal infections that develop in immunocompromised and diabetic patients. Any episode of sinusitis not responding to short-term antibacterial therapy should evoke the diagnosis of zygomycosis in the latter population, especially in cases of a surrounding necrotic area. Appropriate diagnosis is obtained after careful direct examination of the sample and culture. Current therapy underscores the need to control glycaemia and acidosis in addition to the need for urgent administration of high-dose liposomal amphotericin B in combination with extensive surgery.

Topics: Amphotericin B; Antifungal Agents; Diabetes Complications; Humans; Sinusitis; Zygomycosis

To review the literature on the use of amphotericin irrigation for the treatment of chronic rhinosinusitis.. Although the etiology of acute rhinosinusitis is usually bacterial in nature, the exact etiology of chronic rhinosinusitis is unclear. Recent literature reports pointed to fungal colonization as a likely pathogenesis. It was hypothesized that a nonallergic eosinophilic immunoglobulin response to these fungi by the host was the cause of the symptoms, not a fungal invasion into the mucosa. The paper reviews the most recent articles investigating the use of amphotericin irrigation, as well as sprays and oral medications, of the nasal and sinus mucosa in patients with chronic rhinosinusitis.. The use of amphotericin for patients with chronic rhinosinusitis is not substantiated by the majority of publications. Although some studies found improvement on radiographic images, the symptoms of the disorder were not improved even with fungal eradication. Further studies need to be carried out to determine if changes in dosage, treatment time or route of administration could improve results.

Topics: Administration, Intranasal; Amphotericin B; Antifungal Agents; Chronic Disease; Humans; Mycoses; Rhinitis; Sinusitis; Therapeutic Irrigation

Chronic rhinosinusitis (CRS) is an inflammatory disorder affecting the nose and paranasal sinuses. Although bacteria have long been implicated as pathogens in most forms of CRS, it has been recognized that fungi may be responsible for some forms of CRS. Recent studies have shown that under optimal conditions, fungi can be identified within the nose and paranasal sinuses of nearly every individual. Considerable controversy exists concerning the proper diagnosis of and potential overlap between 'allergic fungal rhinosinusitis' and 'chronic rhinosinusitis'. Although the disease name 'allergic fungal rhinosinusitis' is suggestive of an immunoglobulin E (IgE) mediated reaction to fungi, recent studies demonstrate the presence of elevated serum IgE levels to one fungus while another fungus is present in CRS mucin of the same individual, questioning the role of type I hypersensitivity. Several mechanisms explaining the role of fungi in the pathogenesis of CRS, all requiring additional investigations with adequate controls, have been suggested and will be reviewed. Although preliminary trials suggest a beneficial effect of topical and oral antifungal agents in the treatment of CRS patients, several double-blind placebo controlled trials do not. Presently, in the absence of convincing immunological data and evidence of clinical improvement of CRS upon therapy with antifungal agents, the case against the fungus remains unproven.

Topics: Amphotericin B; Antifungal Agents; Eosinophilia; Humans; Immunity, Cellular; Immunoglobulin G; Nasal Mucosa; Rhinitis; Sinusitis; Specimen Handling; T-Lymphocytes; Treatment Outcome

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

To evaluate the clinical characteristics of patients affected by hematologic malignancies who developed mucormycosis and to ascertain the factors which influenced the outcome following mycotic infection.. This was a retrospective study conducted over a 15-year period (1987-2001). The study included 59 patients with hematologic malignancies with a proven or probable mucormycosis admitted in 18 Hematology Divisions in tertiary care or university hospitals.. The most frequent sites of infection were lung (64%) and orbito-sinus-facial (24%); cerebral involvement observed in 19% of cases was always associated with other sites of infection. Antifungal treatment was empirically administered in 49 patients (83%); 7 patients underwent radical surgical debridement (12%). Therapy was successful for only 18 patients (37%). Forty-seven patients died within 3 months of the diagnosis of fungal infection: the cause of death was mucormycosis in 41 patients (87%) and progression of hematologic disease in 6 patients (13%). At univariate analysis, the factors that correlated with a positive outcome from infection were the following: male sex, amphotericin B treatment, neutrophil recovery from post-chemotherapy aplasia. At multivariate analysis, the only factor that significantly correlated with recovery from infection was the liposomal amphotericin B treatment.. Mucormycosis is a rare filamentous fungal infection that occurs most frequently in neutropenic patients with acute leukemia. It does not seem to have increased in recent years. Although a reduction of mortality has been observed recently, the mortality rate still remains high. Extensive and aggressive diagnostic and therapeutic procedures are essential in order to improve the prognosis in these patients.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Amphotericin B; Antifungal Agents; Encephalitis; Female; Fungemia; Hematologic Neoplasms; Humans; Immunocompromised Host; Italy; Lung Diseases, Fungal; Male; Middle Aged; Mucormycosis; Neutropenia; Retrospective Studies; Risk Factors; Sinusitis; Treatment Outcome; Triazoles

Rhinocerebral mucormycosis (RCM) is an invasive fungal infection that necessitates, in most cases, aggressive surgical debridement and high cumulative, often nephrotoxic doses of amphotericin B. A 50-year-old woman with RCM was treated successfully with amphotericin B lipid complex as primary therapy. The patient previously had displayed progressive intracranial involvement and rising serum creatinine levels while receiving the conventional (nonlipid) form of amphotericin B. A literature review identified only a few cases where systemic antifungal therapy was administered, with minimal or no surgery. Our case further supports that amphotericin B lipid complex can be used as primary therapy in selected patients with RCM, without the need for surgical exenteration.

Topics: Amphotericin B; Antifungal Agents; Female; Humans; Lipids; Middle Aged; Mucormycosis; Sinusitis

The deep mycoses are uncommon infections, usually acquired from the inhalation or ingestion of fungal spores, sometimes from the soil in areas of endemicity, such as in the Americas and south-east Asia, or from decaying vegetable matter. They are also seen in immunocompromised persons and, increasingly, in HIV-infected persons. Respiratory involvement is frequent, with granuloma formation, and mucocutaneous involvement may be seen. Oral lesions of the deep mycoses are typically chronic but non-specific, though nodular or ulcerative appearances are common. Person-to-person transmission is rare. In HIV disease, the most common orofacial involvement of deep mycoses has been in histoplasmosis, cryptococcosis, aspergillosis and zygomycosis. Diagnosis is usually confirmed by lesional biopsy although culture may also be valuable. Treatment is with amphotericin or an azole.

Topics: Acquired Immunodeficiency Syndrome; Adult; AIDS-Related Opportunistic Infections; Amphotericin B; Aspergillosis; Azoles; Cryptococcosis; Female; Histoplasmosis; HIV Infections; Humans; Lung Diseases, Fungal; Male; Middle Aged; Mouth Diseases; Mucormycosis; Mycoses; Sinusitis

Rhinocerebral mucormycosis with intracranial involvement has a high mortality. The standard therapy consists of aggressive surgical débridement accompanied by high doses of amphotericin B deoxycholate. Even with this therapy, the mortality rate has been 48% in the series reported since 1980. We treated a 60-year-old diabetic woman with rhinocerebral mucormycosis involving the cavernous sinus whose infection responded to medical therapy with amphotericin B lipid complex. To our knowledge, this is the only well-documented medical cure of a patient with rhinocerebral mucormycosis and intracranial involvement.

Topics: Amphotericin B; Antifungal Agents; Brain Diseases; Female; Humans; Middle Aged; Mucormycosis; Sinusitis

A case of disseminated invasive fusarial infection (DFI) with sinus involvement in a patient with acute myeloblastic leukaemia is reported. Amphotericin B with rifampin were administrated and wide radical sinus surgery was performed. Nevertheless, the patient died six weeks later. The four principal forms of fusarial infections in humans are discussed: toxicosis, allergic fungal sinusitis, locally invasive infection, and disseminated invasive infection. Prognosis of DFI in the immunocompromised host is usually poor, and treatment is difficult. Profound and prolonged neutropaenia appears to be the major predisposing factor. The literature on infections caused by Fusarium species in immunocompromised hosts is reviewed, especially those where the sinuses were involved.

Topics: Amphotericin B; Antifungal Agents; Fatal Outcome; Fusarium; Humans; Immunocompromised Host; Leukemia, Myeloid, Acute; Male; Middle Aged; Mycoses; Opportunistic Infections; Sinusitis

We report a clinical case of severe medullary aplasia complicated by fungal antritis. The treatment adopted for this patient consists in a clean operation of the infective focus and the local instillation of Amfotericina B during the post operative period. In this way the systemic circulation is not interested by the use of Amfotericina B, which is extremely important to avoid the inevitable onset of several unwanted side-effects; besides, we avoid the progression of the infective focus and its systemic diffusion.

Topics: Adult; Amphotericin B; Aspergillosis; Aspergillus flavus; Bone Marrow Diseases; Combined Modality Therapy; Fusarium; Humans; Immunosuppression Therapy; Male; Mycoses; Opportunistic Infections; Recurrence; Sinusitis

Invasive aspergillosis is the most frequent cause of infectious death after allogeneic bone marrow transplantation. Risk factors include the patient's condition (granulocytopenia, immunosuppression) and his environment (air spores count). Pulmonary infections are prominent. Other infections usually occur in the setting of disseminated disease via hematogenous spread. Cerebral aspergillosis appears to be especially frequent and of very poor prognosis. Infections of the paranasal sinuses occur less often and are associated or not with pneumonitis. Mycologically confirmed diagnosis is difficult to obtain: treatment will often have to be instored on clinical findings alone or even on an empiric basis. However, the prognosis remains extremely poor explaining the actual physicians' concern in finding a better prophylaxis of this infection.

Topics: Amphotericin B; Aspergillosis; Bone Marrow Transplantation; Humans; Itraconazole; Lung Diseases, Fungal; Risk Factors; Sinusitis; Transplantation, Homologous

Invasive fungal sinusitis is becoming increasingly common in patients undergoing BMT. This study was undertaken to evaluate the incidence, presenting symptoms, diagnosis procedures, treatment and outcome of invasive fungal sinusitis. The study population comprised 423 consecutive BMT patients at Hadassah University Hospital from January 1986 to August 1992. Eleven patients (2.6%) developed invasive fungal sinusitis, 8 had underlying hematologic malignancies and 3 severe aplastic anemia (SAA). Median interval between BMT and fungal sinusitis was 22.5 days (range 2-106 days). Eight of 11 patients had protracted neutropenia (median 8 days with median neutrophil count at the time of fungal sinusitis diagnosis of 0.25 x 10(9)/l). Four patients developed GVHD before fungal sinusitis was diagnosed. Presenting symptoms were fever (100%), orbital swelling (63%), facial pain (54%) and nasal congestion (36%). In 8 patients Aspergillus species were isolated (A. flavus in 7, A. quadrilineatus in 1); in 1 patient Candida albicans was isolated and in the other 2 fungal elements were detected histologically (Fusarium and Mucor, respectively). Six of the patients underwent surgical debridement at diagnosis. Three received granulocyte transfusions. All patients received systemic amphotericin B (7 conventional and 4 amphotericin B colloidal dispersion (ABCD)). Only 2 of the 11 patients responded completely to therapy with a follow-up of 15 months. It appears that invasive fungal sinusitis is a potentially fatal complication in immunocompromised patients post-BMT. Current treatment approaches are largely ineffective and new methods of management of this serious problem are needed.

Topics: Adolescent; Adult; Amphotericin B; Anemia, Aplastic; Bone Marrow Purging; Bone Marrow Transplantation; Child; Child, Preschool; Cohort Studies; Combined Modality Therapy; Debridement; Drainage; Female; Follow-Up Studies; Graft vs Host Disease; Granulocytes; Humans; Immunocompromised Host; Incidence; Infant; Leukemia; Leukocyte Transfusion; Lymphoma; Male; Middle Aged; Mitosporic Fungi; Mycoses; Neutropenia; Sinusitis; Survival Rate; Treatment Outcome

Topics: Amphotericin B; Diabetes Complications; Diagnosis, Differential; Humans; Mucormycosis; Neoplasms; Paranasal Sinuses; Sinusitis

Topics: Adolescent; Adult; Aged; Amphotericin B; Brain Diseases; Child; Child, Preschool; Corticosterone; Diabetes Complications; Female; Humans; Infant; Infant, Newborn; Leukemia; Lung Diseases, Fungal; Male; Meningoencephalitis; Middle Aged; Mucormycosis; Postoperative Complications; Sinusitis; Substance-Related Disorders; Syndrome; Transplantation, Homologous

Previous studies have shown controversial results of topical amphotericin B (AMB) nasal irrigation for chronic rhinosinusitis (CRS). The purpose of this study was to evaluate the efficacy of 200 μg/mL AMB nasal irrigation as an adjuvant therapy after functional endoscopic sinus surgery (FESS).. Patients with CRS who had received FESS for treatment were recruited and assigned to 1 of 2 groups at random at 1 month postsurgery. In the AMB group patients received nasal irrigation with 200 μg/mL of AMB for 2 months on a daily basis. In the control group normal saline irrigation was given instead. Before FESS and before and after nasal irrigation, patients' sinonasal symptoms were assessed through a questionnaire that was a Taiwanese version of the 22-item Sino-Nasal Outcome Test (TWSNOT-22). In addition, patients received endoscopic examination, acoustic rhinometry, smell test, saccharine transit test, and bacterial cultures obtained from their middle meati.. A total of 73 patients completed the study between December 2014 and January 2017. Among them, 37 received nasal irrigation with AMB solution, and 36 with saline. In the AMB group, scores of TWSNOT-22 dropped significantly after irrigation compared with before (p = 0.005). In the control group, TWSNOT-22 scores did not changed after irrigation (p = 0.451). However, there were no significant differences in TWSNOT-22, endoscopic score, smell test, saccharine transit test, and bacterial culture rate after irrigation between 2 groups.. Our study showed that in post-FESS care, nasal irrigation with 200 μg/mL of AMB did not provide additional benefit compared with saline irrigation.

Topics: Adult; Aged; Aged, 80 and over; Amphotericin B; Antifungal Agents; Chemotherapy, Adjuvant; Chronic Disease; Double-Blind Method; Endoscopy; Female; Humans; Male; Middle Aged; Nasal Lavage; Paranasal Sinuses; Postoperative Care; Rhinitis; Sinusitis; Young Adult

Chronic rhinosinusitis (CRS) affects 1-4% of the adult population. The etiology of this multifactorial, chronic disease, which leads to a significant impairment of the quality of life, often accompanied by nasal polyposis, is not fully understood. In the past decade, it was presumed that the disease, which causes characteristic eosinophilic infiltration of the nasal mucosa, is triggered by an enhanced (but not classical allergic IgE-type) immune response against fungal organisms in the nasal mucus. If this supposition is correct, then it appears obvious that the administration of amphotericin B nasal spray in adequate concentration following endoscopic polypectomy should be advantageous for these patients, and might even reduce the number of recurrent cases. To check on this assumption, we conducted a prospective randomized placebo-controlled trial involving 33 patients, 30 of whom remained in the study throughout. Patients with nasal polyposis were operated on with an endoscopic technique between 1 November 2005 and 1 October 2006; group A (14 randomly selected patients) were treated with a nasal spray containing 5 mg/ml amphotericin B, while the placebo group B (16 randomly selected patients) received a nasal spray lacking amphotericin B. We evaluated our results with the aid of a modified Lund-Mackay CT score, the SNAQ-11 test (which assesses changes in the symptoms), a quality of life test and endoscopy. The SPSS 14.0 for Windows program was utilized to process the data of examinations performed preoperatively and 1 year postoperatively. The CT scores of the group A patients 1 year after the operation exhibited wide scattering, without signs of recovery. The CT scores of the group B patients indicated a slight improvement, though this did not prove significant relative to group A. Both the SNAQ-11 test and the quality of life test revealed a significant improvement in each group, but the degrees of change in these tests did not differ significantly between the two groups of patients. The endoscopic findings indicated a slight improvement to the advantage of the amphotericin B-treated group 12 months after the operation. These results lead to the conclusion that the administration of amphotericin B nasal spray to patients operated on for nasal polyposis does not give rise to a significant alteration in either CT score, clinical symptoms, or quality of life. The more favorable clinical aspects observed in the amphotericin B-treated group during the endo

Topics: Administration, Intranasal; Amphotericin B; Antifungal Agents; Chronic Disease; Double-Blind Method; Female; Humans; Male; Middle Aged; Nasal Polyps; Placebos; Prospective Studies; Quality of Life; Recurrence; Rhinitis; Sinusitis; Treatment Outcome

It has been suggested that an exaggerated immune response to fungi is crucial in the pathogenesis of chronic rhinosinusitis (CRS). Based on this rationale, the use of topical antifungals (amphotericin B) has been advocated. Studies on its clinical effectiveness are, however, contradictory.. To examine the effect of nasal antifungal treatment on secreted mediators in samples of nasal lavage fluid from patients with CRS with or without nasal polyps (NP).. Part two of a prospective double-blind, placebo-controlled multicenter clinical trial investigating the effect of 13 weeks of treatment with amphotericin B or placebo on the levels of pro-inflammatory cytokines, chemokines and growth factors (i.e., IL-1beta, IL-1RA, IL-2, IL-2R, IL-3, IL-4, IL-5, IL-6, IL-7, IL-8, IL-10, IL-12 (p40/p70 subunits), IL-13, IL-15, IL-17, TNF-alpha, IFN-alpha, IFN-gamma, G-CSF, GM-CSF, MIP-1alpha, MIP-1beta, IP-10, MIG, eotaxin, RANTES, MCP-1, MCP-2, MCP-3, VEGF, EGF, FGF-basic, HGF, Gro-alpha) and albumin via a fluorescent enzyme immunoassay in nasal lavage specimens of CRS patients with or without NP.. Topical amphotericin B had no significant effect on the level of any of the tested pro-inflammatory cytokines, chemokines, and growth factors in CRS nasal lavage samples. Treatment with placebo, however, increased the level of MIP-1alpha and MIP-1beta, which are mediators involved in wound healing.. Topical amphotericin B has no significant effect on activation markers of nasal inflammatory cells in chronic rhinosinusitis with or without nasal polyps.

Topics: Administration, Intranasal; Administration, Topical; Adult; Amphotericin B; Antifungal Agents; Chemokines; Chi-Square Distribution; Chronic Disease; Cytokines; Double-Blind Method; Female; Humans; Inflammation; Intercellular Signaling Peptides and Proteins; Male; Middle Aged; Nasal Lavage; Nasal Polyps; Prospective Studies; Rhinitis; Sinusitis; Statistics, Nonparametric; Treatment Outcome

Chronic rhinosinusitis affects 1-4% of the adult population. The aetiology of this multifactorial, chronic disease, which leads to a significant impairment of the quality of life, often accompanied by nasal polyposis, is not fully understood. In the past decade it was presumed that the disease, which causes characteristic eosinophilic infiltration of the nasal mucosa, is triggered by an enhanced (but not classical allergic IgE type) immune response.. If this supposition is correct, then it appears obvious that the administration of amphotericin B nasal spray in adequate concentration following endoscopic polypectomy should be advantageous for these patients, and might even reduce the number of recurrent cases.. To check on this assumption, the authors conducted a prospective randomized placebo-controlled trial involving 33 patients, 30 of whom remained in the study throughout. Patients with nasal polyposis were operated on with an endoscopic technique between 1 November 2005 and 1 October 2006; one group of them (group A, 14 randomly selected patients) was treated with a nasal spray containing 5 mg/ml amphotericin B, while the placebo group (group B, 16 randomly selected patients) received a nasal spray lacking amphotericin B. The results were evaluated with the aid of a modified Lund-Mackay CT score, the SNAQ-11 test (which evaluates changes in the symptoms), the life-quality test and endoscopy. The SPSS 14.0 for Windows program was utilized to process the data of examinations performed preoperatively and one year postoperatively.. The CT scores of the group A patients exhibited wide scattering without signs of recovery one year after the operation. The CT scores of the group B patients indicated a slight improvement, though this did not prove significant in relation to group A. Both the SNAQ-11 test and the life-quality test revealed a significant improvement in each group, but the degrees of change in these tests did not significantly differ between the two groups of patients. The endoscopic findings indicated a slight improvement to the advantage of the amphotericin B-treated group 12 months after the operation.. These results lead to the conclusion that the administration of amphotericin B nasal spray to patients operated on for nasal polyposis does not give rise to a significant alteration in CT scores, clinical symptoms, or quality of life. The more favourable clinical aspects observed in the amphotericin B-treated group during the endoscopic follow-up did not correspond to an improvement in the symptoms. In connection with the conclusions drawn from this study the authors discuss the available data on the fungal theory. They critically analyse the contradictory observations of 7 recent clinical studies.

Topics: Adult; Aerosols; Aged; Amphotericin B; Anti-Bacterial Agents; Antifungal Agents; Chronic Disease; Endoscopy; Female; Humans; Male; Middle Aged; Nasal Polyps; Postoperative Period; Prospective Studies; Quality of Life; Rhinitis; Secondary Prevention; Severity of Illness Index; Sinusitis; Surveys and Questionnaires; Treatment Outcome

To examine the effect of nasal antifungal treatment on eosinophil cationic protein (ECP) and tryptase levels in samples of nasal lavage fluid from patients with chronic rhinosinusitis and nasal polyps.. Prospective double-blind placebo-controlled clinical trial.. Tertiary surgical center.. Subjects with severe chronic rhinosinusitis and nasal polyps. Of 120 screened patients, 76 were eligible. Six patients withdrew because of minor adverse events, and 10 dropped out for other reasons. In total, 60 patients completed the study according to the study protocol.. Nasal treatment with amphotericin B or saline control for 8 weeks.. Nasal lavages were performed before and after treatment. Fungal elements were assessed by culture and with different polymerase chain reaction assays. Levels of ECP and tryptase were determined by fluorescent enzyme immunoassay.. No correlation between cell activation markers and fungus detection was observed before treatment (all P>.20). Nasal amphotericin B treatment had no effect on levels of ECP (P = .17) or tryptase (P = .09) in nasal lavage samples. Moreover, successful fungus eradication, defined as fungus detection before but not after treatment, did not influence nasal ECP or tryptase levels (all P>.40).. Neither topical amphotericin B therapy nor fungal state before and after treatment had any significant influence on activation markers of nasal inflammatory cells in chronic rhinosinusitis.

Topics: Administration, Intranasal; Adult; Aged; Amphotericin B; Antifungal Agents; Chronic Disease; Double-Blind Method; Female; Humans; Male; Middle Aged; Nasal Mucosa; Nasal Polyps; Prospective Studies; Rhinitis; Sinusitis; Tomography, X-Ray Computed; Treatment Outcome

Chronic rhinosinusitis (CRS) is one of the most common chronic diseases. Recently, it has been suggested that an exaggerated immune response to fungi is crucial in the pathogenesis of the disease. On the basis of this hypothesis, intranasal treatment with amphotericin B should benefit patients with CRS. Data from 2 uncontrolled and 2 controlled trials are conflicting, however.. To clarify the role of intranasal antifungal drugs in the treatment of CRS, we conducted a large, double-blind, placebo-controlled, multicenter study comparing the effectiveness of amphotericin B nasal lavages with placebo.. A total of 116 randomly selected patients with CRS were instructed to instill 25 mL amphotericin B (100 microg/mL) or placebo to each nostril twice daily for 3 months. Primary outcomes included a reduction in total visual analog scale (VAS) score and nasal endoscopy score. Secondary outcome measures included peak nasal inspiratory flow, polyp score, quality of life (Short Form-36, Rhinosinusitis Outcome Measure-31), and individual VAS scores.. Analysis was based on intention to treat and involved all patients randomly assigned. Mean VAS scores, Short Form-36 and Rhinosinusitis Outcome Measure-31 data, peak nasal inspiratory flow values, nasal endoscopy scores, and polyp scores were similar in both treatment groups at the time of randomization, and no significant differences were observed after 13 weeks of treatment.. Amphotericin B nasal lavages in the described dosing and time schedule do not reduce clinical signs and symptoms in patients with CRS.. Amphotericin B nasal lavages in the described dosing and time schedule are ineffective and therefore not advised in the treatment of patients with CRS.

Topics: Administration, Intranasal; Amphotericin B; Antifungal Agents; Chronic Disease; Double-Blind Method; Female; Humans; Male; Middle Aged; Rhinitis; Sinusitis; Therapeutic Irrigation

Chronic rhinosinusitis (CRS) is one of the most common chronic diseases. Its etiology is unknown, and there is a paucity of effective medical treatments.. We tested the hypothesis that intranasal antifungal treatment improves the objective computed tomography (CT) findings (inflammatory mucosal thickening), nasal endoscopy stages, and symptoms of CRS.. A randomized, placebo-controlled, double-blind, single-center trial used amphotericin B to treat 30 randomly selected patients with CRS. Patients were instructed to instill 20 mL amphotericin B (250 mug/mL) or placebo to each nostril twice daily for 6 months. The primary outcome was a quantitative reduction in inflammatory mucosal thickening on CT scans of a standardized coronal cut. Secondary outcome measures were endoscopic scores, patient symptom scores, and levels of intranasal inflammatory mediators.. Twenty-four patients completed the 6 months of treatment. Patients receiving amphotericin B achieved a relative reduction in the percentage of mucosal thickening on CT scans (n = 10; -8.8%) compared with placebo (n = 14; +2.5%; P = .030). Likewise, the changes in the endoscopic scores improved in the amphotericin B group compared with placebo ( P = .038). Between-group comparisons of the changes in the intranasal mucus levels of eosinophil-derived neurotoxin showed a reduction in the amphotericin B group and an increase in the placebo group ( P = .046); levels of IL-5 showed similar tendencies ( P = .082).. Intranasal amphotericin B reduced inflammatory mucosal thickening on both CT scan and nasal endoscopy and decreased the levels of intranasal markers for eosinophilic inflammation in patients with CRS.

Topics: Administration, Intranasal; Adult; Aged; Amphotericin B; Antifungal Agents; Chronic Disease; Double-Blind Method; Eosinophils; Female; Humans; Interleukin-5; Lymphocyte Count; Male; Middle Aged; Mucus; Nasal Mucosa; Pilot Projects; Rhinitis; Sinusitis

Recently, fungal elements were suspected to be the causative agent of chronic rhinosinusitis, and benefits of topical amphotericin B therapy have been reported.. The effects of amphotericin B versus control nasal spray on chronic rhinosinusitis were compared in a double-blind, randomized clinical trial.. Patients with chronic rhinosinusitis were administered 200 microL per nostril amphotericin B (3 mg/mL) or saline nasal spray 4 times daily over a period of 8 weeks. The response rate, defined as a 50% reduction of pretreatment computed tomography score, was the primary outcome variable. Additional outcome variables included a symptom score, a quality of life score, and an endoscopy score. Before and after treatment, nasal lavages were pretreated with dithiothreitol and examined for fungal elements by PCR and standard culture techniques.. Seventy-eight patients were included, and 60 patients finished the study per protocol. In the control group, no positive response (0 of 32) was observed, and 2 of 28 patients responded in the amphotericin B group (P>.2). The symptom scores were distinctly worse after amphotericin B therapy (P <.005). The other parameters investigated did not differ remarkably between the treatment groups.. Nasal amphotericin B spray in the described dosing and time schedule is ineffective and deteriorates patient symptoms.

Topics: Administration, Topical; Adult; Aged; Amphotericin B; Antifungal Agents; Chronic Disease; Double-Blind Method; Female; Humans; Male; Middle Aged; Nasal Polyps; Prospective Studies; Rhinitis; Sinusitis; Tomography, X-Ray Computed

Invasive fungal rhinosinusitis (IFR) is one of the most important causes of morbidity and mortality in immunocompromised patients, principally those with cellular immunodeficiency, with mortality ranging from 50 to 80%. Prophylaxis and early diagnosis increase the chances of successful treatment.. Clinical prospective randomized study.. To present cases of IFR and to compare them with data reported in the literature.. Analysis of eleven cases of IFR confirmed by pathologist examination.. Aspergillus was found to be the most prevalent pathogen. Symptoms ranged from high fever in most cases to nasal discharge, ulceration of the nasal mucosa, headache and periorbital edema.. The combination of amphotericin B and endoscopic surgery, associated or not with Caldwell-Luc surgery, showed good results. The use of liposomal amphotericin B also presented a satisfactory outcome.

Topics: Adolescent; Adult; Amphotericin B; Antifungal Agents; Female; Humans; Immunocompromised Host; Liposomes; Male; Middle Aged; Prospective Studies; Rhinitis; Sinusitis; Tomography, X-Ray Computed

Chronic rhinosinusitis (CRS) is the most common chronic disease that is frequently refractory to treatment.. We sought to establish the safety and demonstrate the clinical efficacy of intranasal antifungal drug therapy in patients with CRS in a pilot trial.. A prospective open-label trial used amphotericin B as a medical treatment in 51 randomly selected patients with CRS. The antifungal agent was applied intranasally as 20 mL of a 100 microg/mL solution twice daily. The outcome was measured by using their symptoms and by using an endoscopic scoring system in all patients. In addition, pretreatment and posttreatment coronal computed tomographic scans of the nose and sinuses were available for evaluation in 13 patients.. By using amphotericin B, improvement of sinusitis symptoms was observed in 38 (75%) of 51 patients. Endoscopically, 18 (35%) of 51 patients became disease free, and an additional 20 (39%) of 51 had improvement of at least one stage (P <.001). No effect was seen in 13 (25%) of 51 patients. The available computed tomographic scans before and after treatment demonstrated a significant reduction in the inflammatory mucosa thickening that had occluded the paranasal sinuses (P <.0001 in maxillary sinus).. This open-label pilot trial demonstrates that direct mucoadministration of an antifungal drug appears to be both safe and effective in the treatment of patients with CRS. Therefore controlled and blinded trials are indicated to clarify the novel role of intranasal antifungal drugs in the treatment of CRS.

Topics: Administration, Intranasal; Adolescent; Adult; Aged; Amphotericin B; Antifungal Agents; Child; Chronic Disease; Female; Humans; Length of Stay; Male; Middle Aged; Prospective Studies; Rhinitis; Sinusitis; Tomography, X-Ray Computed

We report a case of optic neuropathy related to sphenoid sinus aspergillosis which showed good visual recovery with surgery and medical antifungal treatment.. Observational case study Case Presentation A 62-year-old man presented with decreased visual acuity in the right eye for 3 weeks. His visual acuity was counting fingers in the right eye and 20/20 in the left eye. Relative afferent pupillary defects were detected in the right eye. Optic neuropathy related to invasive fungal sphenoid sinusitis was suspected via radiologic evaluation. Endoscopic sinus surgery was performed and histopathological examination revealed aspergillosis. Amphotericin B combined with ceftriaxone and metronidazole was started. After the fungal culture results were positive for the Aspergillus species, amphotericin B was changed to voriconazole. At 1 month after surgery, visual acuity improved to 20/25.. Appropriate radiologic evaluation can be helpful when optic neuropathy associated with a fungal infection is suspected, and timely surgical and medial treatment should be considered.

Topics: Amphotericin B; Antifungal Agents; Aspergillosis; Humans; Male; Middle Aged; Optic Nerve Diseases; Sinusitis; Sphenoid Sinus

Acute invasive fungal rhinosinusitis (AIFRS) is a fatal infection associated with high morbidity and mortality. Although it is a rare disease, upsurge of AIFRS was noticed during the second wave of COVID-19 disease. Early diagnosis and management is the cornerstone for good outcomes. However, management of AIFRS is challengeable especially in developing countries due to limited resources and high prices of antifungal agents. No previous studies have been conducted to evaluate the outcomes of management of AIFRS in Syria. The purpose of this study is to report the results of management of AIFRS with low doses of liposomal amphotericin B in our tertiary hospital in Syria.. The outcomes of management of AIFRS cases were followed through a prospective observational study between January 2021 and July 2022. The required medical data were collected for each individual. Three-month mortality rate was studied. SPSS v.26 was used to perform the statistical analysis. Pearson Chi-square test was used to study the associations between different variables and mortality. Survival curves were plotted by the Kaplan-Meier to compare the survival probability. Log Rank (Mantel-Cox) test and Cox regression were conducted to evaluate the factors affecting survival within the follow up period.. Of 70 cases, 36 (51.4%) were males and 34 (48.6%) were females. The mean age of patients was 52.5 years old. The most common underlying risk factor was diabetes mellitus (84.3%). The used dose of liposomal amphotericin B ranged between 2-3 mg/kg per day. The overall 3-month mortality rate was 35.7%. Significant association was found between survival and the following variables: Age, orbital involvement, stage, and comorbidity.. The overall mortality rate was close to other studies. However, survival rate was worse than comparable studies in selected cases of AIFRS (older ages, involved orbits, advanced stages, and chronic immunodeficiency). Therefore, low doses of liposomal amphotericin B could be less effective in such cases and high doses are recommended.

Topics: Acute Disease; Antifungal Agents; COVID-19; Female; Hospitals, University; Humans; Male; Middle Aged; Mycoses; Rhinitis; Sinusitis; Syria

This report highlights the role of local amphotericin B (AMB) injection in cases of maxillary mucormycosis. The COVID-19 pandemic has resulted in a dramatic rise in the number of rhino-orbital mucormycosis cases. Although extensive surgical debridement remains the gold standard treatment, tissue salvage is desirable. The cases of two patients treated with local AMB are reported here, indicating that early intervention for maxillary fungal sinusitis in the form of local AMB may avoid the need for more invasive treatment.

Topics: Amphotericin B; Antifungal Agents; Humans; Maxillary Sinusitis; Mucormycosis; Orbital Diseases; Pandemics; Sinusitis

To assess whether a modified treatment ladder algorithm incorporating transcutaneous retrobulbar amphotericin B (TRAMB) for invasive fungal rhino-orbital sinusitis can reduce the risk of exenteration without compromising survival.. Retrospective, comparative clinical study with historical control subjects.. Fifty consecutive patients with biopsy-proven invasive fungal sinusitis and radiographic evidence of orbital involvement were evaluated at a single tertiary institution from 1999-2020. TRAMB was incorporated as part of the treatment algorithm in 2015. Demographics, underlying immune derangement, infective organism, ophthalmic examination, surgical care, and survival were compared in a quasiexperimental pre-post format, dividing patients into a pre-2015 group and a post-2015 group. Risk of exenteration and mortality were the primary outcomes.. Baseline characteristics did not differ significantly between the 2 groups. Nearly all patients underwent a surgical intervention, most commonly functional endoscopic sinus surgery with debridement. TRAMB was administered to 72.7% of the post-2015 group. Exenteration was more common in the pre-2015 group (36.4% vs 9.1% [95% confidence interval {CI} 5.2-48.8]; P = .014), while mortality was similar (40.0% vs 36.7% [95% CI -22.1 to 29.3]; P = .816). After adjusting for potential confounders, patients treated after 2015 were found to have lower risk of exenteration (relative risk 0.28 [95% CI 0.08-0.99]; P = .049) and similar risk of mortality (relative risk 1.04 [95% CI 0.50-2.16]; P = .919).. Compared with historical control subjects, patients with invasive fungal rhino-orbital sinusitis who were treated with a modified treatment ladder algorithm incorporating TRAMB had a lower risk of disfiguring exenteration without an apparent increase in the risk of mortality.

Topics: Algorithms; Amphotericin B; Antifungal Agents; Eye Infections, Fungal; Humans; Invasive Fungal Infections; Orbital Diseases; Retrospective Studies; Sinusitis

To determine the association between antifungal susceptibility test (AFST) results and in vivo therapeutic response in Indian patients with fungal rhinosinusitis.. The clinicoradiological, fungal culture, AFST, histopathology results and outcomes of 48 patients with fungal rhinosinusitis seen between 20132015 were analysed. Minimum inhibitory concentration (MIC) determination was performed for amphotericin B, itraconazole, voriconazole and posaconazole.. Forty patients had invasive and 8 had non-invasive fungal sinusitis. Rhizopus and Aspergillus species which comprised 46.9% each of isolates were mostly associated with acute invasive fungal rhinosinusitis and chronic granulomatous fungal rhinosinusitis respectively. All patients with non-invasive fungal rhinosinusitis had Aspergillus isolates. The Geometric Mean (GM) MIC for R. arrhizus of amphotericin B and posaconazole was 0.51 mcg/mL and 3.08 mcg/mL respectively and for A. flavus species for amphotericin B and voriconazole values were 1.41mcg/mL and 0.35 mcg/mL respectively. In patients with Aspergillus infections, while there was no association of MICs for azoles and outcome (p = 1), a strong association was noted between azole therapy and a good outcome (p = 0.003). In patients with Rhizopus infections, no association was found between MICs for amphotericin B and outcome (p = 1) and because of therapeutic complications, no association was found between amphotericin B therapy and outcome (p = 1).. No significant association exists between in vitro (AFST) and in vivo responses despite low GM MICs for the drugs used in Aspergillus and Rhizopus infections. Therapeutic complications following conventional amphotericin B therapy confounds analysis. Clinical responses suggest that azoles are the drug of choice for Aspergillus infections.

Topics: Amphotericin B; Antifungal Agents; Aspergillosis; Aspergillus; Azoles; Humans; Itraconazole; Microbial Sensitivity Tests; Mucormycosis; Mycoses; Sinusitis; Triazoles; Voriconazole

At present, there is no consensus for optimal orbital infection management in invasive fungal rhinosinusitis patients. This is the first retrospective cohort study aimed to determine efficacy and side effects of the retrobulbar amphotericin B injection for orbital management in invasive fungal rhinosinusitis patients.. A retrospective chart review was conducted from 2005 to 2020. Thirty-six patients (forty-two orbits) diagnosed with invasive fungal rhinosinusitis with orbital invasion, treated with or without retrobulbar amphotericin B injection, were included in the study.. There were a total of 36 patients in the study, 12 patients received retrobulbar amphotericin B injection and 24 did not. There was no significant difference in orbital exenteration and death between two groups. Visual acuity change at the 3rd month was significantly better in the exposure group. There was a significant difference in the overall clinical outcome at 3rd month and 12th month. There was no report of severe side effects in all patients.. Retrobulbar amphotericin B injection showed significant efficacy in stabilizing or even improving visual acuity without any side effects. This procedure should be considered as adjunctive treatment.

Topics: Amphotericin B; Antifungal Agents; Humans; Orbit; Retrospective Studies; Sinusitis

Topics: Academic Medical Centers; Acute Disease; Adolescent; Adult; Aged; Aged, 80 and over; Amphotericin B; Child; Child, Preschool; Comorbidity; Early Diagnosis; Endoscopy; Female; Fungi; Humans; Male; Middle Aged; Mycoses; Retrospective Studies; Rhinitis; Sinusitis; United States; Young Adult

Topics: Amphotericin B; Combined Modality Therapy; Deoxycholic Acid; Diagnosis, Differential; Drug Combinations; Eye Enucleation; Eye Infections, Fungal; Female; Humans; Middle Aged; Orbital Diseases; Rare Diseases; Schizophyllum; Sinusitis

Schizophyllum commune, a basidiomycete fungus, is a quite rare cause of invasive sinusitis for which no standard treatment has yet been established. We report herein a 59-year-old woman who developed S. commune rhinosinusitis after remission induction chemotherapy for her acute myeloid leukemia. No causative microorganisms were identified in the sinus lavage fluid culture, whereas nucleotide sequencing of the internal transcribed spacer region using endoscopic sinus biopsy specimen could confirm the pathogen as S. commune. Liposomal amphotericin B and voriconazole (VRCZ) treatment ameliorated both her clinical symptoms and laboratory findings. The patient was successfully treated with allogeneic stem cell transplantation, under continuous VRCZ administration, without aggravation of S. commune sinusitis. Molecular diagnosis and prompt intervention with suitable antifungal drugs may be crucial to manage this rare infectious complication.

Topics: Amphotericin B; Antifungal Agents; Drug Therapy, Combination; Female; Hematopoietic Stem Cell Transplantation; Humans; Invasive Fungal Infections; Leukemia, Myeloid, Acute; Middle Aged; Molecular Diagnostic Techniques; Rhinitis; Schizophyllum; Sinusitis; Transplantation, Homologous; Treatment Outcome; Voriconazole

Invasive fungal infections are a life-threatening complication of cancer treatments, especially in hemato-oncological patients. Mucormycosis is the third leading cause of invasive fungal infections after Aspergillus and Candida infections. The first clinical symptoms are usually non-specific, which can lead to a late diagnosis and delayed therapy.. The objective of this report is to summarize data in the literature about mucormycosis and to present a case report of a patient with acute lymphoblastic leukemia, who developed this infection at our center. Risk factors for the development of mucormycosis, clinical symptoms, radiology, laboratory results, and outcome were retrospectively evaluated.. We describe a 6-years-old female patient with acute lymphoblastic leukemia. During the induction phase of therapy, the patient developed febrile neutropenia and did not respond to therapy with a combination of antibiotics and supportive treatment. Pansinusitis and orbitocellulitis developed. Examination of the biological material revealed that the etiological agent was a Rhizopus sp. The patient was treated with a combination of antimycotic drugs, but the infection disseminated to the central nervous system. She underwent radical surgical resection of the affected tissue. At this time, she is still under treatment with antimycotic and oncology agents, but is in remission of the main diagnosis and in good clinical condition.. Mucormycosis is an invasive fungal infection with high morbidity and mortality. Early diagnosis and initiation of effective therapy using a combination of amphotericin B administration and surgery are necessary to obtain a favorable outcome. The authors declare they have no potential conflicts of interest concerning drugs, products, or services used in the study. The Editorial Board declares that the manuscript met the ICMJE recommendation for biomedical papers.

Topics: Amphotericin B; Antifungal Agents; Antineoplastic Agents; Central Nervous System; Child; Female; Humans; Mucormycosis; Orbital Cellulitis; Precursor Cell Lymphoblastic Leukemia-Lymphoma; Rhizopus; Sinusitis

We describe an elderly diabetic patient presenting with sudden onset right-sided proptosis and vision loss secondary to rhino-orbital mucormycosis and central retinal vascular occlusion. He underwent orbital exenteration that was complicated by intraoperative cerebrospinal fluid (CSF) leak from lateral orbital wall. The leak was surgically repaired and the patient recovered well. We postulate the cause of the CSF leak to be twofold: necrotic periorbital tissue due to mucormycosis rendering the thin bones susceptible to damage and second, intraoperative manipulation and dissection at the orbital apex with monopolar cautery and instruments. We describe measures taken to successfully repair the CSF leak and the possible precautions that can be taken to avoid it.

Topics: Administration, Intravenous; Amphotericin B; Antifungal Agents; Blepharoptosis; Blindness; Cerebrospinal Fluid Leak; Debridement; Diabetes Mellitus, Type 2; Endoscopy; Humans; Hyphae; Intraoperative Complications; Magnetic Resonance Angiography; Male; Middle Aged; Mucormycosis; Orbit; Orbit Evisceration; Orbital Diseases; Paranasal Sinuses; Retinal Artery Occlusion; Sinusitis; Treatment Outcome

Mucormycosis is an aggressive, angioinvasive fungal infection with a predilection for the rhino-orbital cavity, predominantly in immunocompromised patients such as patients with uncontrolled diabetes. Prognosis is very poor, with a survival rate of 40% to 50%; therefore, early detection and initiation of treatment is paramount. Presenting symptoms are vague and mucormycosis is rare, so recognition, awareness, and knowledge of this infection are key to timely intervention and enhanced patient survival.

Topics: Adult; Amphotericin B; Antifungal Agents; Debridement; Dexamethasone; Diagnosis, Differential; Fluconazole; Humans; Immunocompromised Host; Immunosuppressive Agents; Interleukin 1 Receptor Antagonist Protein; Lymphohistiocytosis, Hemophagocytic; Male; Mucormycosis; Paranasal Sinuses; Prognosis; Sinusitis; Therapeutic Irrigation; Tomography, X-Ray Computed

Topics: Adult; Amphotericin B; Antifungal Agents; Cavernous Sinus Thrombosis; Debridement; Delayed Diagnosis; Diabetes Complications; Humans; Magnetic Resonance Imaging; Male; Mucormycosis; Ophthalmoplegia; Opportunistic Infections; Orbit Evisceration; Orbital Cellulitis; Sinusitis; Triazoles

To determine the effect of topical antifungal irrigation fluid containing amphotericin B on nasal polyp and their recurrence pattern, and to study the association of serum IgE in predicting the presence of fungus along with the nasal polyps.. An interventional study.. Dow University Hospital, Dow International Medical College, DUHS, Karachi, from June 2015 to June 2017.. All adult patients having nasal polyps, who had not undergone any previous nasal surgery, were included in the study. Patients aged under 18 years, history of granulomatous diseases, immunosuppression, invasive fungal sinusitis, and pregnant ladies were excluded from the study. The ratio was kept as 1:2; one receiving irrigation with amphotericin B and the other only saline nasal irrigation without the medicine. After surgery, the patients were divided into two groups; 58 patients were in the placebo group and 29 in the amphotericin group. Serum IgE levels were documented before and one month postoperative treatment. Serum IgE level of more than 250 ng/ml was taken as a high value. All the patients were followed for six months. Recurrence was defined as the recurrence of nasal symptoms and recurrence of mucosal thickening based on repeat CT scan. Frequency tables and cross tabulations using Chi-square test were performed with p-values of 0.05 taken as significant were performed on different variables.. A total of 87 patients were inducted. Overall 22 (25.3%) patients had recurrence of symptoms at six-month followup visit. Twelve (13.7%) of these were in the placebo group and 10 (11.5%) were in the amphotericin B nasal irrigation group. Serum IgE level preoperatively ranged between 52 - 9344 ng/dl; postoperatively it ranged from 13-1050 ng/dl. When pre and postoperative serum IgE level were compared with each other and CT scan scores, using Chi-square test, the difference was significant (p<0.001).. Amphotericin B improved the CT scan score of the patients. The nasal irrigation of amphotericin B did not show significant change in the recurrence pattern of chronic sinuses with polyps. Serum IgE can be used as marker for the presence and response to treatment for non-invasive fungal sinusitis.

Topics: Adolescent; Adult; Aged; Amphotericin B; Antifungal Agents; Biomarkers; Chronic Disease; Endoscopy; Female; Humans; Immunoglobulin E; Male; Middle Aged; Nasal Lavage; Nasal Polyps; Recurrence; Rhinitis; Sinusitis; Tomography, X-Ray Computed

We report the clinical and radiological features as well as outcomes of invasive fungal rhinosinusitis in patients with diabetes from a tertiary care center in North India.. All patients admitted with a diagnosis of invasive fungal rhinosinusitis with pre-existing or newly diagnosed diabetes from 1st January 2008 to 31st December 2015 were included. Hospital records were used to identify clinical features, biochemical investigations and treatment modalities used. The imaging findings were reported at baseline, 30, 60,90 and 120 days of admission and progression of disease was reported as static, worse or improved. The outcomes were sight loss and survival at end of hospital stay.. 22 patients of invasive fungal sinusitis and diabetes were identified. At presentation, 5 had ketoacidosis, all of whom died at the end of hospital stay. Loss of vision in one eye was seen in 70% cases. The survival at end of hospital stay was 72.7% and at six months after end of study period was 57.8%. No patients had radiological improvement at day 30 imaging (including those who subsequently improved).. Radiological improvement is not apparent before two months of therapy. Ketoacidosis is a predictor of mortality in invasive fungal sinusitis with diabetes.

Topics: Adolescent; Adult; Aged; Amphotericin B; Antifungal Agents; Diabetes Mellitus, Type 1; Diabetes Mellitus, Type 2; Female; Humans; India; Invasive Fungal Infections; Male; Middle Aged; Mortality; Rhinitis; Sinusitis; Young Adult

Central nervous system (CNS) infections due to filamentous basidiomycetes are extremely rare. We encountered a case of epidural abscess due to Schizophyllum commune that extended from sinusitis. A 53-year-old Japanese man presented at our hospital with a headache. Computed tomography (CT) of the cranium and sinuses showed ethmoid and sphenoid sinusitis with no intracranial abnormalities. The patient was diagnosed with acute sinusitis and underwent antibiotic treatment. However, the symptoms deteriorated, and the patient came to our hospital again with consciousness disturbance. CT scan of the cranium and sinuses showed no improvement of sinusitis after antibiotic therapy and an epidural abscess emerged in the middle cranial fossa. Therefore, emergency craniotomy and endoscopic sinus fenestration were performed. Filamentous fungal elements were observed in both rhinorrhoea and epidural abscess. The symptoms improved after the operation and administration of liposomal amphotericin B. The clinical isolate was identified as S. commune by a molecular-based method. To our knowledge, this is the first report of epidural abscess due to this fungus. Although rare, clinicians should be aware that S. commune could be a causative agent of CNS infections.

Topics: Amphotericin B; Anti-Bacterial Agents; Epidural Abscess; Humans; Male; Middle Aged; Mycoses; Paranasal Sinuses; Schizophyllum; Sinusitis; Skull; Tomography Scanners, X-Ray Computed; Treatment Outcome

Invasive fusariosis has a high mortality and is predominantly observed in patients with leukemia. We report the first case of a novel species of Fusarium, Fusarium riograndense sp. nov, isolated from a lesion in the nasal cavity lesion of a patient with acute lymphoblastic leukemia. The etiological agent was identified by Multilocus Sequencing Typing (MLST), including RPB2, TEF-1α, and ITS-LSU sequences, the gold standard technique to identify new species of Fusarium. MLST and phenotypic data strongly supported its inclusion in the F. solani species complex (FSSC). The new species produced a red pigment in the Sabouraud Dextrose Agar similar to other members of the complex. The macroconiodia developed from phialides on multibranched conidiophores which merge to form effuse sporodochia with a basal foot-cell instead of papilla in basal cell shape. The microconidia were ellipsoidal, 0-1-septated, produced from long monophialides. Chlamydospores were produced singly or in pairs. Amphotericin B (MIC 1μg/mL) was the most active drug, followed by voriconazole (MIC 8μg/mL). The patient was successfully treated with voriconazole. Our findings indicate another lineage within FSSC capable causing of invasive human infection.

Topics: Amphotericin B; Antifungal Agents; Child; Fusariosis; Fusarium; Humans; Male; Microbial Sensitivity Tests; Multilocus Sequence Typing; Nose; Phylogeny; Rhinitis; Sequence Analysis, DNA; Sinusitis; Spores, Fungal

Mucormycosis is a rare but fulminant opportunistic fungal infection, which occurs most often in diabetic and immunocompromised patients. Dental extractions may create a portal of entry for the fungal infection. The mucormycosis may be the original cause of the pain and can be misdiagnosed as dental pain. In this paper, two cases of mucormycosis are reported after dental extractions and successfully treated with amphotericin B (case #1) and combined with posaconazole (case #2). The two cases we describe exemplify the fulminant mucormycosis of maxillary sinuses after dental extraction inpatients with uncontrolled diabetic support the findings that this predisposing condition created a suitable environment for the Mucorales growth. These case reports emphasize early recognition and urgent treatment of mucormycosis is necessary to prevent the spread of infection Therefore, dental surgeons and healthcare practitioners should become familiar with mucormycosis.

Topics: Adult; Amphotericin B; Antifungal Agents; Diabetes Complications; Diabetes Mellitus; Female; Humans; Immunocompromised Host; Male; Maxillary Sinus; Middle Aged; Mucorales; Mucormycosis; Opportunistic Infections; Sinusitis; Tooth Extraction; Treatment Outcome; Triazoles

Acanthamoeba infections are rare and mostly occur in immunocompromised patients. Most of the reported cases after stem cell transplantation have been diagnosed postmortem. We present the case of a 3-year-old boy with chronic graft versus host disease post hematopoietic transplantation, who was successfully treated for Acanthamoeba.

Topics: Acanthamoeba; Amebiasis; Amebicides; Amphotericin B; Child, Preschool; Graft vs Host Disease; Hematopoietic Stem Cell Transplantation; Humans; Male; Nasal Mucosa; Sinusitis

Topics: Amphotericin B; Antifungal Agents; Child; Child, Preschool; Debridement; Deoxycholic Acid; Diabetes Mellitus, Type 1; Drug Combinations; Humans; Mucormycosis; Rhinitis; Sinusitis

The treatment of chronic granulomatous fungal sinusitis (CGFS), a rare form of invasive fungal sinusitis, is controversial.. To assess the response to postoperative antifungal therapy in patients with CGFS and suggest an effective treatment protocol.. Clinical records of patients with CGFS who had undergone excisive surgery followed by antifungal therapy were reviewed to assess current disease status.. Fourteen male and 4 female patients were diagnosed with CGFS, based on typical histopathological and fungal smear/ culture results. Aspergillus flavus was isolated from 88.9% cases. Stage 1 patients had resectable sinonasal disease, stage 2 had additional spread to orbit/palate and stage 3 had extensive disease. Follow-up ranged from 6 months to 8 years. Residual disease was seen in all but one patient who received amphotericin B as first line therapy and in none of those who received itraconazole or voriconazole. Even those who received azoles as second line therapy were disease free at last follow-up.. Surgery followed by itraconazole or voriconazole for Stage 1 and 2 disease and voriconazole for stage 3 disease is recommended for a good outcome. Amphotericin B is not recommended as first line therapy for CGFS.

Topics: Adult; Aged; Amphotericin B; Antifungal Agents; Chronic Disease; Combined Modality Therapy; Female; Granuloma; Humans; Itraconazole; Male; Middle Aged; Mycoses; Sinusitis; Treatment Outcome; Voriconazole

Topics: Adolescent; Amphotericin B; Antifungal Agents; Ascomycota; Benzenesulfonates; Brain Abscess; Central Nervous System Fungal Infections; Chronic Disease; Coloring Agents; Debridement; Epidural Abscess; Frontal Lobe; Frontal Sinus; Humans; Lactic Acid; Male; Phenols; Pyrimidines; Sinusitis; Treatment Outcome; Triazoles; Voriconazole

Chronic granulomatous invasive fungal sinusitis (CGIFS) is rare and a consensus on ideal management is lacking. We present an extensive case managed successfully with a conservative approach.. Case report and literature review.. The patient presented with unilateral proptosis, papilledema, and headache. Imaging revealed an infiltrative process with extensive intracranial and intraorbital involvement. Biopsy showed fungal elements and granulomatous reaction consistent with CGIFS. The patient was managed with conservative surgery and long-term oral voriconazole.. This case supports a conservative surgical approach in some patients with extensive CGIFS. Oral voriconazole is effective and has significant advantages over more toxic agents administered intravenously.

Topics: Adult; Amphotericin B; Antifungal Agents; Aspergillosis; Aspergillus fumigatus; Chronic Disease; Granuloma; Humans; Male; Pyrimidines; Sinusitis; Triazoles; Voriconazole

Topics: Amphotericin B; Antifungal Agents; Blepharoptosis; Cellulitis; Diabetes Complications; Diagnosis, Differential; Enterobacter aerogenes; Enterobacteriaceae Infections; Humans; Male; Middle Aged; Mucormycosis; Necrosis; Ophthalmoplegia; Orbit; Orbital Diseases; Rhizopus; Sinusitis; Vision Disorders; Visual Acuity; Zygomycosis

To report the clinical characteristics and treatment outcomes of indolent paranasal mucormycosis in immunocompetent individuals.. A retrospective review of four immunocompetent patients with indolent mucormycosis of the paranasal sinus managed by endoscopic sinus surgery only was performed. One year of regular follow up comprised angled endoscopy and repeated paranasal sinus computed tomography three months after surgery.. Clinical symptoms were non-specific. Pre-operative paranasal sinus computed tomography showed opacification of the unilateral maxillary sinus with focal calcification but without bony destruction or extension to the orbit or cranium. All patients underwent endoscopic sinus surgery without administration of antifungal agents. There was no recurrence on regular clinical and radiological follow up.. For indolent paranasal mucormycosis in immunocompetent patients, endoscopic sinus surgery can be the treatment of choice, and the administration of antifungal drugs may not be necessary.

Topics: Aged; Amphotericin B; Antifungal Agents; Endoscopy; Female; Humans; Immunocompetence; Male; Middle Aged; Mucormycosis; Paranasal Sinuses; Retrospective Studies; Sinusitis; Surgical Procedures, Operative; Tomography, X-Ray Computed; Treatment Outcome

Sinonasal polyposis is considered to be the end-result of a chronic inflammatory process in the sinonasal mucosa. Its underlying mechanisms are still unclear, but the involvement of fungi has been suggested for many years. In the present study, we retrospectively evaluated the clinical and mycological profile of 161 patients with chronic rhinosinusitis (CRS) and nasal polyps who were undergoing surgery at our tertiary care facility during 2002 to 2010. CT scan findings and per-operative presence of allergic mucin were provisionally suggestive of fungal rhinosinusitis (FRS) in all the patients. Total serum IgE and peripheral eosinophilia were noted. Histological examination of polyp tissue showed eosinophilic mucin in 100% of the cases and the incidence of allergic fungal rhinosinusitis (AFRS) was 83.9% in the patient population. KOH and/or culture were positive for fungal hyphae or yeast in 93% (150/161) of the patients. Aspergillus spp. were the most commonly recovered isolates (70%). MICs of all A. flavus and A. fumigatus isolates were within the susceptible zone for itraconazole, voriconazole, and amphoterecin B. In conclusion, allergic fungal rhinosinusitis (FRS) is a common disorder in patients with sinonasal polyposis and due to its recurrent and intractable nature, a high degree of clinical suspicion for the presence of FRS in nasal polyposis should be considered.

Topics: Adult; Amphotericin B; Antifungal Agents; Aspergillosis; Chronic Disease; Female; Fungi; Humans; Immunoglobulin E; Incidence; India; Itraconazole; Male; Middle Aged; Mucins; Mycoses; Nasal Polyps; Pyrimidines; Retrospective Studies; Rhinitis, Allergic, Perennial; Sinusitis; Tertiary Healthcare; Tomography, X-Ray Computed; Triazoles; Voriconazole

Topics: Adolescent; Adult; Amphotericin B; Antifungal Agents; Brain Diseases; Central Nervous System Fungal Infections; Combined Modality Therapy; Debridement; Diabetes Complications; Early Diagnosis; Endoscopy; Fatal Outcome; Female; Humans; Male; Maxillary Sinus; Middle Aged; Mucormycosis; Nose Diseases; Opportunistic Infections; Oroantral Fistula; Paranasal Sinus Diseases; Precursor Cell Lymphoblastic Leukemia-Lymphoma; Pregnancy; Pregnancy Complications, Infectious; Sinusitis; Zygomycosis

The objective of this investigation was to explore the possibility of treating patients harboring invasive intracranial aspergillosis (InIA) at an early stage. Nineteen patients (age range 18-42 years) from a total of 114 cases of InIA seen from January 1999- December 2009 were included in this investigation. These individuals, all of whom had a past history of treated allergic fungal sinusitis (AFS) were evaluated as to their immune status, clinical presentations, time-intervals and radiological findings. Past records of seven patients indicated skull base erosion and extension of the paranasal (PNS) masses into intracranial cavity, but none had neurological deficits or symptoms suggestive of raised intracranial pressure. All 19 patients had undergone endoscopic clearance of PNS during their first presentations. Both AFS and InIA were found simultaneously in seven patients, while the time-interval between the two forms was as long as 10 years for two patients. Overall mortality was (8/19; 42%) with all deaths attributable to fungal meningo-encephalitis. As InIA carries a high mortality rate, it seems prudent to evaluate and treat these patients early in the course of their illness. The appearance of the invasive form of the disease in patients with a past history of AFS is not uncommon. The allergic form of disease may not be considered as a separate entity from InIA as both the pathologies may exist in same patient.

Topics: Adolescent; Adult; Amphotericin B; Antifungal Agents; Aspergillosis; Aspergillus flavus; Cohort Studies; Encephalitis; Female; Humans; Hypersensitivity; Itraconazole; Male; Meningitis, Fungal; Sinusitis; Skull; Tomography, X-Ray Computed

Topics: Adolescent; Amphotericin B; Antifungal Agents; Cellulitis; Cranial Nerve Diseases; Delayed Diagnosis; Diabetes Complications; Disease Progression; Disease Susceptibility; Encephalitis; Fatal Outcome; Female; Fungemia; Humans; Male; Middle Aged; Mucormycosis; Multiple Organ Failure; Opportunistic Infections; Sinusitis; Vision Disorders

Aspergillosis and zygomycosis are life-threatening fungal infections in immunocompromised patients. We report a heart transplant recipient with an early pulmonary invasive aspergillosis successfully treated with association of voriconazole and caspofungin. Zygomycosis sinusitis, which was diagnosed while he still was on voriconazole therapy, was successfully treated with the use of combination antifungal therapy including liposomal amphotericin plus posaconazole and conservative surgical debridement.

Topics: Amphotericin B; Antifungal Agents; Debridement; Drug Therapy, Combination; Heart Transplantation; Humans; Immunocompromised Host; Invasive Pulmonary Aspergillosis; Male; Middle Aged; Pyrimidines; Sinusitis; Treatment Outcome; Triazoles; Voriconazole; Zygomycosis

Mucormycosis is an invasive fungal infection usually observed in immunocompromised patients. Mucormycosis is rapidly fatal without an early diagnosis and treatment. We report five patients of rhino-orbital-cerebral mucormycosis and a literature review.. The medical records of five patients presenting with rhino-orbital-cerebral mucormycosis, admitted between January 1995 and December 2007, were analyzed. All patients underwent tissue biopsy. The histologic sections revealed the presence of non-septate hyphae of the order Mucorales.. The five patients, three men and two women, between 27 and 61 years of age, were all diabetic. The main symptoms were exophthalmia (five patients), facial swelling (four patients), periorbital cellulitis (four patients), and cranial nerve palsy (four patients). Anterior rhinoscopy revealed palatine or nasal necrotic lesions in four patients. All presented with diabetic ketoacidosis and CT scan revealed rhino-orbital-cerebral involvement in every patient. All patients were given intravenous amphotericin B. Four patients underwent surgical debridement of necrotic tissue. Two patients survived.. Mucormycosis is usually a fatal infection in diabetic patients. Early diagnosis should be based on imaging data and histology. Amphotericin B must be rapidly initiated and associated with aggressive surgical debridement to reduce mortality.

Topics: Acute Kidney Injury; Adult; Aged; Amphotericin B; Antifungal Agents; Biopsy; Cavernous Sinus Thrombosis; Combined Modality Therapy; Cranial Nerve Diseases; Debridement; Diabetes Complications; Diabetic Ketoacidosis; Disease Susceptibility; Drug Substitution; Encephalitis; Exophthalmos; Female; Humans; Ketoconazole; Male; Middle Aged; Mucorales; Mucormycosis; Orbital Cellulitis; Retrospective Studies; Rhinitis; Sinusitis; Tomography, X-Ray Computed

A 3-yr-old female koala (Phascolarctos cinereus) was diagnosed with a nasal sinus granuloma caused by Cryptococcus gattii after a pre-shipment examination revealed a latex cryptococcal agglutination titer of 1:512. Successful medical and surgical treatment of the granuloma was monitored using serial latex cryptococcal agglutination titers, serum levels of antifungal drugs, and advanced imaging.

Topics: Amphotericin B; Animals; Antifungal Agents; Cryptococcosis; Cryptococcus gattii; Female; Fluconazole; Granuloma; Itraconazole; Phascolarctidae; Sinusitis

Topics: Administration, Topical; Amphotericin B; Biomarkers; Humans; Inflammation; Multicenter Studies as Topic; Randomized Controlled Trials as Topic; Sinusitis

Topics: Adolescent; Alternaria; Amphotericin B; Antifungal Agents; Child, Preschool; Female; Humans; Leukemia, Myeloid, Acute; Male; Mycoses; Pyrimidines; Sinusitis; Triazoles; Voriconazole

Topics: Amphotericin B; Anti-Bacterial Agents; Antifungal Agents; Antineoplastic Combined Chemotherapy Protocols; Combined Modality Therapy; Cytarabine; Digestive System Surgical Procedures; Enterococcus faecium; Fatal Outcome; Female; Gram-Positive Bacterial Infections; Humans; Idarubicin; Leukemia, Myeloid, Acute; Middle Aged; Mucormycosis; Neutropenia; Rhinitis; Shock, Septic; Sinusitis; Typhlitis

Rhino-orbital-cerebral disease is a significant manifestation of zygomycosis in solid organ transplant (SOT) recipients. However, its characteristics and outcome are not well addressed.. SOT recipients with zygomycosis as per the European Organization for Research and Treatment in Cancer and the Mycoses Study Group criteria in a cohort study at our centers published previously and those identified with a PubMed search from the 1950s to November 2009 were studied. Patients with mycosis involving the sinuses, orbits, or central nervous system (CNS) were included.. Patients comprised a total of 90 SOT recipients with rhino-orbital-cerebral zygomycosis, including 13 in our cohort and 77 in the literature. CNS disease occurred in 57% (51 of 90). Overall mortality was 52.3% (46 of 88), and the mortality in patients with CNS disease was 73.5% (36 of 49). In logistic regression analysis, older age (odds ratio [OR] 1.12, 95% confidence interval [CI] 1.04-1.21, P=0.002) was associated with a higher mortality rate, whereas lipid formulations of amphotericin B compared with amphotericin B deoxycholate (OR 0.09, 95% CI 0.02-0.50, P=0.006) and surgery (OR 0.12, 95% CI 0.01-0.94, P=0.043) were independently associated with an improved survival even when controlled for CNS involvement and the era of diagnosis of disease.. Rhino-orbital-cerebral zygomycosis, particularly CNS disease, is associated with substantial mortality rate in SOT recipients. Older age is a significant risk factor for mortality, whereas lipid formulations of amphotericin B and surgery improved outcomes.

Topics: Adult; Aged; Amphotericin B; Antifungal Agents; Brain Diseases; Cohort Studies; Debridement; Female; Humans; Kidney Transplantation; Liver Transplantation; Male; Middle Aged; Mycoses; Organ Transplantation; Regression Analysis; Sinusitis; Zygomycosis

Scytalidium dimidiatum is mainly responsible for human skin and nail infections but the mould has also been reported for invasive infections in immunocompromised individuals. We report a young immunocompetent individual diagnosed with invasive non-traumatic Scytalidium dimidiatum infection involving the left orbital cavity and maxillary sinus.

Topics: Amphotericin B; Antifungal Agents; Ascomycota; Diagnosis, Differential; Exophthalmos; Humans; Immunocompetence; Magnetic Resonance Imaging; Male; Mycoses; Sinusitis; Tomography, X-Ray Computed; Young Adult

Topics: Adolescent; Amphotericin B; Antineoplastic Agents; Humans; Itraconazole; Male; Mucormycosis; Precursor Cell Lymphoblastic Leukemia-Lymphoma; Sinusitis; Treatment Outcome

The role of fungi in chronic rhinosinusitis (CRS) is not clear. Fungi can be detected in the nose and paranasal sinuses of virtually all CRS patients; however, they also appear to be present in healthy controls. Various theories attempt to explain the mechanisms by which fungi can exert an effect on sinus mucosa in susceptible individuals. Further studies are necessary to clarify the role of fungi in CRS, which fungal organisms (if any) are pathogenic, and what exactly characterizes the immunologic response to fungi that may result in the development of disease. However, in the absence of convincing immunologic data and evidence of clinical improvement of CRS after antifungal therapy, the case against the fungus remains unproven.

Topics: Amphotericin B; Antifungal Agents; Antimicrobial Cationic Peptides; Chronic Disease; Cytokines; Fungi; Humans; Hyperplasia; Hypersensitivity; Immunotherapy; Mycoses; Pulmonary Surfactant-Associated Protein D; Sinusitis

Topics: Adolescent; Amphotericin B; Antifungal Agents; Antineoplastic Combined Chemotherapy Protocols; Aspergillosis; Aspergillus flavus; Caspofungin; Combined Modality Therapy; Debridement; Drug Therapy, Combination; Echinocandins; Female; Granulocyte Colony-Stimulating Factor; Humans; Immunocompromised Host; Lipopeptides; Neutropenia; Precursor Cell Lymphoblastic Leukemia-Lymphoma; Sinusitis

Chronic rhinosinusitis (CRS) is an inflammatory disease with a multifactorial etiology. Antifungal therapy is not routinely used to treat it. However, evidence implicating fungi in some forms of CRS recently has been published. Controversy exists as to whether fungi identified in sinonasal cultures are always pathogenic. Immunologic evidence supporting the role of fungi in the pathogenesis of CRS is also debated. Topical antifungal therapy is more widely used than oral therapy, with amphotericin B irrigation being the most common. Although some studies show benefit from this irrigation, others refute the efficacy. Although oral antifungal agents are used uncommonly, itraconazole is the most commonly used drug. The efficacy of oral itraconazole in CRS has never been assessed in a clinical trial. Given the current evidence, the use of antifungals to treat CRS is controversial and has limited indications.

Topics: Administration, Intranasal; Administration, Oral; Administration, Topical; Amphotericin B; Antifungal Agents; Chronic Disease; Humans; Itraconazole; Mycoses; Rhinitis; Sinusitis

Rhinocerebral mucormycosis is an invasive fungal sinusitis with a high mortality rate, especially in immunocompromised patients. A 70-year-old woman, with uncontrolled type 2 diabetes mellitus, presented with a one-month history of non-specific headaches associated with progressive swelling of her left eye. Computed tomography of the brain and orbits showed the extensive involvement of bilateral intranasal sinuses, orbits, extraocular muscle and soft tissues. The diagnosis of invasive mucormycosis was confirmed from a tissue biopsy taken from the internasal septum. Despite the extensive mucormycosis invasion, she was successfully treated with intranasal and systemic amphotericin B and minimal adjunctive intranasal sphenoidotomy.

Topics: Aged; Amphotericin B; Antifungal Agents; Diabetes Mellitus, Type 2; Female; Humans; Mucormycosis; Nose Diseases; Orbital Diseases; Sinusitis

A case of chronic invasive rhinosinusitis in an apparently healthy man, caused by Fusarium verticillioides, is described. The identity of the isolate as F. verticillioides was established by demonstrating characteristic morphological features and by amplification of rDNA using species-specific primers. Surgical debridement of the infected nasal tissue and therapy with amphotericin B resulted in a favorable outcome. To the best of our knowledge, F. verticillioides has not been described previously to cause this condition.

Topics: Amphotericin B; Antifungal Agents; DNA, Fungal; DNA, Ribosomal; Fusarium; Humans; Male; Middle Aged; Mycoses; Polymerase Chain Reaction; Rhinitis; Sinusitis

Fungal infections are rare but represent serious complications following organ transplantation. We present a case of mucormycosis primarily affecting the paranasal sinuses in a 51-year-old man with a kidney allograft. The patient presented with headache, left facial and orbital pain, nasal discharge, and elevation of serum creatinine 18 months after kidney transplantation. Laboratory tests revealed cyclosporine nephrotoxicity, cytomegalovirus infection, and prediabetes. Imaging findings were compatible with left maxillary, ethmoidal, and sphenoidal sinusitis. Diagnosis was made based on pathologic findings and detection of typical fungal hyphea in the infected tissues. The patient was successfully treated by discontinuation of cyclosporine and mycophenolate mofetil, initiation of systemic amphotericin B, and aggressive surgical debridement.

Topics: Amphotericin B; Antifungal Agents; Cyclosporine; Humans; Immunocompromised Host; Immunosuppressive Agents; Kidney Transplantation; Male; Middle Aged; Mucormycosis; Sinusitis; Tooth Extraction

Topics: Administration, Intranasal; Amphotericin B; Antifungal Agents; Humans; Research Design; Rhinitis; Sinusitis; Therapeutic Irrigation

Invasive fungal rhinosinusitis (IFR) is a life-threatening infection. Its onset is subtle and a late diagnosis leads to severe complications. Death may occur within a few weeks notwithstanding treatment. We describe a comprehensive pre- and post-operative approach to care for haematological patients with IFR. Five haematological patients with IFR were treated with systemic antifungal therapy and endoscopic surgical debridement of infected tissues, followed by amphotericin-B directly instilled in the sinuses by a new type of ethmoidal drainage. The IFR remitted in all cases; after 32 months of follow-up, three patients are still alive, and two have died of other causes. Two of the patients who experienced IFR progression to the brain at the IFR onset are still alive. The pharmacological and surgical approach with the post-operative local therapy by a new ethmoidal drainage system could support radical antifungal sinus treatment, thus improving the overall survival.

Topics: Acute Disease; Adult; Aged; Amphotericin B; Antifungal Agents; Antineoplastic Combined Chemotherapy Protocols; Aspergillosis; Chronic Disease; Female; Humans; Immunocompromised Host; Leukemia, Myeloid; Male; Middle Aged; Myeloproliferative Disorders; Precursor Cell Lymphoblastic Leukemia-Lymphoma; Sinusitis; Stem Cell Transplantation

Rhinocerebral mucormycosis is a rapidly progressive and often fatal infection frequently seen in patients with uncontrolled diabetes mellitus and hematologic malignancies. The disease is difficult to diagnose because it often masquerades as bacterial sinusitis. The current report describes a 69-year-old white woman with diabetes mellitus who was prescribed high-dose prednisone therapy for chronic obstructive pulmonary disease. Two weeks after treatment initiation, she presented to the hospital with facial edema on the right side, mouth pain, and general weakness. No black eschars on the nasal mucosae or palates were present on admission. Although bacterial etiology was initially suspected, surgery and tissue samples revealed the presence of rhinocerebral mucormycosis. The patient died at 6 days postadmission despite aggressive medical and surgical intervention. The current report discusses the risk factors associated with rhinocerebral mucormycosis as well as the necessity of early diagnosis and treatment to improve patient outcomes.

Topics: Aged; Amphotericin B; Antifungal Agents; Brain Diseases; Comorbidity; Diabetes Mellitus; Disease Progression; Edema; Fatal Outcome; Female; Glucocorticoids; Humans; Immunocompromised Host; Kidney Failure, Chronic; Mucormycosis; Prednisone; Pulmonary Disease, Chronic Obstructive; Risk Factors; Sinusitis

Invasive fungal rhinosinusitis, a rare infection, is a life threatening disease. Delay in diagnosis may consequently lead to high morbidity and mortality.. Encourage early detection and proper management of invasive fungal rhinosinusitis.. Medical records, radiological, and pathological reports of five patients who were diagnosed as invasive fungal rhinosinusitis were reviewed retrospectively.. Four in five cases of invasive fungal rhinosinusitis, confirmed by pathological study, had successful treatment. One patient had intracerebral hemorrhage that may be associated with the disease spreading. Disease extension was evaluated by CT paranasal sinus in all cases, but it usually did not have classic bony erosion.. Curing infection, correcting underlying conditions, and working up fungal infection should be carried out as early as possible, because morbidity and mortality depend on disease extension and host status.

Topics: Adult; Aged; Amphotericin B; Antifungal Agents; Female; Humans; Itraconazole; Male; Middle Aged; Mycoses; Retrospective Studies; Rhinitis; Sinusitis; Thailand; Time Factors

Invasive fungal sinusitis of the paranasal sinuses in a healthy immunocompetent person is uncommon. Isolated involvement of any paranasal sinus, particularly sphenoid sinus is rare. In this study, five immunocompetent patients who had no nasal complaints but obscure symptoms of headache and orbital symptoms such as diplopia, retro-orbital pain and loss of vision were diagnosed to be having fulminant fungal sinusitis of the sphenoid sinus. Three patients had aspergillosis and two patients had mucormycosis. These patients initially presented to neurologists and ophthalmologists because they had no ENT complaints. The diagnosis was made on endoscopy, radiology and histopathology. They were treated aggressively according to the standard protocols. The purpose of this paper is to bring to light the changing clinical spectrum of invasive fungal sinusitis. It can occur in immunocompetent patients and in the form of isolated sphenoid sinus involvement.

Topics: Adolescent; Adult; Aged; Amphotericin B; Antifungal Agents; Aspergillosis; Diplopia; Endoscopy; Fatal Outcome; Female; Headache; Humans; Immunocompetence; Magnetic Resonance Imaging; Male; Mucormycosis; Sinusitis; Sphenoid Sinus; Tomography, X-Ray Computed; Vision Disorders

Zygomycosis is a highly aggressive infection observed in immunocompromised patients, such as those with haematological malignancies. The sites most frequently involved are the sinuses and the lungs. New diagnostic tools and new antifungal treatments are essential in order to diagnose early and treat efficiently infections due to moulds. We report a case of sinusitis due to Absidia corymbifera occurring during chemotherapy-induced bone marrow aplasia in a patient with acute leukaemia. The sinusitis was successfully treated with AmBisome, and surgical debridement.

Topics: Absidia; Acute Disease; Aerosols; Amphotericin B; Amsacrine; Antibiotic Prophylaxis; Antifungal Agents; Antineoplastic Combined Chemotherapy Protocols; Combined Modality Therapy; Cytarabine; Daunorubicin; Debridement; Drug Resistance, Fungal; Drug Resistance, Neoplasm; Etoposide; Fluconazole; Humans; Immunocompromised Host; Leukemia; Liposomes; Middle Aged; Mucormycosis; Sinusitis; Tomography, X-Ray Computed

This report describes the case of fungal sinusitis in severely immunocompromised 32-year-old male with common-type acute lymphoblastic leukemia who relapsed after autologous peripheral blood transplantation. Empirical therapy with antibiotics and conventional amphotericin B failed to resolve the infection. Following therapy with AmBisome his symptoms abated and significantly improved scan picture was seen.

Topics: Adult; Amphotericin B; Anti-Infective Agents; Antifungal Agents; Antineoplastic Combined Chemotherapy Protocols; Bacterial Infections; Combined Modality Therapy; Cytarabine; Cytomegalovirus Infections; Enterococcus faecalis; Fatal Outcome; Humans; Idarubicin; Immunocompromised Host; Immunoglobulins, Intravenous; Liposomes; Male; Mycoses; Peripheral Blood Stem Cell Transplantation; Pneumonia; Postoperative Complications; Precursor B-Cell Lymphoblastic Leukemia-Lymphoma; Pseudomonas putida; Pulmonary Edema; Pyrimidines; Sinusitis; Staphylococcus epidermidis; Transplantation, Autologous; Triazoles; Voriconazole

We report on a 10-year-old girl with severe aplastic anaemia who developed rhinocerebral infection caused by Absidia corymbifera and a possible co-infection caused by Alternaria alternata. Despite prolonged neutropenia, therapy with liposomal amphotericin B and posaconazole improved the clinical condition. Subsequently, the girl underwent allogeneic haematopoietic stem cell transplantation (HSCT) for the underlying disease, but the fungal infection remained under control with the antifungal treatment. No severe side effect of the antifungal drugs was noted. Unfortunately, the girl died 5 months after HSCT due to disseminated adenovirus infection.

Topics: Absidia; Alternaria; Amphotericin B; Anemia, Aplastic; Antifungal Agents; Central Nervous System Fungal Infections; Child; Female; Humans; Radiography; Sinusitis; Stem Cell Transplantation; Telencephalon; Transplantation, Homologous; Triazoles; Zygomycosis

Mucormycosis of the nasal cavity and paranasal sinuses is an uncommon opportunistic fungal infection, which often has an aggressive, life-threatening course. Patients who have this condition are generally diabetic or immunosuppressed. However, mucormycosis can also occur in immunocompetent individuals. The most effective treatment consists of reversal of the source of immunocompromise, immediate surgical debridement and administration of systemic amphotericin B. No consensus has been reached regarding the appropriate surgical treatment or the total dose of amphotericin B. We present the case of a patient suffering from localized bilateral paranasal mucormycosis who was treated by means of endoscopic sinus surgery and administration of systemic amphotericin B. We suggest that endoscopic sinus surgery is the choice of treatment for localized paranasal mucormycosis in an immunocompetent patient, and that the total dose of amphotericin B can be determined by the extent of disease and the postoperative endoscopic findings.

Topics: Aged; Amphotericin B; Antifungal Agents; Endoscopy; Humans; Immunocompetence; Male; Mucormycosis; Sinusitis

Fungal sinusitis caused by invasive fungal infections, such as Mucormycosis, occurs predominantly in an immunocompromised patient. However, invasive cranial bone mycoses are rare and are usually associated with host immunodeficiency. They are difficult to diagnose, and in many cases are fatal. Treatment consists of antifungal chemotherapy, radical surgical debridement, and control of the underlying immunological condition. We report a case of Mucormycosis in a patient with type 1 diabetes mellitus. The patient had a history of dental pathology and associated renal dysfunction. The patient was managed by extensive surgical debridement followed by amphotericin B lipid complex injection (Abelcet 5 mg/bw kg/day) as an antifungal agent. Our patient's ocular function was affected. The radical treatment and follow-up by a multidisciplinary team eliminated the mucor-related consequences, however, the patient died because of end-stage renal failure. In conclusion, type 1 diabetes may be associated with invasive fungal sinusitis.

Topics: Adult; Amphotericin B; Antifungal Agents; Diabetes Mellitus, Type 1; Diabetic Nephropathies; Diagnosis, Differential; Humans; Male; Mucormycosis; Sinusitis; Tomography, X-Ray Computed

This case report describes craniofacial zygomycosis in a 24-year-old male with Hodgkin's disease who underwent chemotherapy and autologous hematopoietic stem cell transplantation, followed by a nonmyeloablative allogeneic transplant. Empirical therapy with itraconazole and amoxicillin-clavulanate failed to resolve the infection. Postdiagnosis, surgery and treatment with high-dose liposomal amphotericin B eradicated the disease.

Topics: Adult; Amphotericin B; Antifungal Agents; Facial Pain; Hematopoietic Stem Cell Transplantation; Hodgkin Disease; Humans; Liposomes; Male; Mucormycosis; Rhizopus; Sinusitis; Transplantation, Homologous

The case of extensive, invasive fungal sinusitis in 72 years old man was presented in this paper. The surgical treatment was performed in this patient--rightsided maxillectomy with orbitotomy. Results of histological and mycological examinations of postoperative material shoved evidence of Aspergillus Fumigatus. The additional pharmacotherapy with Amphotericin B and Orungal was attached. Despite of such aggressive treatment patient died 9 months after the last operation.

Topics: Aged; Amphotericin B; Antifungal Agents; Aspergillosis; Aspergillus fumigatus; Chronic Disease; Humans; Male; Sinusitis; Treatment Outcome

Acanthamoeba infection is a rare, difficult-to-treat, and often fatal, opportunistic parasitic infection in immunocompromised hosts, such as patients infected with HIV. We describe an aggressive nasal and sinus infection by Acanthamoeba spp. in a person with AIDS. The resolution of this Acanthamoeba infection was secondary to a multidisciplinary treatment approach involving a combination of surgery as well as high-dose amphotericin B plus 5-fluorocytosine. In the era of the HIV/AIDS pandemic, the present report underscores the need for early identification and prompt aggressive treatment to ensure successful management of this rare but potentially fatal opportunistic infection.

Topics: Acanthamoeba; Adult; AIDS-Related Opportunistic Infections; Amebiasis; Amebicides; Amphotericin B; Animals; Flucytosine; HIV Infections; Humans; Male; Rhinitis; Sinusitis; Treatment Outcome

Mucormycoses are seen with an increasing incidence in immunocompromised patients. Most common presentations are rhinocerebral and pulmonary. We here report the experience of a single center with mucormycoses in patients with hematologic malignancies.. Mucormycoses were diagnosed in six patients, (median age of 52 years; range, 26-74) treated between 2001-2004. Diagnoses included acute myeloid leukemia (AML) (n=3), acute lymphoblastic leukemia (n=1), chronic lymphocytic leukemia (n=1) and multiple myeloma (n=1). Mucormycosis was diagnosed in the neutropenic state following allogeneic hematopoietic cell transplantation (n=3) or intense chemotherapy (n=3). Sites of infections were rhinocerebral, facial and pulmonary involvement in one patient each and disseminated mucormycosis in three patients. The diagnosis was established by computed tomography followed by surgical interventions and histological diagnosis in 4 patients and post-mortem in two patients. Species identified were Rhizopus (n=3), Rhizomucor (n=2) and Absidia (n=1). Treatment responses were best if surgical resection was followed by aggressive antifungal chemotherapy. Five of six 6 patients died, all of complications of mucormycosis or their underlying disease. Only one patient with facial mucormycosis is still alive.. This experience demonstrates that patient with mucormycoses have a high mortality rate and early recognition followed by aggressive surgical debridement, high dose antifungal therapy and attempts to correct the underlying immunocompromised state are crucial in the treatment of this fatal infection.

Topics: Adult; Aged; Amphotericin B; Antifungal Agents; Antineoplastic Agents; Communicable Diseases, Emerging; Dermatomycoses; Disease Susceptibility; Female; Fluconazole; Hematologic Neoplasms; Hematopoietic Stem Cell Transplantation; Humans; Immunocompromised Host; Itraconazole; Lung Diseases, Fungal; Male; Middle Aged; Mucormycosis; Neutropenia; Pyrimidines; Sinusitis; Transplantation Conditioning; Triazoles; Viscera; Voriconazole

Topics: Amphotericin B; Antifungal Agents; Black People; Combined Modality Therapy; Debridement; Diabetes Mellitus, Type 2; Diabetic Ketoacidosis; Female; Genetic Predisposition to Disease; Humans; Infusions, Intravenous; Liposomes; Middle Aged; Mucormycosis; Remission Induction; Rhizopus; Sinusitis

Mucormycosis is a fatal infection of the immunocompromised individual. It is unusual to affect healthy individuals. We report eight such cases of infection caused by this emerging fungal pathogen in healthy patients. Of the eight cases, three were infected with Apophysomyces elegans, again an unusual pathogen causing mucormycosis.. Retrospective case review conducted at a tertiary referral center.. From 1999 to 2003, eight cases of mucormycosis were managed in otherwise healthy patients. Seven of them were treated with surgery. Clinical presentation, imaging studies, mycologic findings, operative findings at surgery, and postoperative results were evaluated. A review of the literature pertaining to mucormycosis infecting otherwise healthy patients and A. elegans infecting otherwise healthy patients in the nose and paranasal sinuses also was done.. Of the eight cases, three were infected with A. elegans, with no history of trauma or any invasive procedure. Seven patients underwent surgical treatment. Histopathologic examination showed broad, sparsely aseptate, thin-walled hyphae and angioinvasion with thrombosis.. Mucormycosis must be considered in the differential diagnosis of any severe acute headache, sinusitis, or orbital cellulites, not only in immunocompromised patients but also in the absence of any underlying disease. Successful treatment requires tissue débridement and injection of amphotericin B.

Topics: Adult; Aged; Amphotericin B; Antifungal Agents; Cellulitis; Debridement; Diagnosis, Differential; Female; Headache; Humans; Immunocompetence; Injections; Male; Middle Aged; Mucorales; Mucormycosis; Orbital Diseases; Retrospective Studies; Sinusitis; Treatment Outcome

Genera of the order Mucorales (Rhizopus, Mucor, Rhizomucor, Absidia, Apophysomyces, Cunninghamella, and Saksenaea) cause an angioinvasive infection called zygomycosis. Mortality rates can approach 100% depending on the patient's underlying disease and form of zygomycosis. We report here on the unusual case of a patient with acute myelogenous leukemia and zygomycosis unresponsive to monotherapy with liposomal amphotericin B, who responded favorably following the addition of the echinocandin caspofungin acetate.

Topics: Amphotericin B; Antifungal Agents; Antineoplastic Combined Chemotherapy Protocols; Caspofungin; Combined Modality Therapy; Cytarabine; Debridement; Diplopia; Drug Therapy, Combination; Echinocandins; Humans; Idarubicin; Immunocompromised Host; Leukemia, Myeloid, Acute; Lipopeptides; Male; Middle Aged; Mitoxantrone; Opportunistic Infections; Orbital Diseases; Peptides, Cyclic; Sinusitis; Zygomycosis

Rhizopus species may cause chronic invasive fungal rhinosinusitis in an immunocompetent host.. Individual case report.. Review of inpatient and outpatient records, radiographic studies, pathologic examination, and microbiology of the presented case. Review of the literature.. Rhizopus species may be the cause of chronic invasive fungal rhinosinusitis in an immunocompetent host and result in intracranial extension.

Topics: Adult; Amphotericin B; Chronic Disease; Craniotomy; Debridement; Endoscopy; Ethmoid Sinus; Frontal Lobe; Humans; Immunocompetence; Male; Mucormycosis; Orbital Diseases; Postoperative Complications; Reoperation; Rhinitis; Rhizopus; Sinusitis; Tomography, X-Ray Computed

Children with acute lymphoblastic leukemia (ALL) are at risk for serious electrolyte abnormalities. The authors report their experience in managing a child with ALL who developed severe hyperphosphatemia as a consequence of a large exogenous load of phosphorus from high-dose liposomal amphotericin B. Health care providers need to recognize this potentially life-threatening complication of liposomal amphotericin B, since early detection and intervention can prevent significant morbidity.

Topics: Amphotericin B; Antifungal Agents; Aspergillosis; Calcium Carbonate; Candidiasis; Cellulitis; Child; Drug Carriers; Female; Headache; Humans; Hyperparathyroidism, Secondary; Immunocompromised Host; Itraconazole; Liposomes; Mucormycosis; Orbital Diseases; Parathyroid Hormone; Phosphates; Phosphatidylcholines; Phosphatidylglycerols; Precursor Cell Lymphoblastic Leukemia-Lymphoma; Recurrence; Seizures; Sinusitis; Vitamin D

Topics: Administration, Intranasal; Amphotericin B; Antifungal Agents; Chronic Disease; Humans; Rhinitis; Sinusitis; Tomography, X-Ray Computed

Invasive rhinocerebral mucormycosis is a rare and often fatal opportunistic fungal infection. It is encountered in immunocompromised hosts exemplified by those with diabetes, human immunodeficiency viruses and particularly haematologic malignancies typically after high-dose chemotherapy and stem cell transplantation. In contrast to the more usual outcome with rapid progression and death. We now describe a successful eradication attributable to the use of a newly available antifungal agent.. Haematology department and bone marrow transplantation unit.. Two patients are contrasted. The first with acute leukaemia developed rapidly progressive facial swelling with mucormycosis proven on biopsy. Treatment over 2 months with maximally tolerated doses of amphotericin failed to halt intracranial extension and death resulted. The second, presented with acute lymphoblastic leukaemia in August 1997, underwent successful autologous bone marrow transplantation in February 1998. Relapse followed in March 1999 and after reinduction and consolidation receive a matched unrelated volunteer allograft in September 1999. A second recurrence was documented in April 2000 and in spite of achieving remission he developed a fever that was managed empirically with intravenous amphotericin and, on discharge, oral itraconazole. Left-sided facial swelling expanded rapidly and biopsy showed extensive invasion of the maxillary sinus with mucormycosis. FK463 was added on 5 June 2000 with gradual reduction in facial pain and within 1 month all clinical signs and resolved. Serial biopsies that included histopathologic investigation and microbiologic cultures confirmed eradication of the invasive mucor. In view of the potential danger of recrudescence this treatment regimen was continued through further chemotherapy and, once again disease-free, a second matched unrelated volunteer allograft took place in August 2000. Full reassessment at the time failed to demonstration any residual fungus. Engraftment was confirmed but neutropenic sepsis resulted in severe inflammatory response syndrome with progression to multiple organ dysfunction to which he succumbed without any evidence of leukaemic or systemic mycosis.. Echinocandin FK463 is of documented value in managing invasive candidiasis and aspergillosis. This is believed to be the first case of successful outcome with one of the angiotrophic zygomycetes.

Topics: Acute Disease; Adolescent; Adult; Amphotericin B; Antifungal Agents; Antineoplastic Combined Chemotherapy Protocols; Bone Marrow Transplantation; Combined Modality Therapy; Drug Evaluation; Echinocandins; Fatal Outcome; Female; Humans; Immunocompromised Host; Itraconazole; Leukemia, Myeloid; Lipopeptides; Lipoproteins; Male; Micafungin; Mucormycosis; Multiple Organ Failure; Peptides, Cyclic; Periodontal Abscess; Precursor Cell Lymphoblastic Leukemia-Lymphoma; Sinusitis; Splenectomy; Systemic Inflammatory Response Syndrome; Transplantation, Homologous

Topics: Administration, Intranasal; Amphotericin B; Antifungal Agents; Blood Proteins; Chronic Disease; Diagnosis, Differential; Eosinophil Granule Proteins; Eosinophilia; Fungi; Humans; Mycoses; Nasal Mucosa; Respiratory Mucosa; Rhinitis, Allergic, Perennial; Ribonucleases; Sinusitis

Rhinocerebral mucormycosis (RCM) is a well-described fulminant fungal infection that presents acutely in patients with ketoacidosis and immunosuppression. Very early diagnosis, established with the demonstration of characterised hyphae in tissues, greatly improves the prognosis of RCM. In this regard, the specificity and the sensitivity of frozen section for the diagnosis and the surgical debridement of RCM were evaluated in this study.. Frozen section was performed for the diagnosis (six of seven cases) and surgical treatment (three of seven cases) of RCM. In all cases, diagnosis was made by frozen section and confirmed by histological examination. Frozen section allowed radical surgical excision of infected tissue. In all cases, invasive, broad-based non-septated hyphae with branching at right angles were well demonstrated on toluidine blue staining. Cultures were positive for Rhizopus oryzae in three of seven cases. Outcome was favourable for five of seven patients and two patients died after the diagnosis.. Frozen section is a specific and sensitive method to make both a quick initial diagnosis of RCM and to successfully eradicate the tissue infected by organisms belonging to the order Mucorales.

Topics: Adult; Aged; Amphotericin B; Debridement; Female; Frozen Sections; Histocytological Preparation Techniques; Humans; Liposomes; Male; Middle Aged; Mucorales; Mucormycosis; Sensitivity and Specificity; Sinusitis

Rhinocerebral Mucormycosis is a potentially life-threatening disease, which affects mainly immunocompromised patients. Treatment options include reversing immunosuppression, surgery and systemic and local administration of anti-fungal medication. Amphotericin B is the primary agent employed, but its use is often limited by frequent side effects. Complexing Amphotericin B with lipid structures avoids most of the negative side effects, most importantly the dose-limiting nephrotoxicity. No consensus has been reached regarding the appropriate duration, rate of administration or total dose of treatment. We present a case of a patient suffering from Rhinocerebral Mucormycosis treated by extensive surgery and Liposomal Amphotericin B. He was treated for 29 days at a rate of 3 mg/kg/d and a total dose of 5.6 gram. The dose of Liposomal Aphotericin B used in previously published articles ranged from 1.5 mg/kg/d to 5 mg/kg/d. The response to treatment may be evaluated by physical examination, microbiological cultures, radiological and pathological studies. Taking into account the considerable cost of liposomal Amphotericin B and other lipid complexed formulations, it is imperative to find out what is the appropriate treatment regime for Rhinocerebral and other mucormycosis infections.

Topics: Aged; Amphotericin B; Antifungal Agents; Dose-Response Relationship, Drug; Humans; Liposomes; Male; Mucormycosis; Sinusitis; Surgical Procedures, Operative; Treatment Outcome

Topics: Administration, Intranasal; Air Microbiology; Amphotericin B; Antifungal Agents; Chronic Disease; Double-Blind Method; Fungi; Humans; Mycoses; Nasal Polyps; Prospective Studies; Randomized Controlled Trials as Topic; Sinusitis

We describe a case of invasive fungal sinusitis caused by Scytalidium dimidiatum in a lung transplant recipient. Treatment was complicated by renal failure with amphotericin B therapies. Following 6 months of voriconazole treatment, the patient remained radiographically and clinically stable for a short time before dying of respiratory failure precipitated by graft rejection.

Topics: Amphotericin B; Antifungal Agents; Ascomycota; Female; Humans; Lung Transplantation; Middle Aged; Mycoses; Postoperative Complications; Sinusitis; Tomography, X-Ray Computed

To discuss the clinical presentation, diagnostic criterion and treatment principle of acute fulminant invasive fungal rhinosinusitis (AFFS).. Six patients were diagnosed as AFFS based on history, nose, especially eye symptoms with or without fever, sinus CT and MRI, endoscopic and cytological findings in the nasal cavity. Surgical debridement was performed on 5 of 6 biopsy proven AFFS patients, one of them being amputated of the orbital content. With the original disease controlled simultaneously, 4 of 5 patients were prescribed with systemic amphotericin B or liposomal amphotericin B (1 case) and one with Itraconazole orally. One patient had not been involved with any of the anti-fungi measures.. Mucor (Zygomycetes) was identified on culture in 1 patient, Rhizopus species in 2, Aspergillus in 1, Alternaria in 1 and mixed Mucor and Rhizopus in 1. All patients were proved of tissue invasion histopathologically through biopsy. One patient died without any anti-fungi therapy on the 7th admission day, 3 patients survived for 88 days, 32 and 6 months respectively and died of original diseases (diabetes 1, leukaemia 2). One patient survived 9 months and lost for follow-up, 1 patient survived 11 months after treatment.. A high index of suspicion and early endoscopic investigation through nasal cavity with fungal investigation should highly be strengthened for recognition of this disease. MRI findings should be considered as, or even more, important as that of CT scan on the early diagnoses. Extensive and aggressive surgical debridement, prompt and enough dosage of antifungal therapy intravenously, together with serious controlling of the underlying disease, all take important roles in the complete control of the disease.

Topics: Adolescent; Aged; Amphotericin B; Antifungal Agents; Child; Debridement; Female; Follow-Up Studies; Humans; Male; Middle Aged; Mycoses; Sinusitis

Intranasal application of the antimycotic agent amphotericin B (AmphoB) has been proposed as an effective treatment of chronic rhinosinusitis (CRS) with polyps. AmphoB is a sterol-binding agent known to modify cell membrane structure. The cytotoxic effects of AmphoB were studied on primary human nasal epithelial cells in vitro.. Human epithelial cells were isolated from nasal polyps and middle turbinates of patients suffering from CRS, and grown on collagen-coated polycarbonate filters with an air liquid-interface. After 15 days of culture, cells were exposed apically to 50 microM AmphoB during 4 h daily for 5 days. Some cells were treated during 4 weeks. The bioelectric properties of cells were then studied in Ussing chambers. Integrity of the cell monolayers was assessed by measurement of the transepithelial resistance (R) and immunofluorescent localization of the tight junction protein occludin.. Disruption of the epithelial monolayer integrity was observed in all of the nasal polyps cell cultures, as demonstrated by a 60% drop in R. Immunofluorescence microscopy showed significant loss in cell number and disruption in the distribution of occludin. Turbinate cell cultures elicited no change in R and expression of occludin after AmphoB treatment. However, the transepithelial potential, the basal short-circuit current and the amiloride-sensitive current were reduced by 70%.. AmphoB was cytotoxic for nasal polyp epithelial cells with disruption of the epithelium integrity and loss of tight junctions. In contrast, integrity of turbinate epithelial cells was conserved despite alterations in transepithelial ion transport. These observations may explain the beneficial effect of intranasal application of AmphoB on CRS observed in clinical trials.

Topics: Amphotericin B; Anti-Bacterial Agents; Cell Membrane Permeability; Cells, Cultured; Chronic Disease; Electrophysiology; Epithelial Cells; Female; Fluorescent Antibody Technique; Humans; In Vitro Techniques; Ion Channels; Male; Membrane Proteins; Nasal Polyps; Occludin; Rhinitis; Sinusitis; Tight Junctions; Turbinates

A case of chronic paranasal sinuses with recurrent polyposis caused by miscellaneous infection--fungal (Aspergillus, Candida) and bacterial (Staphylococcus aureus, Enterobacter, Streptococcus) is described. The patient underwent 5 times surgical treatment (polypectomies, sinus operations). Good result was achieved after 2-years application of itraconazole and local Amphotericin B.

Topics: Amphotericin B; Antifungal Agents; Bacterial Infections; Combined Modality Therapy; Drug Administration Schedule; Female; Humans; Itraconazole; Middle Aged; Mycoses; Paranasal Sinus Diseases; Polyps; Recurrence; Sinusitis; Treatment Outcome

Topics: Adult; Amphotericin B; Antifungal Agents; Aspergillosis; Child; Cost-Benefit Analysis; Drug Costs; England; Humans; Liposomes; Liver Transplantation; Lung Diseases, Fungal; Medical Audit; Mycoses; Neutropenia; Organizational Policy; Postoperative Complications; Sinusitis; Treatment Outcome

A series of cases are presented to illustrate the complexity of the care of immunocompromised patients with established invasive fungal infections. These discussions by an expert panel serve to identify areas of controversy and for future research in the care of transplant recipients.

Topics: Adult; Aged; Amphotericin B; Aspergillus fumigatus; Candida; Candida glabrata; Female; Fluconazole; Humans; Kidney; Leukemia, Myeloid, Acute; Lung Transplantation; Male; Middle Aged; Mycoses; Sinusitis; Transplantation

A case report of acute invasive fungal rhinosinusitis in 28 year old woman with acute myeloid leukemia is described in this paper. The diagnosis of the fungal disease was based on clinical presentation, endoscopic evaluation of nasal cavity, computed tomography and magnetic resonance imaging of the paranasal sinuses and histopathological findings. An aggressive treatment including antifungal therapy (amphotericin B), antibiotics and the surgery of paranasal sinuses was implemented. Unfortunately the underlying disease and the fungal invasion progressed rapidly and the patient died on the forth week post-op due to cardiorespiratory failure.

Topics: Adult; Amphotericin B; Antifungal Agents; Fatal Outcome; Female; Humans; Leukemia, Myeloid; Mycoses; Rhinitis; Sinusitis

Invasive fungal sinusitis increasingly causes significant morbidity and mortality in immunocompromised patients. It is difficult to treat. Despite standard treatment by surgical debridement and intravenous amphotericin B, morbidity and mortality remain high. Conventional amphotericin B is the standard drug but its use is limited by dose-related nephrotoxicity and infusion-related acute toxicity. Liposomal amphotericin B has proven to be as effective as conventional amphotericin B with less nephrotoxicity and infusion reaction. We report four cases of invasive fungal sinusitis who were treated with liposomal amphotericin B after having severe side effects from conventional amphotericin B. There were two cases of mucormycosis and two cases of aspergillosis. All patients had diabetes millitus. One patient had systemic lupus erythematosus and another was receiving immunosuppressive drugs after kidney transplantation. All cases needed multiple operations for sinus surgery. Two cases had acute reaction to amphotericin B infusion, one had active lupus nephritis with renal insufficiency, and one was considered treatment failure from amphotericin B. The patients received liposomal amphotericin B at the total doses of 4.55-8.85 g. Two cases of mucormycosis were considered to be successfully treated. In cases of aspergillosis, one was considered improved and another one with immunocompromised status died with active disease. From our experience, surgery is the main treatment for patients with invasive fungal sinusitis and liposomal amphotericin B is an effective alternative drug for adjuvant medical treatment. However, the degree of immunosuppression of the patients, the extension of fungal sinusitis and perhaps the species of fungus are important factors determining the clinical response.

Topics: Adult; Aged; Amphotericin B; Antifungal Agents; Aspergillosis; Diabetes Complications; Diabetes Mellitus; Female; Humans; Immunocompromised Host; Liposomes; Male; Middle Aged; Mucormycosis; Sinusitis

Of the 21 patients with aspergillosis of central nervous system seen during the years 1990-1997, 16 (76%) had aspergillosis of sino-cranial origin. The occupation in patients with sino-cranial aspergillosis was either agricultural or manual work and predisposing risk factors were present in only two (12.5%) patients. Skull-base syndromes were the presenting features in 13 patients and three patients presented with features of intracranial space-occupying lesion. Paranasal sinus mass lesions were seen in all the 16 patients. Computerized tomography showed intracranial extradural-enhancing mass lesions in the anterior, middle or posterior cranial fossa in nine (68%) patients, intracranial and orbital lesions in four and orbital lesions in three. Well-formed granuloma with dense fibrosis was the histological feature. Survival rates were not good even after surgical and antifungal chemotherapy. Surgical treatment was subradical in our series. The majority of cases of sinocranial aspergillosis are reported from countries with temperate climates and the high incidence in these regions is probably related to constant exposure to the high spore content of pathogenic Aspergillus species in the 'mouldy' work environment.

Topics: Adolescent; Adult; Aged; Amphotericin B; Antifungal Agents; Aspergillosis; Aspergillus; Biopsy; Brain Diseases; Central Nervous System Fungal Infections; Climate; Female; Flucytosine; Granuloma; Humans; India; Male; Middle Aged; Occupational Diseases; Orbital Diseases; Risk Factors; Sinusitis; Tomography, X-Ray Computed

We report a case of life-threatening nasal sinus zygomycosis that developed during remission induction therapy for a relapsed acute lymphoblastic leukaemia. The patient was successfully treated with liposomal amphotericin B and granulocyte-colony stimulating factor followed by surgical reconstruction of the resultant cutaneous defect.

Topics: Absidia; Amphotericin B; Antifungal Agents; Child; Dermatomycoses; Humans; Male; Mucormycosis; Precursor Cell Lymphoblastic Leukemia-Lymphoma; Sinusitis; Tomography, X-Ray Computed

Acute fulminant fungal sinusitis is characterized by acute symptoms and rapid progress with a mortality rate of 60-80%. A large number of survivors have permanent neurological, visual and cosmetic disabilities. This clearly underscores the need of early recognition of this disease in at risk population in order to start urgent treatment. The at-risk population of diabetics, AIDS and other immunosuppressed is likely to increase, as will the incidence of acute fulminant fungal sinusitis. In the present study we have reviewed nine cases of acute fulminant fungal sinusitis to determine clinical presentation, related radiological picture and optimum treatment. Most common presenting features were fever, headache, facial swelling and proptosis. Many patients presented with blindness, facial paralysis and meningitis. Predisposing causes were uncontrolled diabetes with ketoacidosis in four out of six cases, post renal transplant immunosuppression and leukemia. All patients were treated with amphotericin B or liposomal amphotericin B (AmBisome). Diagnosis was confirmed by biopsy and culture of sinus mucosa, soft tissues of cheek, or orbit. Mucor (Zygomycetes) was identified on culture or histopathology in all cases. Surgical debridement was performed in seven cases. Six out of nine patients survived but morbidity was high: only two patients survived without any permanent disability.

Topics: Acute Disease; Adolescent; Adult; Amphotericin B; Antifungal Agents; Female; Humans; Male; Middle Aged; Mucor; Mucormycosis; Radiography; Retrospective Studies; Sinusitis

Chronic invasive fungal rhinosinusitis is an increasingly recognized, but inadequately characterized, disease entity which is separate and distinct from acute fulminant invasive fungal sinusitis and allergic fungal sinusitis. Chronic invasive fungal rhinosinusitis is divided into granulomatous and nongranulomatous subtypes based on histopathology, but the clinical distinction between the two subtypes is not clear. Current management includes varying degrees of surgical débridement and a prolonged course of antifungal agents. A protracted clinical course with recurrence after treatment is common.

Topics: Acute Disease; Aged; Aged, 80 and over; Amphotericin B; Antifungal Agents; Aspergillosis; Aspergillus fumigatus; Chronic Disease; Diagnosis, Differential; Female; Humans; Male; Middle Aged; Rhinitis; Sinusitis; Tomography, X-Ray Computed

Invasive sinonasal fungal disease is a potentially fatal complication of chemotherapy-induced immunosuppression and neutropenia. We reviewed the outcomes of seven cancer patients who had been diagnosed with invasive fungal sinusitis; six patients had hematologic malignancies and one had breast cancer. At the time of their sinus diagnosis, all patients had been hospitalized and were receiving combination chemotherapy for their underlying malignancy. Impairment of their immune function was characterized by an absolute neutrophil count of less than 1,000/mm3. Aggressive management of their sinonasal fungal disease consisted of surgical debridement and systemic amphotericin B for all patients, and treatment with granulocyte colony-stimulating factor for two patients. Invasive Aspergillus infection was identified in six patients and invasive Candida albicans infection in one. Although the prognosis for these patients was poor and two patients died of the fungal infection, the aggressive treatment strategy resulted in long-term survival for the remaining five patients.

Topics: Adolescent; Adult; Amphotericin B; Antifungal Agents; Aspergillus; Candida albicans; Child; Combined Modality Therapy; Debridement; Female; Fever; Humans; Immunocompromised Host; Male; Middle Aged; Mycoses; Neutropenia; Paranasal Sinuses; Retrospective Studies; Sinusitis; Treatment Outcome

Topics: Adolescent; Amphotericin B; Antifungal Agents; Antineoplastic Agents; Aspergillosis; Aspergillus; Humans; Leukemia, Myeloid, Acute; Male; Opportunistic Infections; Rhinitis; Sinusitis; Tomography, X-Ray Computed

Invasive aspergillosis and fulminant aspergillosis are rarities with a high mortality. In the literature there is no patient surviving an extended invasive aspergillosis of the paranasal sinuses and skull base after failure of operative intervention and of postoperative amphotericin B therapy. We report a complete remission of an invasive, partially fulminant aspergillosis. After an incomplete removal of the mycotic mass, we started postoperative drug therapy with amphotericin B. Under this treatment, the mycosis progressed. Additionally, the patient developed severe side effects, so that the treatment was interrupted. At this moment, we started a combined antimycotic drug therapy with liposomal amphotericin B and itraconazole. Within 10 weeks, clinically and radiologically, there was complete remission. The patient died 63 weeks after this treatment, due to a fulminant bacterial pneumonia. Postmortem histologic examination showed no aspergillosis in the skull base, paranasal sinuses, or lung.

Topics: Amphotericin B; Antifungal Agents; Aspergillosis; Drug Carriers; Drug Therapy, Combination; Female; Humans; Itraconazole; Liposomes; Middle Aged; Postoperative Care; Sinusitis; Skull Base

This is a report of the use of endoscopic sinus surgery in the management of three patients diagnosed with rhino-orbital or rhino-orbito-cerebral mucormycosis. A retrospective review was performed of the clinical examinations and imaging studies of three patients who underwent endoscopic sinus surgery as part of their therapy for mucormycosis. In addition to endoscopic surgery, all patients had aggressive control of underlying risk factors (diabetes mellitus, immunosuppression) and prolonged intravenous amphotericin B therapy. All three patients survived and avoided orbital exenteration. In selected patients with rhino-orbito-cerebral mucormycosis, endoscopic techniques can play a valuable role in diagnosis and management.

Topics: Adult; Amphotericin B; Brain Diseases; Endoscopy; Female; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Mucormycosis; Orbital Diseases; Paranasal Sinuses; Sinusitis

Depending on the aggressiveness of the pathogen and a patient's immunocompetence, fungal polypoid pansinusitis or allergic fungal sinusitis (AFS) may be a life-threatening disease. Apart from the clinical findings, its diagnosis is based on the demonstration of mucinous material with abundant eosinophils in the paranasal sinuses (indicating an allergic process), cultivation of the causative pathogen and immunocompetence of the patient. In a 20-year-old immigrant Sudanese woman, AFS due to Bipolaris (Drechslera) hawaiiensis was diagnosed. Because of intracranial extension, the disease had led to erosion of the cranial base and orbit with amaurosis on the right side and focal epilepsy. In addition to endonasal microsurgical pansinus operations, local irrigation therapy with amphothericin B was accompanied by systemic treatment with itraconazole after in vitro cultivation of the pathogen and determination of its sensitivities. Interdisciplinary management included a combination of endonasal surgery with debridement of infected tissues and wide drainage of the sinuses without removal of skull bone or the dural lesion in addition to specific antimycotic treatment. Injury to adjacent anatomical structures must be avoided in any case to prevent systemic or possibly lethal dissemination of infection.

Topics: Adult; Amphotericin B; Debridement; Drug Therapy, Combination; Endoscopy; Female; Humans; Itraconazole; Magnetic Resonance Imaging; Microsurgery; Mitosporic Fungi; Paranasal Sinuses; Patient Care Team; Respiratory Hypersensitivity; Sinusitis; Therapeutic Irrigation

Aspergillus sinusitis is usually a lethal condition in bone marrow transplanted patients. We report the case of a patient known to have a sinus infection with Aspergillus flavus before treatment with allogenic bone marrow transplantation for a refractory acute myelogenous leukemia. Exacerbation of the sinusitis during the neutropenic period required a multidisciplinary approach. Cure was achieved after treatment with a combination of surgery (Caldwell-Luc procedure), long term ABCD (amphotericin B colloidal dispersion) therapy (7 months) and granulocyte transfusions during the period preceding engraftment. The use of granulocyte transfusion in this salvage setting is discussed. Aggressive multimodality management of aspergillus sinusitis in immunosuppressed patients may lead to a cure and might not preclude allogenic transplantation.

Topics: Adult; Amphotericin B; Antifungal Agents; Aspergillosis; Bone Marrow Transplantation; Female; Granulocytes; Humans; Immunocompromised Host; Leukemia, Myeloid, Acute; Leukocyte Transfusion; Neutropenia; Sinusitis

Topics: Amphotericin B; Antifungal Agents; Azoles; Drug Therapy, Combination; Humans; Mycoses; Sinusitis

The microbiology, epidemiology, clinical features, and treatment of aspergillosis are discussed. Aspergillosis is a fungal infection that is increasingly found in patients with advanced HIV disease. The lung is involved in almost 75 percent of aspergillus infections. The central nervous system is the second most commonly infected site, occurring in about 10 to 15 percent of reported cases. Sinus involvement is recognized as a feature of aspergillosis, accounting for about 75 percent of all cases of fungal sinusitis seen in AIDS patients. While these infections are more than likely localized, dissemination to many organs can occur. The prognosis of patients with aspergillosis is poor, and its treatment is difficult. Treatment with amphotericin B is considered the gold standard, but responses are limited, with only 20 to 30 percent of patients responding in most cases. Itraconzole is approved as a second-line therapy. Surgery may also be appropriate for some cases of aspergillosis.

Topics: Amphotericin B; Antifungal Agents; Aspergillosis; Central Nervous System Diseases; HIV Infections; Humans; Itraconazole; Lung Diseases; Sinusitis

A case report of two HIV-infected men diagnosed with aspergillus sinusitis is provided. Despite aggressive treatment with antifungal agents, such as amphotericin B and itraconazole, the sinusitis would not resolve. Both protease inhibitor-naive patients were treated with the same antiretroviral regimen. Only one of the patients had a dramatic drop in viral load; the other patient succumbed to neurologic deficits and respiratory failure. Many patients who are using protease inhibitors continue to have good clinical status despite rising viral loads. The availability of antiretroviral therapy has changed the outlook for opportunistic infections, such as severe intestinal cryptosporidiosis, PML, and azole-resistant oral candidiasis. The key role in recovery is successful treatment with antiretroviral therapy to enable the body to fight such infections.

Topics: Acquired Immunodeficiency Syndrome; Adult; AIDS-Related Opportunistic Infections; Amphotericin B; Anti-HIV Agents; Antifungal Agents; Aspergillosis; Aspergillus fumigatus; CD4 Lymphocyte Count; Humans; Itraconazole; Male; Middle Aged; Sinusitis; Treatment Outcome; Viral Load

Mucormycosis usually occurs in immunocompromised patients or in patients with diabetes mellitus. Pathogens are moulds of the mucorales species. The diagnosis is made by histological examination of biopsies. A 39 year-old patient with insulin-dependent diabetes mellitus was admitted with a tentative diagnosis of a tumour of the maxilla. After diagnosis of hyphae of the mucorales species, the patient's diabetes was stabilised and he was treated over 17 weeks with amphotericin B (40 mg per day) and made a good recovery. A 58 year-old insulin-dependent patient with ethmoidali and sphenoidali sinusitis did not respond to antibiotic therapy. Mucormycosis was diagnosed by means of biopsy. Although treatment with amphotericin B was started, the patient died after 3 weeks due to multiple organ failure.

Topics: Adult; Amphotericin B; Antifungal Agents; Biopsy; Combined Modality Therapy; Diabetes Mellitus, Type 1; Diabetes Mellitus, Type 2; Fatal Outcome; Humans; Male; Middle Aged; Mucormycosis; Opportunistic Infections; Paranasal Sinuses; Sinusitis

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

Topics: Amphotericin B; Antifungal Agents; Brain Diseases; Drug Combinations; Humans; Mucormycosis; Phosphatidylcholines; Phosphatidylglycerols; Sinusitis

The aim of this study was to review the eight histopathologically proven cases of invasive fungal sinusitis that occurred at the Toronto Hospital for Sick Children between 1985 and 1995, seven of which that clustered between March 1990 and February 1992.. A retrospective review of the relevant cases and a review of the literature are presented.. A clinical review of this rare, life-threatening entity, occurring almost exclusively in severely neutropenic patients is presented and compared to the relevant clinical findings from an analysis of this series, the largest reported to date and first to document a significant clustering (p < .01).. We conclude, based on epidemiologic evidence, that this clustering was directly related to the release of airborne fungal spores from dormant soil reservoirs disturbed during hospital construction. Therefore, we strongly advocate increased vigilance with respect to precautions against airborne pathogens wherever severely neutropenic hosts are treated.

Topics: Adolescent; Amphotericin B; Anemia, Aplastic; Antifungal Agents; Aspergillus; Child; Female; Humans; Leukemia, Myeloid, Acute; Male; Mucor; Neutropenia; Precursor Cell Lymphoblastic Leukemia-Lymphoma; Retrospective Studies; Sinusitis; Wilms Tumor

To evaluate the following: the incidence of invasive Aspergillus sinusitis (AS); the value of surveillance nasal cultures and screening radiologic studies in predicting AS; the clinical criteria used to decide on surgical biopsy in patients suspected of having AS; the surgical and medical management of AS; and the outcome of AS in the peritransplantation period of children who underwent bone marrow transplantation.. Retrospective medical chart review.. Tertiary care children's hospital.. Eighty pediatric patients who underwent bone marrow transplantation for a variety of refractory malignant neoplasms or lymphohematopoietic disorders at the Children's National Medical Center, Washington, DC, from April 1, 1988, to September 30, 1993.. Diagnostic surgical biopsies, surgical débridement, and treatment with amphotericin B.. Resolution of AS and discharge from the hospital.. Seventy-two patients had screening sinus radiographs, 27 of which showed abnormalities. Aspergillus sinusitis developed in three of the patients with abnormal screening radiographs. Fifty-eight patients had screening nasal cultures. One culture was positive for Aspergillus, and histopathologically proved AS developed in this patient. Twelve diagnostic biopsies were done in nine patients. Three biopsy specimens showed histopathologic evidence of AS. The three patients with AS were successfully treated with aggressive surgical and medical therapy and were discharged from the hospital.. The incidence of AS was 4% (3/80) in the patients who underwent bone marrow transplantation. Screening radiographs, while not a good predictor of AS, have a role in evaluation of patients undergoing bone marrow transplantation to define preexisting sinus disease. Screening nasal cultures do not reliably predict AS. When AS is suspected and diagnostic biopsy is considered, the seven clinical criteria outlined in this article should be used. Survival of immunocompromised patients with AS requires early diagnosis and aggressive surgical and medical therapy.

Topics: Adolescent; Adult; Amphotericin B; Antifungal Agents; Aspergillosis; Biopsy; Bone Marrow Transplantation; Child; Child, Preschool; Debridement; Female; Follow-Up Studies; Forecasting; Humans; Immunocompromised Host; Incidence; Infant; Leukemia; Male; Nose; Postoperative Complications; Radiography; Retrospective Studies; Sinusitis; Treatment Outcome

Opportunistic mycotic infections, such as aspergillosis, can produce morbid consequences with or without aggressive therapy in an immunocompromised patient. Treatment including amphotericin B and resection of the infected tissue must be considered early in the overall management of the patient. We describe two patients with acute myelogenous leukemia who underwent intense cytoreductive therapy with bone marrow transplantation and an associated fungal infection treated with an investigational form of amphotericin B.

Topics: Adult; Amphotericin B; Antineoplastic Combined Chemotherapy Protocols; Aspergillosis; Bone Marrow Transplantation; Female; Humans; Immunocompromised Host; Leukemia, Myeloid, Acute; Male; Oroantral Fistula; Sinusitis; Stomatitis; Tomography, X-Ray Computed

Most cases of mucormycosis occur in immunosuppressed children. Intracranial extension is lethal and must be prevented with early specific treatment.. A 42 month-old boy was admitted suffering from acute lymphoblastic leukemia. Edema of the left eyelid developed on the sixth day of induction chemotherapy. Mucormycosis was suspected because of gradual extension of infection to nasal ala and periorbital area with fever, edema of nasal turbinates and nasal black secretions. Chemotherapy was discontinued and the patient was given intravenous amphotericin B (1.0 mg/kg/day) and heparin associated with G.CSF. Improvement was only temporary and scan examination performed on day 17 showed involvement of the orbit, eye and wall of the maxillary sinus; cultures of secretions were positive for staphylococcus and Absidia corymbifera. Remission of leukemia was obtained a few days later permitting surgical resection of involved tissues on day 30. A relapse of mucormycosis was observed six weeks later despite prolonged administration of amphotericin B requiring extended resection of necrotic areas and replacement of amphotericin B by its liposomal form (Ambisome). Bone marrow relapse of leukemia required further chemotherapy. The patient is in good condition 30 months after the initial symptoms.. Our patient seems to be the first with prolonged remission of facial mucormycosis and acute leukemia despite relapse of both diseases. This favorable outcome could be due to the use of Ambisome.

Topics: Amphotericin B; Child, Preschool; Humans; Injections, Intravenous; Male; Mucormycosis; Opportunistic Infections; Orbital Diseases; Precursor Cell Lymphoblastic Leukemia-Lymphoma; Sinusitis

Invasive aspergillosis is a severe complication in the immunocompromised patient. Despite antifungal treatment the mortality rate is higher than 90% if the immunity deficiency is not corrected. The use and dosage of conventional amphotericin B (deoxycholate-suspended formulation) is limited by its toxicity, especially nephrotoxicity. To reduce these untoward effects, amphotericin B has been formulated in liposomes. Better tolerance and lower nephrotoxicity in the liposomal formulations allow higher doses to be given safely, even in the presence of renal failure. Liposomal encapsulated amphotericin B (LAmB) is a safe and effective alternative to conventional formulations for antifungal therapy. We present a case of a 60-year-old man affected by chronic lymphocytic leukaemia. In the course of his disease and after chemotherapy treatment, he presented an invasive aspergillosis of the lung and paransal sinuses. The rhino-sinusal lesion had progressed despite surgical debridement and treatment with amphotericin B in a dosage of 50 mg per day. Moreover, renal impairment caused by conventional amphotericin was detected. Then, LAmB was started at a dose of 150 mg per day. Treatment with LAmB has resulted in clinical recovery and radiologic ressolution.

Topics: Amphotericin B; Antifungal Agents; Aspergillosis; Aspergillosis, Allergic Bronchopulmonary; Deoxycholic Acid; Drug Carriers; Drug Combinations; Humans; Leukemia, Lymphocytic, Chronic, B-Cell; Liposomes; Male; Middle Aged; Remission Induction; Sinusitis; Treatment Failure

Topics: Adult; Amphotericin B; Antibodies, Fungal; Aspergillosis, Allergic Bronchopulmonary; Aspergillus fumigatus; Brain Abscess; Combined Modality Therapy; Humans; Hypersensitivity; Immunoglobulin A; Male; Sinusitis

Topics: Amphotericin B; Drug Carriers; Humans; Liposomes; Liver Transplantation; Male; Middle Aged; Mucormycosis; Rhizopus; Sinusitis

Mucormycosis is a rare infection that occurs in immunocompromised patients. The rhinocerebral form presents in diabetics as a severe necrotizing sinusitis and is not frequent in patients with haematologic malignancies. Diagnosis requires direct examination and culture of biopsy specimens. Two patients with rhinocerebral mucormycosis and haematologic neoplasms (Non-Hodgkin's lymphoma and acute myeloblastic leukaemia) are described. Both patients had severe drug-induced neutropenia when the infection appeared. One patient died in spite of aggressive treatment with surgery and amphotericin.

Topics: Aged; Amphotericin B; Antineoplastic Combined Chemotherapy Protocols; Female; Humans; Leukemia, Myeloid, Acute; Lymphoma, B-Cell; Middle Aged; Mucormycosis; Osteitis; Sinusitis; Skull

A 55-year-old man presented with diabetic ketoacidosis and pansinusitis due to infection with Candida albicans. The infection responded to local drainage procedures, the administration of amphotericin B (2 g), and aggressive medical therapy of the ketoacidosis. Sinusitis due to C albicans is rare but may be more frequently seen in the immunocompromised host. Unlike those infections caused by Mucor or Aspergillus species, sinusitis due to C albicans may respond to local drainage and amphotericin B therapy.

Topics: Amphotericin B; Candidiasis; Diabetic Ketoacidosis; Humans; Male; Maxillary Sinus; Middle Aged; Sinusitis

Topics: Adult; Amphotericin B; Ethmoid Sinus; Female; Humans; Hypersensitivity; Middle Aged; Mycoses; Sinusitis

Invasive sinonasal aspergillosis is a severe and frequently fatal infection in immunosuppressed patients with hematologic malignancies. Seven patients with sinonasal aspergillosis who failed to respond to conventional amphotericin B (AmpB) were treated with liposomal AmpB (L-AmpB).AmpB was incorporated into multilamellar vesicles consisting of dimyristoyl phosphatidyl-choline and dimyristoyl phosphatidylglycerol in a 7:3 molar ratio. Five patients had underlying hematologic malignancies, one patient had aplastic anemia, and one patient had no underlying disease. All patients had biopsy-proven invasive Aspergillus sinusitis, and had failed conventional antifungal therapy including AmpB. Five patients were cured and two did not respond to treatment. Fever and chills were infrequent and, when they occurred, mild, and responded well to conventional management. No severe renal or central nervous system toxicity was observed. L-AmpB is effective and less toxic than conventional AmpB in the treatment of invasive Aspergillus sinusitis.

Topics: Amphotericin B; Aspergillosis; Drug Evaluation; Humans; Leukemia; Liposomes; Methods; Opportunistic Infections; Sinusitis; Time Factors

Aspergillus infection can be a major cause of morbidity in immunocompromised patients, especially when there is pulmonary involvement. Diagnosis of aspergillosis is often complicated by the varied clinical presentation and compromised medical status of such patients. Four cases of head and neck Aspergillus infections in bone marrow transplant patients are presented. Involvement predominantly was limited to the oral cavity and/or sinuses, and in one case, the ear. Two cases were successfully managed with a combined antibiotic and surgical approach, and one case with antibiotics only. The fourth case was managed with antibiotics and surgery, but fatal hemorrhage secondary to sinus involvement developed.

Topics: Adult; Amphotericin B; Anti-Bacterial Agents; Aspergillosis; Aspergillus fumigatus; Bone Marrow Transplantation; Child; Female; Humans; Male; Maxillary Sinus; Middle Aged; Mouth Diseases; Otitis; Sinusitis

A 29-year old female patient suffering from severe pain in her right eye, headache, ophthalmoplegia and ptosis of the right eye, total roentgenological opacity of the right maxillary sinus and ethmoidal cells , as well as signs of bone destruction in the orbital floor, was operated on under the suspicion of a tumour. Histological and bacteriological examinations as well as fungus cultures indicated, however, that the patient was suffering from a chronic infection caused by Penicillium notatum. Surgical treatment and postoperative intravenous administration of amphotericin B resulted in complete recovery of the patient.

Topics: Adult; Amphotericin B; Bacteriological Techniques; Combined Modality Therapy; Diagnosis, Differential; Ethmoid Sinus; Female; Humans; Maxillary Sinus; Mycoses; Orbital Diseases; Penicillium; Reoperation; Sinusitis; Sphenoid Sinus

Paranasal sinusitis occurred in 52 immunosuppressed cancer patients treated over 5 years at the University of Maryland Cancer Center. Twenty-one patients had aspergillus sinusitis; Aspergillus sp, including flavus and niger were directly recovered from sinus in 19 of the 21 infections. Two other patients with sinus involvement and positive nose cultures for Aspergillus flavus or fumigatus and microbiologically documented pulmonary aspergillosis were considered clinically, although not microbiologically, documented. Predisposing factors for aspergillus sinusitis during the 60 days prior to infection diagnosis were granulocyte count less than 500 microliter (mean duration, 42 days versus 14 days for sinusitis of other etiology; P less than 0.001), prolonged hospitalization (mean duration, 22 days versus 14 days for patients with nonfungal sinusitis; P less than 0.001), and prolonged antibiotic therapy (mean duration, 22 days versus 9 days; P less than 0.001). Treatment with amphotericin B was initially successful for 18 of 21 patients; however, 11 of 18 patients had infection recurrence that always developed at time of tumor exacerbation and reinstitution or intensification of chemotherapy. These findings suggest that aspergillus sinusitis in cancer patients is seen in association with prolonged neutropenia and antibiotic therapy, is amenable to therapy, but tends to recur with relapse of malignancy.

Topics: Adult; Agranulocytosis; Amphotericin B; Aspergillosis; Humans; Immunosuppression Therapy; Length of Stay; Middle Aged; Neoplasms; Recurrence; Sinusitis

Right maxillary sinus mucormycosis developed in a 45-year-old patient with hairy cell leukemia and pancytopenia. The patient recovered with surgical debridement, amphotericin therapy, and institution of alpha-2 interferon as therapy for his hairy cell leukemia. This may be the first case of the use of alpha-2-interferon therapy in a patient with documented systemic fungal infection and hairy cell leukemia and a rare example of recovery from this infection in a hematologic malignancy.

Topics: Amphotericin B; Combined Modality Therapy; Debridement; Humans; Interferon Type I; Leukemia, Hairy Cell; Male; Maxillary Sinus; Middle Aged; Mucormycosis; Pancytopenia; Sinusitis

Identification of the cause and subsequent specific therapy are indicated for those prolonged or relapsing fevers that follow abdominal surgery. On rare occasions, these fevers can be attributed to potentially life-threatening occult infections, including maxillary sinusitis, acute cholecystitis, antibiotic-related pseudomembranous colitis, toxic shock syndrome, systemic candidiasis, and transfusion-related cytomegalovirus disease, malaria, and babesiosis. Early recognition and appropriate treatment of these infections relieve anxiety, reduce hospital costs, and increase patient survival rates.

Topics: Abdomen; Acute Disease; Amphotericin B; Anti-Bacterial Agents; Bacterial Infections; Candidiasis; Cholecystitis; Clostridium Infections; Colitis; Fever; Foreign Bodies; Humans; Intubation, Gastrointestinal; Intubation, Intratracheal; Maxillary Sinus; Postoperative Complications; Shock, Septic; Sinusitis; Staphylococcal Infections; Transfusion Reaction

There is an increasing number of reports of fungal infections of the nose and paranasal sinuses, due in part to increasing recognition of this condition in both healthy and immunologically depressed patients. Three cases of aspergillosis of the maxillary sinus are presented, one of which demonstrates bone destruction in an otherwise healthy individual. In diagnosing aspergillosis sinusitis it is important to submit material for microscopic examination, as cultures are often negative for fungus. Treatment consists of surgery to establish good aeration and drainage with the addition of antifungal drugs in selected cases.

Topics: Aged; Amphotericin B; Aspergillosis; Combined Modality Therapy; Female; Humans; Male; Maxillary Sinus; Middle Aged; Risk; Sinusitis; Tomography, X-Ray Computed

Fulminant Aspergillus sinusitis is a disease of immunocompromised hosts strongly associated with neutropenia. A case of sinusitis due to Aspergillus flavus that developed in a patient with acute leukemia during the third week of treatment with amphotericin B is described. Indium 111-labeled white blood cell scanning demonstrated uptake of granulocytes into the involved sinuses. Thereafter, use of granulocyte transfusions was associated with stabilization of the patient's clinical course.

Topics: Amphotericin B; Aspergillosis; Aspergillus flavus; Blood Transfusion; Female; Granulocytes; Humans; Leukemia, Myeloid, Acute; Middle Aged; Paranasal Sinuses; Sinusitis

A 31-year-old man had a maxillary sinus infection and osteomyelitis. In vitro lymphocyte transformation studies indicated that he had a specific immune tolerance to Alternaria organisms. The etiologic agent was recovered and was identified as Alternaria alternata.

Topics: Adult; Alternaria; Amphotericin B; Humans; Immune Tolerance; Immunity, Cellular; Leukocyte Count; Lymphocyte Activation; Male; Maxillary Sinus; Miconazole; Mitosporic Fungi; Osteomyelitis; Palate; Sinusitis

Topics: Aged; Amphotericin B; Diabetes Complications; Ethmoid Sinus; Humans; Male; Mucormycosis; Sinusitis

Mucormycosis is a very serious complication of debilitating diseases, and particularly of diabetes. Presently the treatment of choice is amphotericine B. A patient is described who, like most other renal transplant patients with mucormycosis, had cranial localization of this disease and diabetes. The clinical findings were classical and the diagnosis was confirmed histologically.

Topics: Adult; Amphotericin B; Ethmoid Sinus; Humans; Kidney Transplantation; Male; Maxillary Sinus; Mucormycosis; Paranasal Sinuses; Sinusitis; Transplantation, Homologous

Topics: Amphotericin B; Ampicillin; Aspergillus fumigatus; Bacterial Infections; Erythromycin; Humans; Mycoses; Nystatin; Penicillin Resistance; Sinusitis; Tetracycline; Trimethoprim

The first case of Allescheria (Petriellidium) boydii sinusitis is reported. The organism was isolated from the maxillary sinus in an elderly, diabetic, chronic alcoholic man on maintenance hemodialysis who developed a syndrome resembling mucormycosis. Infections with A. boydii are infrequent and are most commonly limited to Madura foot. In addition, several cases of pulmonary and central nervous system involvement have been described. There is no established therapy for A. boydii, since the published data on antimicrobial sensitivity are limited. Our organism was inhibited by 1.25 mg of amphotericin B per ml and 0.15 mg of miconazide per ml.

Topics: Alcoholism; Amphotericin B; Ascomycota; Diabetes Complications; Humans; Male; Maxillary Sinus; Miconazole; Middle Aged; Mycoses; Sinusitis

Topics: Aerosols; Air Sacs; Amphotericin B; Animal Nutritional Physiological Phenomena; Animals; Bird Diseases; Birds; Blood Proteins; Bronchitis; Canaries; Enteral Nutrition; Hematocrit; Incubators; Mite Infestations; Respiratory Tract Diseases; Sinusitis; Sneezing; Thyroid Diseases; Vocalization, Animal

Topics: Amphotericin B; Extremities; Female; Humans; Maxillary Sinus; Middle Aged; Mycoses; Osteomyelitis; Phlebitis; Psychoses, Substance-Induced; Rhizopus; Sinusitis

Topics: Adolescent; Adult; Amphotericin B; Diabetes Complications; Diabetes Mellitus; Diet, Diabetic; Female; Humans; Insulin; Mucormycosis; Mucous Membrane; Rhizopus; Sinusitis

Topics: Amphotericin B; Antifungal Agents; Aspergillosis; Diagnosis, Differential; Female; Humans; Maxillary Sinus; Middle Aged; Natamycin; Nystatin; Radiography; Respiratory Tract Infections; Rhinitis; Sinusitis

Topics: Amphotericin B; Aneurysm, Infected; Angiography; Autopsy; Carotid Arteries; Cerebral Arteries; Child; Eosinophils; Glucose Tolerance Test; Humans; Intracranial Aneurysm; Lymphocytes; Male; Orbit; Paranasal Sinuses; Penicillium; Rupture; Sinusitis; Subarachnoid Hemorrhage

Topics: Adrenal Cortex Hormones; Amphotericin B; Biopsy; Blepharoptosis; Blindness; Brain Diseases; Child; Child, Preschool; Conjunctiva; Edema; Exophthalmos; Eye Diseases; Humans; Inflammation; Male; Mucormycosis; Paranasal Sinuses; Penicillins; Sinusitis

Topics: Acremonium; Amphotericin B; Anti-Bacterial Agents; Antigen-Antibody Reactions; Asthma; Bone Diseases; Candidiasis; Diet; Diet Therapy; Drug Therapy; Food Hypersensitivity; Granuloma; Humans; Immunotherapy, Active; Jaw; Mouth Diseases; Palate; Paranasal Sinuses; Pathology; Sinusitis; Skin Tests; Spores; Spores, Fungal

Topics: Amphotericin B; Carotid Artery Diseases; Cranial Sinuses; Eye Manifestations; Gangrene; Geriatrics; Humans; Mucormycosis; Nose; Nystatin; Ophthalmoplegia; Orbit; Paranasal Sinuses; Sinus Thrombosis, Intracranial; Sinusitis

Topics: Amphotericin B; Antifungal Agents; Aspergillus flavus; Disease; Ethmoid Sinus; Humans; Mycoses; Nystatin; Orbit; Orbital Diseases; Sinusitis