phenylephrine-hydrochloride and Aspergillosis

Topics: Antifungal Agents; Aspergillosis; Child, Preschool; Humans; Immunocompromised Host; Male; Mouth; Nose; Voriconazole

Acute invasive fungal rhinosinusitis (AIFRS) represents a fulminant, potentially fatal, disease process in immunocompromised patients. The diagnosis often rests on high index of clinical suspicion, with relative paucity of data on the diagnostic and therapeutic implications of intraoperative frozen sections.. Retrospective review was performed for 18 cases undergoing endoscopic sinus surgery for AIFRS. Reliability of intraoperative frozen section diagnosis was evaluated for all patients using final pathology as the gold standard.. A total of 66 frozen sections were performed. Diagnostic accuracy of frozen sections illustrated sensitivity of 72.7% (95% confidence interval [CI], 0.57 to 0.85), specificity of 100% (95% CI, 0.85 to 1.00), positive predictive value (PPV) of 100% (95% CI, 0.89 to 1.00), and negative predictive value (NPV) of 64.7% (95% CI, 0.46 to 0.80). There was no statistically significant difference in sensitivity of frozen sections in cases of Mucor and Aspergillus at 68.8%% and 76.2%, respectively (p = 0.61).. This study represents the largest series assessing the diagnostic accuracy of frozen section analysis in AIFRS. Frozen section analysis is an effective tool for guiding intraoperative decision making in patients with AIFRS with a high PPV. A Low NPV underscores the importance of clinical suspicion and intraoperative decision making based on endoscopic findings when negative frozen section results are encountered. Further, frozen section analysis appears to be equally effective in detecting either Mucor or Aspergillus.

Topics: Acute Disease; Adult; Aged; Aspergillosis; Aspergillus; Decision Making; Endoscopy; Female; Frozen Sections; Humans; Immunocompromised Host; Invasive Fungal Infections; Male; Middle Aged; Mucor; Mucormycosis; Nasal Surgical Procedures; Nose; Rhinitis; Sensitivity and Specificity; Sinusitis; Young Adult

The pathogenesis of MSFB development remains unclear, but it has been suggested that poor sinus ventilation is associated with disease development; such a ventilation is influenced by anatomical variation of the paranasal sinuses. Thus, we sought to determine whether sinonasal anatomical variations were associated with MSFB development.. Thirty-one patients with MSFB and 28 gender-matched control patients were included in the present study. The presence or absence of Haller cells and a concha bullosa were scored, and the angle of septal deviation and the minimal and maximal lengths of the infundibulum were measured on preoperative computed tomography images.. In the MSFB group, both a concha bullosa (61.3% vs. 28.6%, p=0.006) and Haller cells (41.9% vs. 30.4%) were present at higher frequencies than in the control group, although the between-group difference in Haller cell occurrence was not statistically significant (p=0.348). In addition, MSFB patients had a significantly lower mean infundibular width (3.23±0.69mm vs. 3.99±1.17mm, p<0.001) and a longer infundibular length (9.71±1.43mm vs. 8.23±1.72mm, p<0.001) than controls.. Sinonasal anatomical variations, especially the presence of a concha bullosa, and/or a narrow and long infundibulum, may play roles in the development of maxillary sinus fungal balls (MSFBs).

Topics: Adult; Aged; Anatomic Variation; Aspergillosis; Female; Foreign Bodies; Humans; Male; Maxillary Sinus; Maxillary Sinusitis; Middle Aged; Nose; Paranasal Sinuses; Retrospective Studies; Tomography, X-Ray Computed; Turbinates

On the basis of phenotypic identification methods, Aspergillus fumigatus is reported as the most commonly identified aetiological agent of canine sino-nasal aspergillosis (SNA). However, definitive identification of Aspergillus spp. using phenotypic features alone is unreliable. The aim of this study was to determine the molecular identities of fungal species causing SNA in dogs. Genomic DNA was extracted from 91 fungal isolates from 90 dogs diagnosed with SNA in Australia, the USA and Belgium, and the ITS1-5.8S-ITS2 ribosomal DNA and partial β-tubulin regions were sequenced. Eighty-eight of 91 (96.7%) isolates were identified as A. fumigatus and 3/91 (3.3%) belonged to Aspergillus section Nigri spp. (Aspergillus tubingensis: 2/91; Aspergillus uvarum: 1/91). These findings confirm that A. fumigatus is the most common aetiological agent of canine SNA. This is the first report to document a pathogenic role for A. tubingensis and A. uvarum in dogs.

Topics: Animals; Aspergillosis; Aspergillus; Aspergillus fumigatus; Australia; Belgium; Calmodulin; Dog Diseases; Dogs; Female; Fungal Proteins; Male; Molecular Sequence Data; Nose; Phylogeny; Polymerase Chain Reaction; RNA, Ribosomal, 5.8S; Sequence Analysis, DNA; Tubulin; United States

Volatile chemical profiles collected from the headspace of Aspergillus fumigatus (a pathogenic fungus that causes invasive pulmonary aspergillosis, allergic bronchopulmonary aspergillosis and chronic fungal sinusitis) grown on media with the connective tissue protein elastin, found in lung tissue, contained a large abundance of the sesquiterpene farnesene (3,7,11-trimethyl-1,3,6,10-dodecatetraene) and, depending on extraction time and sorbent material, other farnesene isomers and sesquiterpenes such as bisabolene (methyl-4-(6-methylhepta-1,5-dien-2-yl)cyclohex-1-ene). When human lung cells were cultured externally and infected with A. fumigatus, farnesene was also detected in each model lung system. Volatiles measured from cultured nasal lavage collected from a patient diagnosed with chronic fungal sinusitis, a condition frequently caused by A. fumigatus, revealed the presence of another pathogenic fungus, less frequently responsible for sinusitis, Epicoccum nigrum. The volatile profile of E. nigrum differed markedly from that of A. fumigatus with no sesquiterpenes detected.

Topics: Aspergillosis; Aspergillosis, Allergic Bronchopulmonary; Aspergillus fumigatus; Biomarkers; Gas Chromatography-Mass Spectrometry; Humans; Lung; Lung Diseases, Fungal; Nasal Lavage; Nose; Sinusitis

In this retrospective study of 41 cats with chronic nasal disease diagnoses included nasal neoplasia (n = 19), idiopathic chronic rhinosinusitis (ICRS) (n = 12), nasopharyngeal polyps (n = 3), foreign bodies (n = 2), nasopharyngeal stenosis (n = 1) and nasal aspergillosis (n = 1). In 3 cats diagnosis could not be established despite thorough work-up. Gender, indoor or outdoor housing, quality or quantity of nasal discharge, bacteriological findings of nasal flushes, radiology and CT findings did not differ significantly between cats with neoplasia and cats with ICRS. Cats with neoplasia were older (3 - 15, median 11 years) and showed clinical signs for a shorter period of time (1 - 8, median 2 months) than cats with ICRS (age 1 - 13, median 7.5 years; signs: 1 - 36, median 5 months). In all cats with neoplasia a mass was detected rhinoscopically, while this was only seen in 30 % of cats with ICRS. The exact diagnosis has to be established by examination of biopsy samples. A combination of physical examination, imaging studies and rhinoscopy with cytological and histopathological examination of samples enhances the likelihood for a correct diagnosis.

Topics: Age Factors; Animals; Aspergillosis; Biopsy; Cat Diseases; Cats; Chronic Disease; Diagnosis, Differential; Female; Foreign Bodies; Male; Nasal Polyps; Nose; Nose Diseases; Nose Neoplasms; Paranasal Sinus Diseases; Retrospective Studies; Rhinitis; Sinusitis

A study was performed to investigate the air quality of a haematopoietic SCT ward, colonization of the upper airways with Aspergillus spp. and the role of galactomannan (GM) ELISA testing in serum in the diagnosis of invasive aspergillosis (IA). In 102 allo-SCT recipients, two cases of IA (one proven and one probable) were seen. Of 2071 serum samples, 12 were positive, two in a patient with proven IA and 10 in patients without IA. Of the 2059 negative samples, 22 were taken from the patient with probable IA. Of the 245 environmental samples, 20 (8.2%) were positive for filamentous fungi. Aspergillus fumigatus was seen in 14 samples. A total of 657 oral and nasal swabs were taken. Seven nasal samples and one oral sample were positive for Aspergillus species (A. fumigatus 4, A. niger 4) in four patients, one of whom had probable IA. In summary, most environmental samples were negative, colonization of the oral and nasal cavities was rare and IA was diagnosed in only 2% of patients. The GM ELISA test remained negative in one of two patients with IA and does not seem useful in a population of patients with a low incidence of IA.

Topics: Air Microbiology; Antigens, Fungal; Aspergillosis; Aspergillus fumigatus; Enzyme-Linked Immunosorbent Assay; Galactose; Hematopoietic Stem Cell Transplantation; Humans; Mannans; Mouth; Nose; Patient Isolation

In the last few years an increase has been observed in the incidence of fungal sinusitis in immunocompetent subjects. We present a case of mycotic sinusitis in a 12-year-old patient, in which there were several aspects that could have made the diagnosis more difficult, thus delaying her definitive treatment. This case illustrates how to arrive at a correct diagnosis of this pathology. It must be based on the histological and radiological studies, but always without forgetting a key aspect as it is a suspected diagnosis. The treatment of fungal sinusitis is surgical, and currently, endoscopic sinus surgery is the choice. We describe the clinical characteristics of this pathology and the diagnostic methods required.

Topics: Aspergillosis; Child; Facial Pain; Female; Humans; Maxillary Sinusitis; Nose; Olfaction Disorders; Suppuration

To determine results of diagnostic testing, including detection of nasal or frontal sinus fungal plaques, in dogs with nasal aspergillosis.. Retrospective case series.. 46 dogs with nasal aspergillosis.. Medical records were reviewed for information on computed tomographic findings; rhinoscopic findings, including whether fungal plaques were seen in the nasal cavity; results of frontal sinus trephination and sinuscopy, including whether fungal plaques were seen in the frontal sinus; and results of histologic examination of biopsy specimens.. In 38 (83%) dogs, fungal plaques were seen in the nasal cavity during rhinoscopy, whereas in the remaining 8 (17%), fungal plaques were not seen in the nasal cavity but were seen in the frontal sinus. Duration of clinical signs, proportions of dogs in which the referring veterinarian had performed a nasal examination prior to referral, proportions of dogs with computed tomographic evidence of nasal cavity cavitation or sinus involvement, and proportions of dogs with rhinoscopic evidence of destructive rhinitis were not significantly different between dogs with nasal fungal plaques and dogs with fungal plaques only in the frontal sinus.. Results confirm that frontal sinus involvement is common in dogs with nasal aspergillosis and suggest that frontal sinus trephination and sinuscopy may aid in the diagnosis of aspergillosis in dogs, particularly dogs with rhinoscopic evidence of destructive rhinitis and computed tomographic evidence of sinus involvement that lack detectable fungal plaques in the nasal cavity.

Topics: Animals; Aspergillosis; Dog Diseases; Dogs; Endoscopy; Female; Male; Nose; Nose Diseases; Retrospective Studies; Sensitivity and Specificity; Tomography, X-Ray Computed

To compare the efficacy and diagnostic value of four different sample collection techniques for cytological identification of nasal aspergillosis-penicilliosis in dogs.. Fifteen dogs with a history of persistent nasal discharge and clinical and radiographic findings suggestive of aspergillosis were evaluated using four different cytological sampling techniques. These were a direct smear from the nasal discharge, blind swab collection under general anaesthesia, brushing from suspect lesions under direct endoscopic visualisation and a squash technique of mucosal biopsies from suspect lesions obtained under direct endoscopic visualisation.. Direct smear collection and blind swab collection detected fungal hyphae in 13.3 and 20 per cent of examined cases, respectively; brush samples detected fungal hyphae in 93.3 per cent and fungal spores in the 45 per cent of examined cases and squash samples detected fungal hyphae in 100 per cent and fungal spores in 36 per cent of examined cases.. This study confirmed the high accuracy of cytology samples in the diagnosis of nasal aspergillosis-penicilliosis when collected under direct endoscopic visualisation and showed the poor value of samples that were collected by blind swabs or prepared from samples of nasal discharge.

Topics: Animals; Aspergillosis; Aspergillus; Cytological Techniques; Dog Diseases; Dogs; Endoscopy; Female; Male; Nose; Nose Diseases; Predictive Value of Tests; Radiography; Specimen Handling

To determine radiographic, magnetic resonance imaging (MRI), computed tomography (CT), and rhinoscopic features of nasal aspergillosis in dogs.. Prospective study.. 15 client-owned dogs.. All dogs had clinical signs of chronic nasal disease; the diagnosis of nasal aspergillosis was made on the basis of positive results for at least 2 diagnostic tests (serology, cytology, histology, or fungal culture) and detection of typical intrasinusal and intranasal fungal colonies and turbinate destruction via rhinoscopy. Radiography, MRI, and CT were performed under general anesthesia. Rhinoscopy was repeated to evaluate lesions and initiate treatment. Findings of radiography, MRI, CT, and rhinoscopy were compared.. MRI and CT revealed lesions suggestive of nasal aspergillosis more frequently than did radiography. Computed tomography was the best technique for detection of cortical bone lesions; the nature of abnormal soft tissue, however, could not be identified. Magnetic resonance imaging allowed evaluation of lesions of the frontal bone and was especially useful for differentiating between a thickened mucosa and secretions or fungal colonies; however, fungal colonies could not be differentiated from secretions. Rhinoscopy allowed identification of the nature of intranasal and intrasinusal soft tissue but was not as useful as CT and MRI for defining the extent of lesions and provided no information regarding bone lesions.. The value of CT and MRI for diagnosis of nasal aspergillosis was similar and greater than that of radiography. Rhinoscopy is necessary because it is the only technique that allows direct visualization of fungal colonies.

Topics: Animals; Aspergillosis; Chronic Disease; Diagnosis, Differential; Dog Diseases; Dogs; Endoscopy; Female; Magnetic Resonance Imaging; Male; Nose; Nose Diseases; Prospective Studies; Sensitivity and Specificity; Tomography, X-Ray Computed

Until recently aspergillosis of the paranasal sinuses has been considered a rare disease but nowadays it is frequently discussed in the literature. The reason is the nonspecific clinical course of the disease resembling recurrent chronic rhinosinusitis and its difficult histological and radiological verification. Although there have been clinical suspicions of this diseases in quite a few patients presenting with recurrent polyposis of the sinuses associated with aspirin intolerance and bronchial asthma we could prove sinus aspergillosis histologically and computed-tomographically only in one patient.

Topics: Adolescent; Aspergillosis; Aspergillus; Diagnosis, Differential; Female; Humans; Nose; Paranasal Sinuses; Sinusitis

Although expansion of bony walls occurs in allergic fungal disease of the nose and paranasal sinuses by increased mucus secretion and fungal growth, the latter is apparently confined to the lumen and does not invade the tissues. Nevertheless, spread of the disease process from paranasal sinuses to orbit, cheek and intracranial cavity is well described. An imaging and histopathological study was carried out in 16 cases to determine how the disease originates and spreads. The infection starts in the nasal cavity, the lumen of a sinus or in a seromucinous gland or duct. A thin vascular zone of intense allergic inflammation surrounds the infected mucin. Erosion of bone takes place focally, probably by substances produced by the inflammatory tissue, allowing intromission by the thin vascular layer together with its underlying fungus-containing mucus and so extension of the disease process through the eroded bone.

Topics: Adult; Aspergillosis; Bone Resorption; Child; Female; Humans; Hypersensitivity; Magnetic Resonance Imaging; Male; Middle Aged; Mucins; Mycoses; Nasal Mucosa; Nose; Paranasal Sinuses; Sinusitis; Tomography, X-Ray Computed

To examine the clinical response to topical administration of clotrimazole in dogs with nasal aspergillosis, to compare effect of surgically placed versus nonsurgically placed catheters used for administration on outcome, and to examine whether subjective scoring of computed tomographic images can predict outcome.. Retrospective case series.. 60 dogs with nasal aspergillosis.. Information including signalment, history, diagnostics, treatment method, and outcome was retrieved from medical records of dogs with nasal aspergillosis treated between 1990 and 1996 at the University of California School of Veterinary Medicine or cooperating referral practices. Final outcome was determined by telephone conversations with owners and referring veterinarians. Images obtained before treatment were subjectively assessed to develop an algorithm for predicting outcome.. Clotrimazole solution (1%) was infused during a 1-hour period via catheters surgically placed in the frontal sinus and nose (27 dogs) and via nonsurgically placed catheters in the nose (18). An additional 15 dogs received 2 to 4 infusions by either route. Topical administration of clotrimazole resulted in resolution of clinical disease in 65% of dogs after 1 treatment and 87% of dogs after one or more treatments. The scoring system correctly classified dogs with unfavorable and favorable responses 71 to 78% and 79 to 93% of the time, respectively.. Topical administration of clotrimazole, using either technique, was an effective treatment for nasal aspergillosis in dogs. Use of non-invasive intranasal infusion of clotrimazole eliminated the need for surgical trephination of frontal sinuses in many dogs and was associated with fewer complications.

Topics: Administration, Intranasal; Administration, Topical; Animals; Antifungal Agents; Aspergillosis; Catheters, Indwelling; Clotrimazole; Curettage; Dog Diseases; Dogs; Female; Follow-Up Studies; Frontal Bone; Frontal Sinus; Infusions, Parenteral; Male; Nose; Retrospective Studies; Rhinitis; Suction; Tomography, X-Ray Computed; Treatment Failure; Treatment Outcome; Trephining

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

Topics: Acute Disease; Aged; Aspergillosis; Aspergillus fumigatus; Female; Humans; Leukemia; Nose; Paranasal Sinus Diseases

Aspergillosis in cancer patients is a problem. Because not all patients can undergo invasive procedures, we sought other methods for diagnosis. We reviewed the data from all patients with acute nonlymphocytic leukemia treated at our center during a 3-year period. Of 125 patients, 18 had invasive aspergillosis (cases). Eleven patients had nose cultures growing Aspergillus flavus or A. fumigatus; 10 of these 11 had aspergillosis, whereas only eight of 114 without such nose cultures had invasive disease (P less than 0.000001). Thus, A. flavus on nose culture appears "predictive" for aspergillosis. Absence of such a culture does not preclude infection. Of 125 patients, 61 had sterile nose culture(s) and 14 of the 18 cases had such a sterile nose culture. Only four of the 64 patients without sterile nose cultures developed aspergillosis (P less than 0.008), suggesting a relation between sterile nose culture and aspergillosis. Carbenicillin was used for a longer period among cases and patients with predictive nose cultures than among patients without aspergillosis. These data may help identify patients at risk of aspergillosis and help determine antifungal therapy when invasive procedures are contraindicated.

Topics: Acute Disease; Agranulocytosis; Anti-Bacterial Agents; Aspergillosis; Aspergillus flavus; Aspergillus fumigatus; Carbenicillin; Drug Therapy, Combination; Humans; Leukemia; Nose

Topics: Adult; Aged; Aspergillosis; Calculi; Diagnosis, Differential; Diagnostic Errors; Female; Foreign Bodies; Foreign-Body Reaction; Humans; Male; Nose; Nose Diseases

Topics: Amphotericin B; Animals; Aspergillosis; Aspergillus fumigatus; Blood Cell Count; Dog Diseases; Dogs; Hematocrit; Kidney; Male; Nose; Nose Diseases; Urea

Topics: Adult; Antigens, Fungal; Aspergillosis; Aspergillus fumigatus; Bronchi; Eosinophilia; Female; Humans; Leukocyte Count; Lung Diseases, Fungal; Male; Middle Aged; Nose; Precipitins; Respiratory Hypersensitivity; Skin Tests; Time Factors

Topics: Armenia; Aspergillosis; Burns; Burns, Chemical; Chemical Industry; Citrates; Facial Dermatoses; Humans; Nose; Occupational Diseases