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Soundarya R, Deepa HC, Prakash PY, Geetha V. Fungal Rhinosinusitis: An integrated diagnostic approach. Ann Diagn Pathol 2025; 75:152415. [PMID: 39615372 DOI: 10.1016/j.anndiagpath.2024.152415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2024] [Revised: 11/24/2024] [Accepted: 11/25/2024] [Indexed: 02/17/2025]
Abstract
Classification of fungal rhinosinusitis (FRS) based on histomorphology and clinical presentation aids in early diagnosis and prompt patient management. In this retrospective observational study, clinicopathologic findings in patients diagnosed with fungal rhinosinusitis between January 2019 and December 2021 were evaluated. Clinical and imaging findings were retrieved from hospital records; slides from routine and histochemical studies were reviewed, and the cases were classified into non-invasive [fungal ball (FB) and allergic fungal rhinosinusitis (AFRS)] and invasive FRS [acute invasive fungal rhinosinusitis (AIFRS), chronic invasive fungal rhinosinusitis (CIFRS) and chronic invasive granulomatous fungal rhinosinusitis (CGFRS)]. Fungal cultures were also compared with histopathology. Of the 85 patients in the study, 34% were non-invasive (86% FB,10% AFRS, and 4% unclassified), and 66% were invasive (70% AIFRS, 21% CGFRS, and 9% CIFRS). The mean age of patients was 51 years, with a male-to-female ratio of 1.5:1. The most common comorbidity was diabetes with COVID-19 co-infection. Culture reports were available for 77 patients, of which 36 cases had growth, the majority of which were Aspergillus; 7 patients had coinfection with Aspergillus and Mucorales. Comparing histopathology to the gold standard mycology for Aspergillus, a sensitivity of 90%, specificity of 96%, and Cohen's Kappa of 0.8 was achieved. This study emphasizes the value of an integrated diagnostic approach in arriving at an appropriate diagnosis. In resource-limited settings, histopathological evaluation can be a valuable screening tool, aiding in early diagnosis.
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Affiliation(s)
- R Soundarya
- Department of Pathology, Kasturba medical college, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka 576104, India.
| | - H C Deepa
- Department of Pathology, Kasturba medical college, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka 576104, India.
| | - Peralam Yegneswaran Prakash
- Department of Microbiology, Kasturba medical college, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka 576104, India.
| | - V Geetha
- Department of Pathology, Kasturba medical college, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka 576104, India.
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Kassotis A, Coombs A, Matari N, Lignelli A, Kazim M. The Algorithmic Role of Critical Radiographic Features in the Treatment of Angioinvasive Fungal Sinusitis. Ophthalmic Plast Reconstr Surg 2025; 41:1-7. [PMID: 39240228 DOI: 10.1097/iop.0000000000002783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/07/2024]
Abstract
INTRODUCTION Angioinvasive fungal sinusitis (AIFS) is a rapidly progressive, highly morbid infection. It can be challenging to obtain an early diagnosis, but intervention in the acute period is crucial for prognosis. Previous literature has identified numerous radiographic features with high sensitivity and specificity for AIFS, even in early disease. Bedside nasal endoscopy can substantiate the diagnosis but can also yield false negative results. Initially, these patients may present to the ophthalmologist. Thus, to avoid visual and potentially life-threatening complications, subtle clinical signs in conjunction with suspicious radiographic features must be promptly recognized by the ophthalmologist and escalated appropriately. We review, for the benefit of the ophthalmic community, the salient radiographic features of AIFS and integrate them into a decision-making algorithm for diagnostic workup and management. METHODS A literature search was conducted using a comprehensive keyword search in the Pubmed and Embase databases. English studies from 1988 to 2022 describing the radiographic features of AIFS queried. Literature on the newly described entity, COVID-19 COVID-19-associated mucormycosis was included. The authors collected the most frequently reported indicators of AIFS. RESULTS The authors review 4 radiographic findings that are frequently associated with AIFS, including in the early stages of disease: 1) loss of contrast enhancement in the nasal turbinate and maxilla (i.e., "black turbinate and maxillary sign"), (2) periantral involvement seen as changes in density, fat stranding or obliteration of the anterior, retromaxillary, or retroantral fat planes on CT, (3) Tissue invasion without bony erosion, (4) Hypointense T2W sinonasal secretions on MRI in the setting of acute sinusitis. The authors additionally propose an algorithm that suggests surgical exploration for patients with clinical concern for AIFS and these radiographic features, even if bedside nasal endoscopy is inconsistent with AIFS. CONCLUSION The radiographic signs highlighted herein should heighten suspicion for AIFS in the appropriate clinical setting, prompting urgent surgical exploration regardless of nasal endoscopy findings.
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Affiliation(s)
| | - Allison Coombs
- Department of Ophthalmology, Edward Harkness Eye Institute
| | - Nahill Matari
- Department of Radiology, Columbia University Irving Medical Center, New York, U.S.A
| | - Angela Lignelli
- Department of Radiology, Columbia University Irving Medical Center, New York, U.S.A
| | - Michael Kazim
- Department of Ophthalmology, Edward Harkness Eye Institute
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Aljubran HJ, Bamalan OA, Alabdulaal MR, Almolani F, Alahmari MS, Alkhatib A, Almomen A. Mortality patterns in chronic granulomatous invasive fungal rhinosinusitis: insights from two fatal cases. J Surg Case Rep 2024; 2024:rjae770. [PMID: 39669287 PMCID: PMC11635823 DOI: 10.1093/jscr/rjae770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2024] [Accepted: 11/19/2024] [Indexed: 12/14/2024] Open
Abstract
Chronic granulomatous invasive fungal rhinosinusitis (CGIFRS) is a type of invasive fungal rhinosinusitis that is characterized by the presence of pathologic findings of non-caseating granulomas in the paranasal sinuses. This article describes two cases of CGIFRS with fatal outcomes. The first case was for a 36-year-old man who presented with headache, dizziness, and vomiting for 1 month. This patient had received the traditional treatment, although the patient's condition suddenly deteriorated after 1 week of surgery and died due to the disease's complications. Similarly, the second case was for a 31-year-old man who presented with bilateral nasal obstruction and left eye proptosis for 1 year. This patient had a recurrence of CGIFRS after the first presentation, which was complicated by a cerebral abscess after 2 months of surgery. This study, therefore, underscores the severity of CGIFRS as a potentially fatal disease.
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Affiliation(s)
- Hussain J Aljubran
- College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam 43221, Saudi Arabia
| | - Omar A Bamalan
- Department of Surgery, Security Forces Hospital, Dammam 43221, Saudi Arabia
| | | | - Fadhel Almolani
- Department of Radiology, King Fahad Specialist Hospital, Dammam 32253, Saudi Arabia
| | - Mohammad S Alahmari
- Department of Otolaryngology Head and Neck Surgery, King Fahad Specialist Hospital, Dammam 32253, Saudi Arabia
| | - Abdulrahman Alkhatib
- Department of Otolaryngology Head and Neck Surgery, King Fahad Specialist Hospital, Dammam 32253, Saudi Arabia
| | - Ali Almomen
- Department of Otolaryngology Head and Neck Surgery, King Fahad Specialist Hospital, Dammam 32253, Saudi Arabia
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Mosito SM, Saeedullah S, Robinson L, Houghton SJ, Quitter C. Chronic Granulomatous Invasive Fungal Rhinosinusitis With Intracranial Extension in an Immunocompetent Patient: A Case Report. Cureus 2024; 16:e71236. [PMID: 39525206 PMCID: PMC11550388 DOI: 10.7759/cureus.71236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/10/2024] [Indexed: 11/16/2024] Open
Abstract
Chronic granulomatous invasive fungal rhinosinusitis (CGIFRS) is an uncommon disease pathology seen in immunocompetent patients. The most common causative fungal agents reported in the literature are members of the Aspergillus species. CGIFRS may be mistaken for sinonasal malignancy because of its invasive pattern. This article reports a case of CGIFRS in an immunocompetent male patient with intracranial extension who responded well to antifungals (liposomal Amphotericin and Itraconazole) after surgical debulking. Appropriate clinicopathological evaluation and diagnosis are essential for proper management. Only a few such cases have been reported in the literature. In the Republic of South Africa, no case of CGIFRS with intracranial extension has been reported prior to this case.
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Affiliation(s)
- Sylvia M Mosito
- Otolaryngology - Head and Neck Surgery, University of Pretoria, Pretoria, ZAF
| | - Shehzad Saeedullah
- Otolaryngology - Head and Neck Surgery, Northwest General Hospital, Peshawar, PAK
| | - Liam Robinson
- Maxillofacial Radiology, Steve Biko Academic Hospital, Pretoria, ZAF
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Kim TH, Kim S. Persistent Severe Headache After Removal of Fungus Ball From the Sphenoid Sinus: A Case Report. Ann Otol Rhinol Laryngol 2024; 133:755-759. [PMID: 38726728 DOI: 10.1177/00034894241253961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/31/2024]
Abstract
OBJECTIVE Granulomatous invasive fungal sinusitis (GIFS) is a rare and life-threatening disease, whereas fungus ball (FB) is the most common form of noninvasive fungal sinusitis. Both GIFS and FB primarily develop in immunocompetent patients, with the former associated with higher mortality and morbidity. METHODS A chart review and review of the literature. RESULTS We present the case of a 77-year-old woman with mixed fungal sinusitis who was successfully treated with voriconazole. CONCLUSIONS GIFS and FB can coexist in extremely rare cases, known as mixed fungal sinusitis; however, the diagnosis and subsequent treatment of mixed fungal sinusitis can be delayed because of a lack of awareness of the underlying concept. Therefore, it is crucial for clinicians to recognize the concept of mixed fungal sinusitis.
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Affiliation(s)
- Tae Hoon Kim
- Department of Otorhinolaryngology-Head & Neck Surgery, Daegu Fatima Hospital, Daegu, South Korea
| | - SungHee Kim
- Department of Otorhinolaryngology-Head & Neck Surgery, Daegu Fatima Hospital, Daegu, South Korea
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Kordjazi M, Bazgir N, Eftekharian K, Farajpour M, Dilmaghani NA. Manifestations of Mucormycosis and Its Complications in COVID-19 Patients: A Case Series Study. EAR, NOSE & THROAT JOURNAL 2024; 103:145S-152S. [PMID: 36583239 PMCID: PMC9805989 DOI: 10.1177/01455613221143859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 11/16/2022] [Accepted: 11/18/2022] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVE Mucormycosis is an opportunistic fungal disease that affects immunocompromised patients. With the advent of SARS-CoV-2, this opportunistic disease has increased. METHODS A case series of 47 patients with COVID-19 associated mucormycosis have been analyzed. Demographic information, signs, symptoms, laboratory investigations, imaging studies, and their association with ICU admission and 30-day mortality were assessed. RESULTS Total number of 47 consecutive rhino-orbital cerebral mucormycosis (ROCM) cases were analyzed. Periorbital swelling was the most common sign among patients. Majority of cases had diabetes. All patients received liposomal Amphotericin B. Debridement was performed for all cases. CONCLUSIONS SARS-CoV-2 increases the susceptibility to mucormycosis infection in various ways. Uncontrolled level of HbA1c in all patients, even non-diabetic individuals, indicates hyperglycemia over the past three months. Diabetes, orbital exenteration, ptosis, periorbital swelling, DKA, LOC, brain involvement, and mechanical ventilation all correlated with a higher rate of ICU admission and 30-day mortality. In addition, a higher white blood cell count is related to the higher probability of ICU admission. While considering all of the inflammatory laboratory data and HbA1c could help predict 30-day mortality.
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Affiliation(s)
- Mohammadsmaeil Kordjazi
- Departmentof Otorhinolaryngology,
Loghman Hakim Educational Hospital, Shahid Beheshti University of Medical
Sciences, Tehran, Iran
| | - Narges Bazgir
- School of Medicine, Shahid Beheshti University of Medical
Sciences, Tehran, Iran
| | - Kourosh Eftekharian
- Department of Otolaryngology, Head
and Neck Surgery, Loghman Hakim Educational Hospital, School of Medicine, Shahid Beheshti University of Medical
Sciences, Tehran, Iran
| | - Mostafa Farajpour
- Depatement of general surgery, Arak University of Medical
Sciences, Arak, Iran
| | - Nader Akbari Dilmaghani
- Department of Otolaryngology, Head
and Neck Surgery, Loghman Hakim Educational Hospital, School of Medicine, Shahid Beheshti University of Medical
Sciences, Tehran, Iran
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Bahethi R, Talmor G, Choudhry H, Lemdani M, Singh P, Patel R, Hsueh W. Chronic invasive fungal rhinosinusitis and granulomatous invasive fungal sinusitis: A systematic review of symptomatology and outcomes. Am J Otolaryngol 2024; 45:104064. [PMID: 37769504 DOI: 10.1016/j.amjoto.2023.104064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 09/18/2023] [Accepted: 09/20/2023] [Indexed: 10/03/2023]
Abstract
INTRODUCTION Chronic invasive fungal rhinosinusitis (CIFRS) and granulomatous invasive fungal sinusitis are two uncommon diseases differentiated primarily by the pathologic finding of non-caseating granulomas in GIFRS. Both share many similarities in presentation. We aim to characterize the symptomatology and outcomes of these diseases. METHODS A comprehensive search strategy was designed to identify studies in the Cochrane, EMBASE and PubMed databases from database inception to January 2022. Inclusion criteria included all patients with a diagnosis of either CIFRS or GIFRS. All studies were screened by two reviewers. Chi-square analyses were used where appropriate. RESULTS 51 studies were included totaling 513 patients. The majority were diagnosed with CIFRS (389, 75.8 %) compared to GIFRS (124, 24.4 %). CIFRS was more common in immunocompromised or diabetic patients (p < 0.0001; p = 0.02). Patients with CIFRS were more likely to exhibit nasal symptoms including discharge (p = 0.0001), obstruction (p = 0.03) and congestion (p = 0.001) as well as systemic symptoms including fever, which no GIFRS patient exhibited, facial pain (p = 0.007), headache (p = 0.004). Aspergillus was the most common organism identified in both groups with a slight predominance among GIFRS patients (p = 0.01). GIFRS patients were also more likely to present with no identifiable organisms (p = 0.0006). CIFRS patients were more likely to die of disease (p = 0.0008). CONCLUSIONS CIFRS generally presents with more symptoms and is associated with poorer outcomes primarily occurring in an immunocompromised population. GIFRS likely follows a more insidious course in immunocompetent patients. Understanding the key differences in symptomatology and outcomes for these two populations is critical for appropriate diagnosis and prognostication.
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Affiliation(s)
- Rohini Bahethi
- Department of Otolaryngology-Head and Neck Surgery at Rutgers New, Jersey Medical School, Newark, NJ, United States.
| | - Guy Talmor
- Department of Otolaryngology-Head and Neck Surgery at Rutgers New, Jersey Medical School, Newark, NJ, United States
| | - Hannaan Choudhry
- Department of Otolaryngology-Head and Neck Surgery at Rutgers New, Jersey Medical School, Newark, NJ, United States
| | - Mehdi Lemdani
- Department of Otolaryngology-Head and Neck Surgery at Rutgers New, Jersey Medical School, Newark, NJ, United States
| | - Priyanka Singh
- Department of Otolaryngology-Head and Neck Surgery at Rutgers New, Jersey Medical School, Newark, NJ, United States
| | - Rushi Patel
- Department of Otolaryngology-Head and Neck Surgery at Rutgers New, Jersey Medical School, Newark, NJ, United States
| | - Wayne Hsueh
- Department of Otolaryngology-Head and Neck Surgery at Rutgers New, Jersey Medical School, Newark, NJ, United States
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Agarwal V, Kumia K, Gupta A, Singh V. Local injection of amphotericin B: novel use in the treatment of fungal maxillary sinusitis. Int J Oral Maxillofac Surg 2023; 52:1282-1285. [PMID: 37550130 DOI: 10.1016/j.ijom.2023.07.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 07/11/2023] [Accepted: 07/24/2023] [Indexed: 08/09/2023]
Abstract
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.
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Affiliation(s)
- V Agarwal
- Department of Oral Medicine and Radiology, Maulana Azad Institute of Dental Sciences, New Delhi, India
| | - K Kumia
- Department of Oral Medicine and Radiology, Post Graduate Institute of Dental Sciences, Rohtak, India
| | - A Gupta
- Department of Oral Medicine and Radiology, Post Graduate Institute of Dental Sciences, Rohtak, India.
| | - V Singh
- Department of Oral and Maxillofacial Surgery, Post Graduate Institute of Dental Sciences, Rohtak, India
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Bhavana K, Vaidyanathan A, Haidry N, Bharti B, Kumar A, Shivhare P. A Novel Classification System for Oral Cavity Mucormycosis: a Hospital Based Cross-Sectional Study. J Maxillofac Oral Surg 2023; 22:1139-1147. [PMID: 38105861 PMCID: PMC10719203 DOI: 10.1007/s12663-023-01951-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 05/29/2023] [Indexed: 12/19/2023] Open
Abstract
Background Rhino-oculo-cerebral Mucormycosis (ROCM) is a well-known complication post-COVID-19 infection. The extension of this disease into the oral cavity is a grey area with no proper protocol for management of the same in the existing literature. Based on our experience in the management of oral extension, this study aims to propose a protocol to treat these cases. Aim To derive a classification for the surgeon from retrospectively collected data of 53 operated cases of oral Mucormycosis. Settings and Design Hospital record-based cross-sectional study; evaluation of the previously treated 53 cases of oral extension of post-COVID-19 Rhino-oculo-cerebral Mucormycosis in the duration between May 2021 to August 2021. Follow-up for a period of 1 year. Methods and Material Based on the preoperative data, 4 parameters were taken -Tooth tenderness, Tooth mobility, Palatal perforation, and Radiological findings. A clinical-radiological classification system was derived based on the intraoperative data from the OT notes and the preoperative findings corresponding to the 4 parameters. Statistical Analysis The statistical analysis was done using SPSS for windows version 20 software (SPSS Inc., Chicago, IL, USA). Results Totally 220 cases of ROCM were recorded in our institute. Of this, 53 patients were treated for ROCM extending into the oral cavity. In 27 patients, we were able to achieve primary closure. In 26 patients, there was oro-antral communication after removal of the palate. Based on this data, we derived a protocol that may be used by the treating surgeon to manage oral cavity cases of ROCM, so that aggressive tissue resection may be avoided unnecessarily. Conclusion This protocol will help the treating surgeon to have a clearer outlook on treating this disease.
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Affiliation(s)
- Kranti Bhavana
- Department of ENT, AIIMS, All India Institute of Medical Sciences, Phulwarisharif, Patna, Bihar 801507 India
| | - Aiswarya Vaidyanathan
- Department of Dentistry, AIIMS, All India Institute of Medical Sciences, Phulwarisharif, Patna, Bihar 801507 India
| | - Naqoosh Haidry
- Department of Dentistry, AIIMS, All India Institute of Medical Sciences, Phulwarisharif, Patna, Bihar 801507 India
| | - Bhartendu Bharti
- Department of ENT, AIIMS, All India Institute of Medical Sciences, Phulwarisharif, Patna, Bihar 801507 India
| | - Anil Kumar
- Trauma and Emergency medicine, AIIMS, All India Institute of Medical Sciences, Phulwarisharif, Patna, Bihar 801507 India
| | - Peeyush Shivhare
- Department of Dentistry, AIIMS, All India Institute of Medical Sciences, Phulwarisharif, Patna, Bihar 801507 India
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B H S, Kumbhalkar S, Selvi K, G D, Bidkar V, Dabhekar S, Prathipati K, Sawal A. Sinonasal and Orbital Imaging Findings in COVID-Associated Rhino-Orbito-Cerebral Mucormycosis During the Second Wave of COVID-19: A Retrospective Cohort Study in a Tertiary Hospital in Central India. Cureus 2023; 15:e42674. [PMID: 37649953 PMCID: PMC10463103 DOI: 10.7759/cureus.42674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 07/30/2023] [Indexed: 09/01/2023] Open
Abstract
Background Mucormycosis is a consequence of the angioinvasive disease caused by filamentous fungi that belong to the order Mucorales, particularly Mucor, Rhizopus, and Rhizomucor. Rhizopus oryzae is the most prevalent form. The invading hyphae lead to damage of blood vessels leading to thrombosis and consequent tissue necrosis. The incidence of this disease entity witnessed a significant rise during the second wave of the coronavirus disease 2019 (COVID-19) pandemic. Timely diagnosis and prompt treatment are crucial to diminish both the mortality and morbidity associated with this disease. Imaging plays a pivotal role in diagnosing the ailment, evaluating its extent, identifying complications such as thrombosis, and facilitating surgical planning. It demonstrates exceptional sensitivity in detecting the disease at its early stages, often before symptoms manifest. Due to the angioinvasive nature of Mucor, early detection assumes utmost importance as it necessitates intensive antifungal therapy and the removal of devitalized tissue through debridement. Methodology We conducted a retrospective cohort study to analyze computed tomography (CT) imaging findings in patients with COVID-associated rhino-orbito-cerebral mucormycosis (ROCM) confirmed by histopathological examination. We compared these findings with CT findings of the nose and paranasal sinuses in patients without mucor following COVID-19 sinusitis (non-ROCM). Results All 16 cases in the non-ROCM group were in stage 1 disease. In contrast, in the ROCM group, three patients had stage 1 disease, five patients had stage 2 disease, and 10 patients had stage 3 disease (p = 0.0001). The pterygopalatine fossa was significantly affected in 10 of 18 ROCM patients and in none of the non-ROCM patients. Conclusions Imaging plays a crucial role in the early detection of mucormycosis. It assists treating physicians in initiating prompt and aggressive treatment, thereby improving the prognosis of this frequently fatal disease.
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Affiliation(s)
- Shrikrishna B H
- Otolaryngology - Head and Neck Surgery, All India Institute of Medical Sciences, Bibinagar, Hyderabad, IND
| | - Sunita Kumbhalkar
- General Medicine, All India Institute of Medical Sciences, Nagpur, Nagpur, IND
| | - Kalai Selvi
- Community Medicine, All India Institute of Medical Sciences, Nagpur, Nagpur, IND
| | - Deepa G
- Anatomy, Datta Meghe Medical College, Nagpur, IND
| | - Vijay Bidkar
- Otolaryngology - Head and Neck Surgery, All India Institute of Medical Sciences, Nagpur, Nagpur, IND
| | - Sandeep Dabhekar
- Otolaryngology - Head and Neck Surgery, All India Institute of Medical Sciences, Nagpur, Nagpur, IND
| | - Kirankumar Prathipati
- Otolaryngology - Head and Neck Surgery, All India Institute of Medical Sciences, Nagpur, Nagpur, IND
| | - Anupama Sawal
- Anatomy, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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Hassan RM, Almalki YE, Basha MAA, Gobran MA, Alqahtani SM, Assiri AM, Alqahtani S, Alduraibi SK, Aboualkheir M, Almushayti ZA, Aldhilan AS, Aly SA, Alshamy AA. Magnetic Resonance Imaging Features of Rhino-Orbito-Cerebral Mucormycosis in Post-COVID-19 Patients: Radio-Pathological Correlation. Diagnostics (Basel) 2023; 13:diagnostics13091546. [PMID: 37174937 PMCID: PMC10177362 DOI: 10.3390/diagnostics13091546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 04/19/2023] [Accepted: 04/23/2023] [Indexed: 05/15/2023] Open
Abstract
There has been a notable increase in rhino-orbito-cerebral mucormycosis (ROCM) post-coronavirus disease 2019 (COVID-19), which is an invasive fungal infection with a fatal outcome. Magnetic resonance imaging (MRI) is a valuable tool for early diagnosis of ROCM and assists in the proper management of these cases. This study aimed to describe the characteristic MRI findings of ROCM in post-COVID-19 patients to help in the early diagnosis and management of these patients. This retrospective descriptive study was conducted at a single hospital and included 52 patients with COVID-19 and a histopathologically proven ROCM infection who were referred for an MRI of the paranasal sinuses (PNS) due to sino-orbital manifestations. Two radiologists reviewed all the MR images in consensus. The diagnosis was confirmed by histopathological examination. The maxillary sinus was the most commonly affected PNS (96.2%). In most patients (57.7%), multiple sinuses were involved with the black turbinate sign on postcontrast images. Extrasinus was evident in 43 patients with orbital involvement. The pterygopalatine fossa was involved in four patients. Three patients had cavernous sinus extension, two had pachymeningeal enhancement, and one had epidural collection. The alveolar margin was affected in two patients, and five patients had an extension to the cheek. The awareness of radiologists by the characteristic MRI features of ROCM in post-COVID-19 patients helps in early detection, early proper management, and prevention of morbid complications.
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Affiliation(s)
- Rania Mostafa Hassan
- Department of Diagnostic Radiology, Faculty of Human Medicine, Zagazig University, Zagazig 44519, Egypt
| | - Yassir Edrees Almalki
- Division of Radiology, Department of Internal Medicine, Medical College, Najran University, Najran 61441, Saudi Arabia
| | | | - Mai Ahmed Gobran
- Department of Surgical Pathology, Faculty of Human Medicine, Zagazig University, Zagazig 44519, Egypt
| | - Saad Misfer Alqahtani
- Department of Pathology, College of Medicine, Najran University Hospital, Najran University, Najran 61441, Saudi Arabia
| | - Abdullah M Assiri
- Department of Surgery, College of Medicine, Najran University, Najran 61441, Saudi Arabia
| | - Saeed Alqahtani
- Department of Surgery, College of Medicine, Najran University, Najran 61441, Saudi Arabia
| | | | - Mervat Aboualkheir
- Department of Radiology and Medical Imaging, College of Medicine, Taibah University, Madinah 42353, Saudi Arabia
| | - Ziyad A Almushayti
- Department of Radiology, College of Medicine, Qassim University, Buraidah 52571, Saudi Arabia
| | - Asim S Aldhilan
- Department of Radiology, College of Medicine, Qassim University, Buraidah 52571, Saudi Arabia
| | - Sameh Abdelaziz Aly
- Department of Diagnostic Radiology, Faculty of Human Medicine, Benha University, Benha 13511, Egypt
| | - Asmaa A Alshamy
- Department of Diagnostic Radiology, Faculty of Human Medicine, Zagazig University, Zagazig 44519, Egypt
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Rupa V, Peter J, Michael JS, Thomas M, Irodi A, Rajshekhar V. Chronic Granulomatous Invasive Fungal Sinusitis in Patients With Immunocompetence: A Review. Otolaryngol Head Neck Surg 2023; 168:669-680. [PMID: 35503655 DOI: 10.1177/01945998221097006] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Accepted: 04/05/2022] [Indexed: 11/16/2022]
Abstract
OBJECTIVE We aimed to study the literature on chronic granulomatous invasive fungal sinusitis to elucidate the changing trends in the management of the disease. DATA SOURCES Using specific keywords, we searched the PubMed, PubMed Central, and Scopus databases over the past 50 years, which yielded 938 articles in the English language. REVIEW METHODS Scrutiny of 147 relevant articles revealed 15 homogenous case series (255 cases of histologically proven chronic granulomatous fungal sinusitis alone) and 8 heterogeneous case series (patients with other types of fungal sinusitis included), which were analyzed in detail (all with >5 cases each). CONCLUSIONS The disease typically affected middle-aged adults with immunocompetence. Most reports were from Sudan, India, and Saudi Arabia. A slowly progressive orbital, cheek, or palatal mass with proptosis (88.2%) or sinonasal symptoms (39.2%) was typical. Ethmoid (57.2%) and maxillary (51.4%) sinuses were chiefly affected with intracranial extension in 35.1%. Aspergillus flavus (64%) was the most frequent isolate reported. Endoscopic excision (78.8%) followed by azole therapy was the preferred treatment in recent reports. Orbital exenteration and craniotomy were infrequently performed. Complete resolution or improvement was reported in 91.3% of patients. Mortality ranged from 5.9% to 22.2%. There is a trend in the literature toward less radical and disfiguring surgery and preferential use of azoles, with good outcomes even in advanced cases. IMPLICATIONS FOR PRACTICE Chronic granulomatous fungal sinusitis should be diagnosed on the basis of well-defined histopathologic features. A combination of endoscopic sinus surgery and azole therapy usually yields good outcomes.
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Affiliation(s)
- Vedantam Rupa
- Department of Otorhinolaryngology, Christian Medical College Hospital, Vellore, India
| | - Jayanthi Peter
- Department of Ophthalmology, Christian Medical College Hospital, Vellore, India
| | | | - Meera Thomas
- Department of Pathology, Christian Medical College Hospital, Vellore, India
| | - Aparna Irodi
- Department of Radiology, Christian Medical College Hospital, Vellore, India
| | - Vedantam Rajshekhar
- Department of Neurological Sciences, Christian Medical College Hospital, Vellore, India
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Saneesh PS, Morampudi SC, Yelamanchi R. Radiological review of rhinocerebral mucormycosis cases during the COVID-19 Pandemic: A single-center experience. World J Radiol 2022; 14:209-218. [PMID: 36160626 PMCID: PMC9350613 DOI: 10.4329/wjr.v14.i7.209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 06/09/2022] [Accepted: 07/18/2022] [Indexed: 02/06/2023] Open
Abstract
Mucormycosis is caused by the fungi belonging to the order Mucorales and class Zygomycetes. The incidence of mucormycosis has increased with the onset of the severe acute respiratory syndrome coronavirus 2 infections leading to the coronavirus disease 2019 (COVID-19) pandemic. This rise is attributed to the use of immunosuppressive medication to treat COVID-19 infections. Authors have retrospectively collected data of our cases of mucormycosis diagnosed from April 2020 to April 2021 at our institute. A total of 20 patients with rhinocerebral mucormycosis were studied. Most of the study subjects were male patients (90%) and were of the age group 41-50 years. Most patients in the review had comorbidities (85%) with diabetes being the most common comorbidity. Para nasal sinuses were involved in all the cases. Involvement of the neck spaces was present in 60% of the cases. Involvement of the central nervous system was present in 80% of the cases. Orbital involvement was present in 90% of the cases. The authors reviewed the various imaging findings of mucormycosis on computed tomography and magnetic resonance imaging in this article.
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Affiliation(s)
- P S Saneesh
- Department of Radiology, Aster MIMS, Kannur 670007, Kerala, India
| | - Satya Chowdary Morampudi
- Department of Radiodiagnosis, Pinnamaneni Siddhartha Institute of Medical Sciences & Research Foundation, Gannavaram 521101, Andhra Pradesh, India
| | - Raghav Yelamanchi
- Department of Surgery, Atal Bihari Vajpayee Institute of Medical Sciences and Dr. Ram Manohar Lohia Hospital, Delhi 110001, Delhi, India
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Pham J, Kulla B, Johnson M. Invasive fungal infection caused by curvularia species in a patient with intranasal drug use: A case report. Med Mycol Case Rep 2022; 37:1-3. [PMID: 35620354 PMCID: PMC9127524 DOI: 10.1016/j.mmcr.2022.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 05/04/2022] [Accepted: 05/07/2022] [Indexed: 11/29/2022] Open
Abstract
Chronic invasive fungal sinusitis (CIFS) is an invasive fungal infection that can occur in immunocompetent individuals and is typically caused by Aspergillus species. Although many reported cases are unable to identify an etiology for the infection, certain risk factors such as chronic intranasal cocaine use can make patients susceptible to CIFS. This case report describes a unique case of CIFS secondary to Curvularia species in an immunocompetent patient with intranasal drug use.
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Kamath S, Kumar M, Sarkar N, Ahmed T, Sunder A. Study of Profile of Mucormycosis During the Second Wave of COVID-19 in a Tertiary Care Hospital. Cureus 2022; 14:e21054. [PMID: 35155019 PMCID: PMC8824768 DOI: 10.7759/cureus.21054] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/08/2022] [Indexed: 12/23/2022] Open
Abstract
Introduction and aim Mucormycosis is a lethal opportunistic infection caused by filamentous fungi of the family Mucoraceae (black fungus). There has been a sudden increase in the incidence of these cases during the second wave of the COVID-19 pandemic due to the immunocompromised state caused by the disease and its treatment. Early diagnosis and appropriate medical management are essential to reduce disease morbidity and mortality. Through this study, we aim to study the clinical features, risk factors, laboratory investigations, and radiological findings of patients with mucormycosis as well as evaluate the clinical outcomes in each case. Methods and materials This was a prospective study that included only confirmed mucormycosis cases admitted in Tata Main Hospital (TMH) from April 2021 to July 2021. A case of mucormycosis was defined as the one in which clinical and radiological features were consistent with mucormycosis and fungus was demonstrated in the tissue by potassium hydroxide (KOH) mount/culture/histopathological examination (HPE). Data relating to epidemiology, risk factors, clinico-radiological features, and outcomes were analyzed and expressed as a percentage of total cases. Results Of the total 15 cases, three patients (33.3%) had active COVID-19 infection, eight (53.3%) were in the post-COVID-19 state, two (13.4%) had COVID-19 like illness and two (13.4%) patients did not have COVID-19 in the recent past. There was male predominance with the male to female ratio being 2.75:1. The commonest associated co-morbid condition was diabetes mellitus (13 patients, 86.7%). Amongst the myriad manifestations, periorbital swelling was the commonest symptom (11 patients, 73.3%). Among neurological manifestations, involvement of cranial nerves was found in nine (60%) patients with the third cranial nerve being the most commonly affected nerve (eight patients, 53.3%). Cavernous sinus thrombosis (CST) was found in one (6.7%) patient. Diagnostic nasal endoscopy (DNE) revealed eschar at various sites in 13 patients (86.7%). Central retinal artery occlusion (CRAO) was found bilaterally in one patient (6.7%) while two patients (13.3%) had CRAO on the left. Radiologically, the most commonly involved sinuses were maxillary and ethmoidal (eight patients, 53.3%). Bilateral sinus involvement was more common (46.7%) than unilateral sinus involvement. The average length of stay (LOS) was 17.5±7.8 days. The overall mortality was 40%. Five (33.3%) patients developed secondary bacterial infections. All patients received medical therapy with intravenous amphotericin B. In addition, seven (46.7%) patients underwent functional endoscopic sinus surgery (FESS) with debridement of which, five (71.4%) patients survived and made a good recovery. One patient (6.7%) with pulmonary mucormycosis underwent lobectomy. Conclusion New-onset headache, black nasal discharge, periorbital swelling, retro-orbital pain, visual diminution, restriction of eye movements should prompt an immediate search for mucormycosis especially in the background of history of diabetes mellitus in patient with recent or current COVID-19 disease. Radio-imaging with computerized tomography and magnetic resonance imaging are complementary to clinical evaluation in assessing the disease extent and diagnosis of complications. Prompt diagnosis is essential due to the angio-invasive nature of the mucor and requires aggressive anti-fungal therapy and debridement of the devitalized tissue.
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Affiliation(s)
| | - Manish Kumar
- Internal Medicine, Tata Main Hospital, Jamshedpur, IND
| | | | - Tauheed Ahmed
- Internal Medicine, Tata Main Hospital, Jamshedpur, IND
| | - Ashok Sunder
- Internal Medicine, Tata Main Hospital, Jamshedpur, IND
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Yadav T, Tiwari S, Gupta A, Garg PK, Khera PS, Rajagopal R, Goyal A, Soni K, Chugh A, Jain V, Sureka B, Elhence P, Misra S. Magnetic Resonance Imaging in Coronavirus Disease - 2019 Associated Rhino-Orbital-Cerebral Mucormycosis (CA-ROCM) - Imaging Analysis of 50 Consecutive Patients. Curr Probl Diagn Radiol 2022; 51:112-120. [PMID: 34802841 PMCID: PMC8564981 DOI: 10.1067/j.cpradiol.2021.09.004] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 09/14/2021] [Accepted: 09/19/2021] [Indexed: 01/04/2023]
Abstract
BACKGROUND AND PURPOSE Rhino-orbital-cerebral mucormycosis has emerged as a major opportunistic infection in patients with COVID-19. High clinical suspicion and prompt imaging are crucial for early diagnosis and management. Our study evaluates imaging characteristics of patients with COVID-19 associated Rhino-orbital-cerebral Mucormycosis (CA-ROCM) in a tertiary care hospital in India. MATERIALS AND METHODS A retrospective analysis of clinical and imaging data of patients with CA-ROCM who presented between December 2020 to June 2021 was performed. All patients had microbiologically or histologically proven sino-nasal mucormycosis along with documented SARS-CoV-2 positive RT-PCR test and/or classical lung imaging features of COVID-19 infection. The extent of sinus involvement, bony erosions, extra-sinus soft tissue extension, orbital-intracranial invasion, perineural spread, and vascular complications were assessed. RESULTS Fifty patients were included for the final analysis. Diabetes was the most common associated comorbidity. Seven patients presented with stage I disease, 18 patients with stage II, and 25 patients with stage III disease. The stage of disease showed a positive statistical correlation with HbA1c levels using Pearson's correlation. The common imaging features were "Black turbinate sign" and nonenhancing sino-nasal mucosa (82%), orbital involvement (76%), and diffusion restriction in the optic nerve (24%). Intracranial involvement was seen as perineural extension into the brain (42%), cerebritis (30%), and internal carotid artery involvement (16%). CONCLUSIONS CA-ROCM is an acute invasive fungal sinusitis with an aggressive clinical course. Black-turbinate sign and peri-antral soft tissue infiltration are early features, whereas extra-nasal tissue infarction, optic nerve diffusion restriction, and vascular invasion are seen with advanced disease.
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Affiliation(s)
- Taruna Yadav
- Department of Diagnostic and Interventional radiology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Sarbesh Tiwari
- Department of Diagnostic and Interventional radiology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India,Reprint requests: Dr. Sarbesh Tiwari MD., DM, Department of Diagnostic and Interventional Radiology, All India Institute of Medical Sciences-Jodhpur, Rajasthan 342008
| | - Aanchal Gupta
- Department of Diagnostic and Interventional radiology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Pawan Kumar Garg
- Department of Diagnostic and Interventional radiology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Pushpinder Singh Khera
- Department of Diagnostic and Interventional radiology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Rengarajan Rajagopal
- Department of Diagnostic and Interventional radiology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Amit Goyal
- Department of E.N.T.-Otorhinolaryngology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Kapil Soni
- Department of E.N.T.-Otorhinolaryngology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Ankita Chugh
- Department of Dentistry, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Vidhi Jain
- Department of Microbiology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Binit Sureka
- Department of Diagnostic and Interventional radiology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Poonam Elhence
- Department of Pathology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Sanjeev Misra
- Professor Department of Surgical Oncology, Director and CEO, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
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Treviño-Gonzalez JL, Santos-Santillana KM, Maldonado-Chapa F, Morales-Del Angel JA, Gomez-Castillo P, Cortes-Ponce JR. "Chronic granulomatous invasive fungal rhinosinusitis associated with SARS-CoV-2 infection: A case report". Ann Med Surg (Lond) 2021; 72:103129. [PMID: 34873446 PMCID: PMC8636311 DOI: 10.1016/j.amsu.2021.103129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 11/22/2021] [Accepted: 11/30/2021] [Indexed: 11/18/2022] Open
Abstract
Introduction and importance Granulomatous chronic invasive fungal rhinosinusitis (GCIFR) is a rare entity with scarce cases reported mainly in subtropical areas. Its prevalence among individuals with clinical suspicion of fungal rhinosinusitis has been reported in approximately 20% in subtropical populations, unlike North America with a prevalence of 0.5%. It is typically associated with Aspergillus flavus and the presence of noncaseating granulomas or Langerhans giant cells on histopathologic examination. Case presentation We describe a case of a patient with clinical history of recent SARS-CoV-2 infection and development of intense cephalalgia, visual impairment, palpebral ptosis, and limitation of extraocular movements. MRI demonstrated the presence of opacification of paranasal sinuses, and a left intraconal abscess. A surgical endoscopic approach was performed and histopathologic examination revealed frontal GCIFR and maxillary fungus ball. Treatment with IV azoles provided adequate clinical response. Clinical discussion The spectrum of the fungal rhinosinusitis disease is not clear. However, non-invasive fungal rhinosinusitis is not often found concomitantly with invasive types. GCIFR typically manifests with an indolent and gradual progression at early stages. Advanced stages can exhibit orbital and intracranial involvement leading to visual impairment, frequent relapses, and a poor prognosis. A higher incidence of invasive fungal rhinosinusitis has been reported in patients with SARS-CoV-2 infection despite an unremarkable medical history, associated with immune dysregulation. Conclusion GCIFR is a rare condition with few cases reported in America. Because of its uncommonness, its diagnosis is often delayed leading to increased morbidity and mortality.
Granulomatous chronic invasive fungal rhinosinusitis is a rare entity with scarce cases reported. Non-invasive fungal rhinosinusitis is not often found concomitantly with invasive types. A higher incidence of invasive fungal rhinosinusitis is observed in SARS-CoV-2 infection. Early diagnosis of fungal rhinosinusitis is essential due to possibly fatal outcome. Physicians should be aware of atypical manifestations for a prompt diagnosis.
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Affiliation(s)
| | | | | | - Josefina Alejandra Morales-Del Angel
- Corresponding author. Otolaryngology and Head and Neck Surgery Division, School of Medicine and University Hospital “Dr. Jose E. González”, Universidad Autónoma de Nuevo León, Ave. Madero y Gonzalitos s/n, Mitras Centro, 64460, Monterrey, Nuevo Leon, Mexico.
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Vaid N, Mishra P, Gokhale N, Vaid S, Vaze V, Kothadiya A, Deka T, Agarwal R. A Proposed Grading System and Experience of COVID-19 Associated Rhino Orbito Cerebral Mucormycosis from an Indian Tertiary Care Center. Indian J Otolaryngol Head Neck Surg 2021; 74:3505-3512. [PMID: 34804905 PMCID: PMC8591427 DOI: 10.1007/s12070-021-02986-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 11/08/2021] [Indexed: 12/30/2022] Open
Abstract
Mucormycosis is an opportunistic fungal infection. India faced an unprecedented increase in patients with post coronavirus disease 2019 (COVID-19) associated rhino-orbito-cerebral mucormycosis (ROCM). This study proposes a grading system which correlates the extent of the disease with the management plan. An observational study was conducted January 2021–June 2021. We identified 65 patients. Eleven patients had mild disease, 27 patients had moderate, 16 patients were severe and 11 patients were graded as very severe. The management was planned based on this grading system. Early diagnosis, aggressive surgical debridement and antifungal drug therapy is the key to improve survival in ROCM. Procedures such as endoscopic orbital clearance, sublabial maxillectomy, and modified endoscopic Denkers (MED) approach facilitate access and surgical debridement. The new grading system proposed assists in planning the approach and extent of surgical debridement.
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Affiliation(s)
- Neelam Vaid
- Department of Otorhinolaryngology, KEM Hospital, Pune, Maharashtra India
| | - Prasun Mishra
- Department of Otorhinolaryngology, Bharati Vidyapeeth Medical College, Pune, Maharashtra India
| | - Nikhil Gokhale
- Department of Otorhinolaryngology, KEM Hospital, Pune, Maharashtra India
| | - Sanjay Vaid
- Head Neck & ENT Division, Star Imaging and Research Centre, Pune , Maharashtra India
| | - Varada Vaze
- Department of Otorhinolaryngology, KEM Hospital, Pune, Maharashtra India
| | - Ajay Kothadiya
- Department of Otorhinolaryngology, KEM Hospital, Pune, Maharashtra India
| | - Trisha Deka
- Department of Otorhinolaryngology, KEM Hospital, Pune, Maharashtra India
| | - Rashmi Agarwal
- Department of Otorhinolaryngology, KEM Hospital, Pune, Maharashtra India
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Deshpande P, Patil K, Guledgud MV, Prashanthi NM. Diagnosis of the misdiagnosed: Mucormycosis depicting periodontitis. J Indian Soc Periodontol 2021; 25:443-447. [PMID: 34667390 PMCID: PMC8452173 DOI: 10.4103/jisp.jisp_720_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Revised: 04/02/2021] [Accepted: 04/04/2021] [Indexed: 12/05/2022] Open
Abstract
Oral cavity is habitat for plethora of micro-organism causing various diseases. The most common includes dental caries, periodontal diseases, etc. Dental practice may rarely encounter unusual and subtle symptoms with nonpathognomonic clinical signs of several fatal diseases which may pretend like a common oral disease. Hence, the knowledge and clinical acumen of diagnostician are necessary for the early diagnosis of such fatal infections to prevent untoward consequences. Mucormycosis is an angioinvasive necrotic fungal infection with a high morbidity and mortality rate. It commonly occurs in patients with debilitating diseases and immunocompromised individuals. Clinically, it manifests as rhino-orbito-cerebral, pulmonary, cutaneous, gastrointestinal, renal, and disseminated form. Disease affecting the facial region is a challenge as it often disseminates with orbital and cranial involvement at the time of diagnosis. This article presents a case of mucormycosis which mimicked as severe periodontitis in a patient leading to delay in the diagnosis and challenges during the treatment.
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Affiliation(s)
- Prasannasrinivas Deshpande
- Department of Oral Medicine and Radiology, JSS Dental College and Hospital, JSS Academy of Higher Education and Research, Mysore, Karnataka, India
| | - Karthikeya Patil
- Department of Oral Medicine and Radiology, JSS Dental College and Hospital, JSS Academy of Higher Education and Research, Mysore, Karnataka, India
| | - Mahima V Guledgud
- Department of Oral Medicine and Radiology, JSS Dental College and Hospital, JSS Academy of Higher Education and Research, Mysore, Karnataka, India
| | - N Mounika Prashanthi
- Department of Oral Medicine and Radiology, JSS Dental College and Hospital, JSS Academy of Higher Education and Research, Mysore, Karnataka, India
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COVID-19 associated mucormycosis: Staging and management recommendations (Report of a multi-disciplinary expert committee). J Oral Biol Craniofac Res 2021; 11:569-580. [PMID: 34395187 PMCID: PMC8354814 DOI: 10.1016/j.jobcr.2021.08.001] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 07/28/2021] [Accepted: 08/04/2021] [Indexed: 12/26/2022] Open
Abstract
Even before the onslaught of COVID-19 pandemic could settle, the unprecedented rise in cases with COVID-19 associated mucormycosis pushed the medical health to the fringe. Hyperglycaemia and corticosteroids appear to be the most consistent associations leading to the commonest manifestation of mucormycosis, Rhino-Orbito-Cerebral Mucormycosis. To address challenges right from categorisation and staging of the disease to the management of relentless progression, a multi-disciplinary expert committee was formed to handle the task in an evidence-based format to enforce best practices. The report of the committee on one hand attempts to succinctly present the currently available evidence while at the other also attempts to bridge the evidence-deficient gaps with the specialty-specific virtuosity of experts.
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Bhalla D, Bhalla AS, Manchanda S. Can imaging suggest the aetiology in skull base osteomyelitis? A systematic literature review. Pol J Radiol 2021; 86:e309-e321. [PMID: 34136049 PMCID: PMC8186306 DOI: 10.5114/pjr.2021.106470] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Accepted: 09/15/2020] [Indexed: 12/27/2022] Open
Abstract
PURPOSE To assess differentiating features between bacterial, Aspergillus, and Mucor skull base osteomyelitis (SBO) with regard to clinical presentation and imaging appearances. MATERIAL AND METHODS A literature search was performed in April 2020 for studies on SBO with a minimum sample size of 10 patients. Studies that reported presenting symptoms, cross-sectional imaging findings, complications, and mortality were included in the analysis. The quality of included articles was tested using the Quality Assessment of Diagnostic Accuracy Studies 2 tool. A data extraction form was used to retrieve relevant parameters from each of the articles. RESULTS Thirteen articles were included in the final analysis. Diabetes mellitus was the most common predisposing factor (12.5-91.0%). Presenting complaints in all bacterial SBO studies were otogenic, while fungal SBO patients had nasal/ocular complaints. Rates of mortality and surgical intervention in the fungal group were 50-100% and 50%, respectively, as compared to the bacterial group - 7-87% and 10%, respectively. On imaging, the site of initial infection in bacterial SBO was the external auditory canal, while in fungal SBO it was the paranasal sinus. The incidence of orbital extension was < 5% in bacterial and 44-70% in fungal SBO, among which Mucor had rates of 65-70%. Bone erosion was less extensive in bacterial SBO, and the patterns differed. The highest incidence of vascular involvement and non-enhancing lesions (23-36%) was seen in Mucor. Aspergillus showed highest sino-cranial extension (52-55%) and homogenous bright enhancement. CONCLUSIONS Systematic analysis of the clinico-radiological parameters in each of the studies revealed differences in presentation, clinical course, extension, bone erosion, and enhancement.
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Affiliation(s)
| | - Ashu S. Bhalla
- Correspondence address: Ashu Seith Bhalla, All India Institute of Medical Sciences, New Delhi, e-mail:
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Alarifi I, Alsaleh S, Alqaryan S, Assiri H, Alsukayt M, Alswayyed M, Alromaih S, Aloulah M, Alroqi AS, AlQahtani A, Sumaily I. Chronic Granulomatous Invasive Fungal Sinusitis: A Case Series and Literature Review. EAR, NOSE & THROAT JOURNAL 2020; 100:720S-727S. [PMID: 32077324 DOI: 10.1177/0145561320904620] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Chronic granulomatous invasive fungal sinusitis (CGIFS) is a peculiar disease of the paranasal sinuses due to its rarity, patient subset, and disease course. We describe 7 cases of histopathologically confirmed CGIFS with different treatment plans and varying outcomes. Of particular note was that one of these patients developed allergic fungal rhinosinusitis after complete resolution of his primary invasive disease, a finding that has never been reported in the literature. Another patient had an atypical fungal species (Aspergillus nidulans) on fungal stain and culture, while one immunodeficient patient had a large intracerebral disease component and died after 2 months of treatment. We also present a review of the pertinent literature investigating this rare disease.
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Affiliation(s)
- Ibrahim Alarifi
- Department of Otolaryngology, College of Medicine, 37950King Saud University, Riyadh, Saudi Arabia
| | - Saad Alsaleh
- Department of Otolaryngology, College of Medicine, 37950King Saud University, Riyadh, Saudi Arabia
| | - Saleh Alqaryan
- Department of Otolaryngology, College of Medicine, 37950King Saud University, Riyadh, Saudi Arabia
| | - Hassan Assiri
- Department of Otolaryngology, College of Medicine, 37950King Saud University, Riyadh, Saudi Arabia
| | - Mohammed Alsukayt
- Department of Otorhinolaryngology, 37849King Fahad Medical City, Riyadh, Saudi Arabia
| | - Mohammed Alswayyed
- Department of Pathology and Laboratory Medicine, College of Medicine, 37850King Saud University, Riyadh, Saudi Arabia
| | - Saud Alromaih
- Department of Otolaryngology, College of Medicine, 37950King Saud University, Riyadh, Saudi Arabia
| | - Mohammad Aloulah
- Department of Otolaryngology, College of Medicine, 37950King Saud University, Riyadh, Saudi Arabia
| | - Ahmad Salman Alroqi
- Department of Otolaryngology, College of Medicine, 37950King Saud University, Riyadh, Saudi Arabia
| | - Abdulaziz AlQahtani
- Department of Otorhinolaryngology, 37849King Fahad Medical City, Riyadh, Saudi Arabia
| | - Ibrahim Sumaily
- Department of Otolaryngology, College of Medicine, 37950King Saud University, Riyadh, Saudi Arabia
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Rae W, Doffinger R, Shelton F, Sproson E, Ismail-Koch H, Lund VJ, Harries PG, Eren E, Salib RJ. A novel insight into the immunologic basis of chronic granulomatous invasive fungal rhinosinusitis. ALLERGY & RHINOLOGY 2016; 7:102-6. [PMID: 27658186 PMCID: PMC5010430 DOI: 10.2500/ar.2016.7.0162] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Background: Chronic granulomatous invasive fungal rhinosinusitis (CGIFRS) is a rare disease. The underlying immune responses that drive the development of CGIFRS, as opposed to successful pathogen clearance and controlled inflammation, are not currently known. Objective: To characterize the immune responses associated with CGIFRS. Methods: In addition to a battery of basic investigations, more in-depth immunologic testing involves ex vivo whole-blood stimulation with the polyclonal T-cell mitogen phytohemagglutinin and fungal antigens with interleukin (IL) 12, was undertaken to investigate cell-mediated immune responses associated with CGIFRS. Results: Ex vivo whole-blood stimulation with the polyclonal T-cell mitogen phytohemagglutinin and fungal antigens with IL-12 identified reduced interferon gamma and increased IL-17A levels within the supernatant, which indicated increased in vivo T-helper (Th)17 responses and impaired Th1 responses compared with healthy controls. Conclusion: These findings suggest that the development of CGIFRS may be associated with an abnormally exaggerated host Th17 response, which caused failure to clear the fungal pathogen with refractory fungal infection of mucosal membranes, resulting in chronic tissue inflammation.
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Affiliation(s)
- William Rae
- Department of Immunology, University Hospital Southampton NHS Foundation Trust, Southampton, UK
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