BACKGROUND Fungal rhinosinusitis is an infectious and/or allergic disease caused by fungi in the sinus and nasal cavity. Due to the warm and humid climate in Guangxi Zhuang Autonomous Region, the incidence of fungal r...BACKGROUND Fungal rhinosinusitis is an infectious and/or allergic disease caused by fungi in the sinus and nasal cavity. Due to the warm and humid climate in Guangxi Zhuang Autonomous Region, the incidence of fungal rhinosinusitis is higher than that in other provinces. However, its physiological mechanism is not yet clear.Not every patient colonized by fungi develops a fungal infection. To a large extent, the immune status of the patient determines the nature of fungal disease in the nasal passages. The pathologic process of progression from harmless fungal colonization to fungal rhinosinusitis is unclear and has not been reported.CASE SUMMURY We report two patients, one who developed fungal rhinosinusitis 1.5 years after surgery performed to treat an inverted papilloma, and the other with a history of hypertension and cerebral infarction. Both patients recovered from their surgeries. An average time of 2.5 years elapsed from the development of maxillary sinus cysts to the development of fungal rhinosinusitis.CONCLUSION According to these case reports, we speculate that the progression of fungal rhinosinusitis from harmless colonization to disease onset requires approximately one to three years and that the length of the process may be related to underlying diseases, surgical treatment, deficient autoimmune status,and abuse of hormone antibiotics and hormones. Additional data are needed to conduct relevant studies to appropriately prevent and treat fungal rhinosinusitis.展开更多
BACKGROUND Invasive fungal rhinosinusitis(IFR) caused by Cunninghamella is very rare but has an extremely high fatality rate. There have been only seven cases of IFR caused by Cunninghamella reported in English and, o...BACKGROUND Invasive fungal rhinosinusitis(IFR) caused by Cunninghamella is very rare but has an extremely high fatality rate. There have been only seven cases of IFR caused by Cunninghamella reported in English and, of these, only three patients survived.In this article, we present another case of IFR caused by Cunninghamella, in which the patient was initially treated successfully but then deteriorated due to a relapse of leukemia 2 mo later.CASE SUMMARY A 50-year-old woman presented with a 2-mo history of right ocular proptosis,blurred vision, rhinorrhea and nasal obstruction. Nasal endoscopic examination showed that the middle turbinate had become necrotic and fragile. Endoscopic sinus surgery and enucleation of the right orbital contents were performed successively. Additionally, the patient was treated with amphotericin B both systematically and topically. Secretion cultivation of the right eye canthus showed infection with Cunninghamella, while postoperative pathology also revealed fungal infection. The patient's condition gradually stabilized after surgery. However, the patient underwent chemotherapy again due to a relapse of leukemia 2 mo later. Unfortunately, her leukocyte count decreased dramatically,leading to a fatal lung infection and hemoptysis.CONCLUSION Aggressive surgical debridements, followed by antifungal drug treatment both systematically and topically, are the most important fundamental treatments for IFR.展开更多
BACKGROUND Concomitant allergic fungal rhinosinusitis(AFRS)and allergic bronchopulmonary aspergillosis(ABPA)are extremely rare,with no more than 20 cases reported in the English literature.CASE SUMMARY A 52-year-old f...BACKGROUND Concomitant allergic fungal rhinosinusitis(AFRS)and allergic bronchopulmonary aspergillosis(ABPA)are extremely rare,with no more than 20 cases reported in the English literature.CASE SUMMARY A 52-year-old female patient complained of right-sided nasal obstruction,rhinorrhea,sneezing,epistaxis,and hyposmia for a period of around 5 mo.Nasal examination detected paleness and edema of the nasal mucous membrane and a polyp in the right middle meatus.A computed tomography(CT)scan of the sinuses revealed a ground-glass opacity filling the right maxillary and ethmoid sinuses,along with bone absorption in the medial wall of the right maxillary sinus.Magnetic resonance images were obtained with T1-weighted,T2-weighted,and gadolinium-enhanced T1-weighted sequences.A well-defined mass,located in the right maxillary and ethmoid sinuses and displaying obvious hypointense features,was observed on both T1-and T2-weighted images,with peripheral enhancement on gadolinium-enhanced T1-weighted images.The patient also has a 20-year history of cough and dyspnea.Chest CT revealed columned and cystiform bronchiectasis in the bilateral bronchus,surrounded by a large number of spotted and funicular high-density lesions.The level of serum total IgE was>5000 kU/L.Serum IgE levels related to house dust and aspergillus showed a positive result,with the values being 3.5 kU/L and 1.2 kU/L.We performed functional endoscopic sinus surgery under local anesthesia.After surgery,topical glucocorticoids and saline irrigation were applied in the nasal cavity until the present time.An oral glucocorticoid(methylprednisolone 16 mg/d)and antifungal agent(itraconazole 200 mg/d)were also used for a period of 4 wk.Montelukast was prescribed at 10 mg/d until the present time.An endoscopic examination showed that the patient was recovering well at 3 mo after surgery.CONCLUSION Since different specialists treat ABPA and AFRS,their coexistence may be overlooked.AFRS accompanied by ABPA requires surgical therapy combined with medical control to improve the symptoms.展开更多
<strong>Objective:</strong> This case-control study aimed to detect the presence of fungal biofilms in cases of fungal sinusitis, trying to find its role in recurrence of fungal sinus infection and resista...<strong>Objective:</strong> This case-control study aimed to detect the presence of fungal biofilms in cases of fungal sinusitis, trying to find its role in recurrence of fungal sinus infection and resistance to medical treatment. <strong>Patients and Methods:</strong> This study was conducted at Ain-Shams University from June-2017 to June-2018 upon 20 patients as the fungal cases are not much in Egypt. All patients were subjected to functional endoscopic sinus surgery and taking specimens. Examination of specimens by scanning electron microscope was made. <strong>Results:</strong> The prevalence of fungal biofilms was 7 (70%) in cases and 0 (0%) in controls (p-value = 0.001). There is higher risk of fungal biofilms in cases of fungal sinusitis, the odds of biofilms is higher in the study group 2.33 than in the control group 0. The lower is the invasiveness, the higher is the fungal biofilms (OR = 0.94, 95% CI 0.46 - 4.05). Also, the analysis showed that the lower is the recurrence the lower is the fungal biofilms (OR = 2.25, 95% CI 0.15 - 7.93). <strong>Conclusion:</strong> This study showed the presence of fungal biofilms in different cases of fungal sinusitis whether primary or recurrent, also whether invasive or non-invasive. Studies with large sample size are recommended to get a strong evidence.展开更多
Studying the pathophysiology of allergic fungal rhinosinusitis (AFRS) has proved challenging. While this clinical entity is easily distinguishable based on the clinical criteria set forth by Bent and Kuhn twenty-five ...Studying the pathophysiology of allergic fungal rhinosinusitis (AFRS) has proved challenging. While this clinical entity is easily distinguishable based on the clinical criteria set forth by Bent and Kuhn twenty-five years ago, studies examining type 2 inflammatory profiles in AFRS can make it seem more alike other CRS subtypes than it is different. Still, evolving research seems to clearly delineate this subtype from others in CRS. This review will critically evaluate the evolution of research examining the pathophysiology of AFRS and will conclude with a summary of the special considerations in the management of this fascinating disease.展开更多
Fungal rhinosinusitis (FRS) is categorized as being either invasive or non-invasive based on the histopathological evidence of tissue invasion by fungi. Endoscopic sinus surgery (ESS) has become the gold standard trea...Fungal rhinosinusitis (FRS) is categorized as being either invasive or non-invasive based on the histopathological evidence of tissue invasion by fungi. Endoscopic sinus surgery (ESS) has become the gold standard treatment for non-invasive FRS including sinus fungal ball. It is considered to be an effective and safe procedure. It is important to keep a sufficient field of view in order to remove the fungal debris completely. ESS should also prevent damage to the nasal cavity structures including the inferior turbinate. This report mainly describes the endoscopic surgical procedures for fungal ball of the maxillary sinus (sinus mycelia) based on our methods and review of the literature, including written articles in Japanese. ESS procedures include the middle meatus approach for the maxillary sinus, the combined approach (both middle and inferior meatal antrostomy) for the maxillary sinus, and endoscopic modified medial maxillectomy (EMMM).展开更多
文摘BACKGROUND Fungal rhinosinusitis is an infectious and/or allergic disease caused by fungi in the sinus and nasal cavity. Due to the warm and humid climate in Guangxi Zhuang Autonomous Region, the incidence of fungal rhinosinusitis is higher than that in other provinces. However, its physiological mechanism is not yet clear.Not every patient colonized by fungi develops a fungal infection. To a large extent, the immune status of the patient determines the nature of fungal disease in the nasal passages. The pathologic process of progression from harmless fungal colonization to fungal rhinosinusitis is unclear and has not been reported.CASE SUMMURY We report two patients, one who developed fungal rhinosinusitis 1.5 years after surgery performed to treat an inverted papilloma, and the other with a history of hypertension and cerebral infarction. Both patients recovered from their surgeries. An average time of 2.5 years elapsed from the development of maxillary sinus cysts to the development of fungal rhinosinusitis.CONCLUSION According to these case reports, we speculate that the progression of fungal rhinosinusitis from harmless colonization to disease onset requires approximately one to three years and that the length of the process may be related to underlying diseases, surgical treatment, deficient autoimmune status,and abuse of hormone antibiotics and hormones. Additional data are needed to conduct relevant studies to appropriately prevent and treat fungal rhinosinusitis.
基金Supported by Zhejiang Province Public Welfare Fund,No.2014C33203National Natural Science Foundation of China,No.81770976
文摘BACKGROUND Invasive fungal rhinosinusitis(IFR) caused by Cunninghamella is very rare but has an extremely high fatality rate. There have been only seven cases of IFR caused by Cunninghamella reported in English and, of these, only three patients survived.In this article, we present another case of IFR caused by Cunninghamella, in which the patient was initially treated successfully but then deteriorated due to a relapse of leukemia 2 mo later.CASE SUMMARY A 50-year-old woman presented with a 2-mo history of right ocular proptosis,blurred vision, rhinorrhea and nasal obstruction. Nasal endoscopic examination showed that the middle turbinate had become necrotic and fragile. Endoscopic sinus surgery and enucleation of the right orbital contents were performed successively. Additionally, the patient was treated with amphotericin B both systematically and topically. Secretion cultivation of the right eye canthus showed infection with Cunninghamella, while postoperative pathology also revealed fungal infection. The patient's condition gradually stabilized after surgery. However, the patient underwent chemotherapy again due to a relapse of leukemia 2 mo later. Unfortunately, her leukocyte count decreased dramatically,leading to a fatal lung infection and hemoptysis.CONCLUSION Aggressive surgical debridements, followed by antifungal drug treatment both systematically and topically, are the most important fundamental treatments for IFR.
文摘BACKGROUND Concomitant allergic fungal rhinosinusitis(AFRS)and allergic bronchopulmonary aspergillosis(ABPA)are extremely rare,with no more than 20 cases reported in the English literature.CASE SUMMARY A 52-year-old female patient complained of right-sided nasal obstruction,rhinorrhea,sneezing,epistaxis,and hyposmia for a period of around 5 mo.Nasal examination detected paleness and edema of the nasal mucous membrane and a polyp in the right middle meatus.A computed tomography(CT)scan of the sinuses revealed a ground-glass opacity filling the right maxillary and ethmoid sinuses,along with bone absorption in the medial wall of the right maxillary sinus.Magnetic resonance images were obtained with T1-weighted,T2-weighted,and gadolinium-enhanced T1-weighted sequences.A well-defined mass,located in the right maxillary and ethmoid sinuses and displaying obvious hypointense features,was observed on both T1-and T2-weighted images,with peripheral enhancement on gadolinium-enhanced T1-weighted images.The patient also has a 20-year history of cough and dyspnea.Chest CT revealed columned and cystiform bronchiectasis in the bilateral bronchus,surrounded by a large number of spotted and funicular high-density lesions.The level of serum total IgE was>5000 kU/L.Serum IgE levels related to house dust and aspergillus showed a positive result,with the values being 3.5 kU/L and 1.2 kU/L.We performed functional endoscopic sinus surgery under local anesthesia.After surgery,topical glucocorticoids and saline irrigation were applied in the nasal cavity until the present time.An oral glucocorticoid(methylprednisolone 16 mg/d)and antifungal agent(itraconazole 200 mg/d)were also used for a period of 4 wk.Montelukast was prescribed at 10 mg/d until the present time.An endoscopic examination showed that the patient was recovering well at 3 mo after surgery.CONCLUSION Since different specialists treat ABPA and AFRS,their coexistence may be overlooked.AFRS accompanied by ABPA requires surgical therapy combined with medical control to improve the symptoms.
文摘<strong>Objective:</strong> This case-control study aimed to detect the presence of fungal biofilms in cases of fungal sinusitis, trying to find its role in recurrence of fungal sinus infection and resistance to medical treatment. <strong>Patients and Methods:</strong> This study was conducted at Ain-Shams University from June-2017 to June-2018 upon 20 patients as the fungal cases are not much in Egypt. All patients were subjected to functional endoscopic sinus surgery and taking specimens. Examination of specimens by scanning electron microscope was made. <strong>Results:</strong> The prevalence of fungal biofilms was 7 (70%) in cases and 0 (0%) in controls (p-value = 0.001). There is higher risk of fungal biofilms in cases of fungal sinusitis, the odds of biofilms is higher in the study group 2.33 than in the control group 0. The lower is the invasiveness, the higher is the fungal biofilms (OR = 0.94, 95% CI 0.46 - 4.05). Also, the analysis showed that the lower is the recurrence the lower is the fungal biofilms (OR = 2.25, 95% CI 0.15 - 7.93). <strong>Conclusion:</strong> This study showed the presence of fungal biofilms in different cases of fungal sinusitis whether primary or recurrent, also whether invasive or non-invasive. Studies with large sample size are recommended to get a strong evidence.
文摘Studying the pathophysiology of allergic fungal rhinosinusitis (AFRS) has proved challenging. While this clinical entity is easily distinguishable based on the clinical criteria set forth by Bent and Kuhn twenty-five years ago, studies examining type 2 inflammatory profiles in AFRS can make it seem more alike other CRS subtypes than it is different. Still, evolving research seems to clearly delineate this subtype from others in CRS. This review will critically evaluate the evolution of research examining the pathophysiology of AFRS and will conclude with a summary of the special considerations in the management of this fascinating disease.
文摘Fungal rhinosinusitis (FRS) is categorized as being either invasive or non-invasive based on the histopathological evidence of tissue invasion by fungi. Endoscopic sinus surgery (ESS) has become the gold standard treatment for non-invasive FRS including sinus fungal ball. It is considered to be an effective and safe procedure. It is important to keep a sufficient field of view in order to remove the fungal debris completely. ESS should also prevent damage to the nasal cavity structures including the inferior turbinate. This report mainly describes the endoscopic surgical procedures for fungal ball of the maxillary sinus (sinus mycelia) based on our methods and review of the literature, including written articles in Japanese. ESS procedures include the middle meatus approach for the maxillary sinus, the combined approach (both middle and inferior meatal antrostomy) for the maxillary sinus, and endoscopic modified medial maxillectomy (EMMM).
