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
<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
Clinical experience has suggested the existence of an intermediate form of fungal sinusitis between the categories of non-invasive fungal sinusitis (non-IFS) and invasive fungal sinusitis (IFS).This fungal sinusitis v...Clinical experience has suggested the existence of an intermediate form of fungal sinusitis between the categories of non-invasive fungal sinusitis (non-IFS) and invasive fungal sinusitis (IFS).This fungal sinusitis variant demonstrates unhealthy mucosa by endoscopy with fungal invasion,but lacks angioinvasion microscopically,representing what clinically behaves as a ‘pre-invasive’ subtype of fungal sinusitis.Unlike non-IFS disease,patients with preinvasive fungal sinusitis were still felt to require anti-fungal medications due to histologic presence of invasive fungus.While sharing some clinical features of IFS,these ‘intermediate’ patients were successfully spared extended and repeated surgical debridements given the microscopic findings,and have been successfully treated with shorter courses of antifungal therapy.These select patients have had favorable outcomes when managed in a judicious and semi-aggressive manner,in an undefined zone between the treatments for routine fungal ball and aggressive IFS.展开更多
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<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Clinical experience has suggested the existence of an intermediate form of fungal sinusitis between the categories of non-invasive fungal sinusitis (non-IFS) and invasive fungal sinusitis (IFS).This fungal sinusitis variant demonstrates unhealthy mucosa by endoscopy with fungal invasion,but lacks angioinvasion microscopically,representing what clinically behaves as a ‘pre-invasive’ subtype of fungal sinusitis.Unlike non-IFS disease,patients with preinvasive fungal sinusitis were still felt to require anti-fungal medications due to histologic presence of invasive fungus.While sharing some clinical features of IFS,these ‘intermediate’ patients were successfully spared extended and repeated surgical debridements given the microscopic findings,and have been successfully treated with shorter courses of antifungal therapy.These select patients have had favorable outcomes when managed in a judicious and semi-aggressive manner,in an undefined zone between the treatments for routine fungal ball and aggressive IFS.
