Acute invasive rhinosinusitis case caused by Aspergillus flavus in two patients prediagnosed with mucormycosis
Abstract
Acute invasive rhinosinusitis caused by Aspergillus spp. may lead to invasive disease and mortality, especially in immunocompromised individuals. In this report, two invasive fungal rhinosinusitis cases in an immune compromised patient have been presented that were pre-diagnosed with mucormycosis, but with a positive culture for Aspergillus flavus. Twenty-four years old male patient with aplastic anemia and seven years old patient with acute lymphoblastic leukemia; facial pain, edema, and necrotic lesions developed in both cases. Tissue samples were obtained from lesions through the nose by biopsy for definitive diagnosis. Septate fungal hyphae observed on the microscopic examination of the specimen, and A. flavus was isolated in the culture in both cases. Surgical debridement could not be performed because of patients’ general conditions. Despite antifungal therapy and treatments, patients died. Delay in diagnosis and treatment may lead to high mortality rates. These cases emphasize the importance of diagnosis with culture. J Microbiol Infect Dis 2015;5(3): 137-141
Key words: Acute invasive fungal rhinosinusitis, Aspergillus flavus, diagnosis.
References
- DelGaudio JM, Clemson LA. An Early Detection Protocol for
- Invasive Fungal Sinusitis in Neutropenic Patients Successfully
- Reduces Extent of Diseases at Presentation and Long Term Morbidity. The Laryngoscope 2009;119:180-183.
- Suslu AE, Ogretmenoglu O, Suslu N, et al. Acute invasive fungal
- rhinosinusitis: our experience with 19 patients. Eur Arch
- Otorhinolaryngol 2009;266:77-82.
- Takahashi H, Hinohira Y, Hato N, et al. Clinical features and
- outcomes of four patients with invasive fungal sinusitis. Auris Nasus Larynx 2011;38:289-294.
- Montone KT, Virginia A Livolsi VA, et al. Fungal Rhinosinusitis:
- A retrospective microbiologic and pathologic review of 400 patients at a single university medical center. Int J Otolaryngol 2012:684835.
- Beltrame A, Sarmati L, Cudillo L, et al. A fatal case of invasive
- fungal sinusitis by Scopulariopsis acremonium in a bone marrow transplant recipient. Int J Infect Dis 2009;13:488-492.
- Valera FCP, do Lago T, Tamashiro E, et al. Prognosis of acute
- invasive fungal rhinosinusitis related to underlying disease Int J Infect Dis 2011;15:841-844.
- Kasapoglu F, Coskun H, Ozmen OA, et al. Acute invasive fungal
- rhinosinusitis: Evaluation of 26 patients treated with endonasal
- or open surgical procedures. Otolaryngology-Head and Neck Surgery 2010;143:614-620.
- Chen CY, Sheng WH, Cheng A, et al. Invasive fungal sinusitis
- in patients with hematological malignancy: 15 years experience
- in a single university hospital in Taiwan. BMC Infectious Diseases 2011;11:250.
- Hachem RY, Kontoyiannis DP, Chemaly RF, et al. Utility of galactomannan enzyme immunoassay and (1,3) beta-D-glucan
- in diagnosis of invasive fungal infections: low sensitivity for
- Aspergillus fumigatus infection in hematologic malignancy patients. J Clin Microbiol 2009;47:129-133.
- Mossa-Basha M, Ilıca AT, Maluf F, et al. The many faces of
- fungal disease of the paranasal sinuses: CT and MRI findings. Diagn Interv Radiol 2013;19:195–200.
- Thomas JW, Elias JA, David WD, et al. Treatment of aspergillosis:
- Clinical practice guidelines of the infectious disease society of America. Clin Infect Dis 2008;46:327-360.
Abstract
Aspergillus türlerinin neden olduğu akut invaziv fungal rinosinüzit; immünsüprese hastalarda mortaliteye yol açabilir.Rinoserebral mukormikoza klinik olarak benzediğinden mukormikoz ön tanısı almış ancak kültürde etken olarak Aspergillus flavus üretilmiş iki invaziv fungal rinosinüzit olgusu bu raporda sunulmuştur. Aplastik anemi tanısıyla takip edilen 24 yaşındaki erkek hasta ve akut lenfoblastik lösemi tanısıyla izlenen yedi yaşındaki kız çocuğunda yüzde ağrı, ödem, ve burun çevresinde nekrotik lezyonlar mevcuttu. Antifungal tedaviye rağmen burunda nekroz gelişti. Tanı amacıyla burundaki lezyondan alınan biyopsi örneğinin mikroskobik incelemesinde septalı hifler görüldü ve kültürde iki olguda da A. flavus izole edildi. İki olgumuzda da gerekli tedaviler yapılmış olup cerrahi debridman hastaların genel durum bozukluğu nedeniyle yapılamadı ve antifungal tedaviye rağmen hastalar kaybedildi. İnvaziv fungal enfeksiyonlarda erken tanı ve tedavi hayati önem taşımaktadır. Bu olgular, fungal enfeksiyonların tanısında ve tedaviyi doğru şekilde yönlendirebilmede kültürün önemini vurgulaması açısından önemlidir
References
- DelGaudio JM, Clemson LA. An Early Detection Protocol for
- Invasive Fungal Sinusitis in Neutropenic Patients Successfully
- Reduces Extent of Diseases at Presentation and Long Term Morbidity. The Laryngoscope 2009;119:180-183.
- Suslu AE, Ogretmenoglu O, Suslu N, et al. Acute invasive fungal
- rhinosinusitis: our experience with 19 patients. Eur Arch
- Otorhinolaryngol 2009;266:77-82.
- Takahashi H, Hinohira Y, Hato N, et al. Clinical features and
- outcomes of four patients with invasive fungal sinusitis. Auris Nasus Larynx 2011;38:289-294.
- Montone KT, Virginia A Livolsi VA, et al. Fungal Rhinosinusitis:
- A retrospective microbiologic and pathologic review of 400 patients at a single university medical center. Int J Otolaryngol 2012:684835.
- Beltrame A, Sarmati L, Cudillo L, et al. A fatal case of invasive
- fungal sinusitis by Scopulariopsis acremonium in a bone marrow transplant recipient. Int J Infect Dis 2009;13:488-492.
- Valera FCP, do Lago T, Tamashiro E, et al. Prognosis of acute
- invasive fungal rhinosinusitis related to underlying disease Int J Infect Dis 2011;15:841-844.
- Kasapoglu F, Coskun H, Ozmen OA, et al. Acute invasive fungal
- rhinosinusitis: Evaluation of 26 patients treated with endonasal
- or open surgical procedures. Otolaryngology-Head and Neck Surgery 2010;143:614-620.
- Chen CY, Sheng WH, Cheng A, et al. Invasive fungal sinusitis
- in patients with hematological malignancy: 15 years experience
- in a single university hospital in Taiwan. BMC Infectious Diseases 2011;11:250.
- Hachem RY, Kontoyiannis DP, Chemaly RF, et al. Utility of galactomannan enzyme immunoassay and (1,3) beta-D-glucan
- in diagnosis of invasive fungal infections: low sensitivity for
- Aspergillus fumigatus infection in hematologic malignancy patients. J Clin Microbiol 2009;47:129-133.
- Mossa-Basha M, Ilıca AT, Maluf F, et al. The many faces of
- fungal disease of the paranasal sinuses: CT and MRI findings. Diagn Interv Radiol 2013;19:195–200.
- Thomas JW, Elias JA, David WD, et al. Treatment of aspergillosis:
- Clinical practice guidelines of the infectious disease society of America. Clin Infect Dis 2008;46:327-360.
Details
| Primary Language | English |
|---|---|
| Journal Section | Case Report |
| Authors | |
| Publication Date | February 6, 2016 |
| Published in Issue | Year 2015 Volume: 5 Issue: 3 |