Allergic fungal sinusitis caused by Bipolaris (Drechslera) hawaiiensis

Abstract

Depending on the aggressiveness of the pathogen and a patient's immunocompetence, fungal polypoid pansinusitis or allergic fungal sinusitis (AFS) may be a life-threatening disease. Apart from the clinical findings, its diagnosis is based on the demonstration of mucinous material with abundant eosinophils in the paranasal sinuses (indicating an allergic process), cultivation of the causative pathogen and immunocompetence of the patient. In a 20-year-old immigrant Sudanese woman, AFS due to Bipolaris (Drechslera) hawaiiensis was diagnosed. Because of intracranial extension, the disease had led to erosion of the cranial base and orbit with amaurosis on the right side and focal epilepsy. In addition to endonasal microsurgical pansinus operations, local irrigation therapy with amphothericin B was accompanied by systemic treatment with itraconazole after in vitro cultivation of the pathogen and determination of its sensitivities. Interdisciplinary management included a combination of endonasal surgery with debridement of infected tissues and wide drainage of the sinuses without removal of skull bone or the dural lesion in addition to specific antimycotic treatment. Injury to adjacent anatomical structures must be avoided in any case to prevent systemic or possibly lethal dissemination of infection.

Diversity of Bipolaris Species in Clinical Samples in the United States and Their Antifungal Susceptibility Profiles

“…The ITS sequence of the type strain of B. hawaiiensis showed similarities of 93.7 and 94.8% with those of the type strains of B. australiensis and B. spicifera, respectively. A BLAST search comparing ITS sequences is the procedure usually used in recent years to confirm Bipolaris species identification (3,6,9,16,18). However, this procedure may not be useful when comparisons are made with inaccurate sequences or when sequences of authentic strains of the species to which the problem isolate belongs have not been deposited.…”

“…These fungi are able to infect both immunocompetent and immunosuppressed patients, mainly in tropical and subtropical areas. The most common clinical presentations are allergic sinusitis, keratitis, endophthalmitis, onychomycosis, peritoneal dialysis-associated peritonitis, lung and skin infections, and, less frequently, central nervous system (CNS) infections (2,4,5,10,16,26,28,31).…”

Fungal biodiversity – as found in nasal mucus

“…from a patient suffering from sinobronchial syndrome. Two surgical isolates were identified as Bipolaris hawaiiensis (teleomorph Cochliobolus hawaiiensis), a known cause of CRS and sinus mycoses [52][53][54][55], and another was identified as B. australiensis. The genus Leptosphaeria presented with the species L. bicolor and L. microscopica in one sample each of nasal mucus from patients suffering from CRS.…”

An expansive paranasal sinus tumour‐like lesion caused by Bipolaris spicifera in an immunocompetent patient

“…Bipolaris spp. are a frequent cause of non‐invasive allergic fungal sinusitis 4–7 . Less commonly, a granulomatous invasive sinusitis caused by Bipolaris spp.…”

“…The diagnosis of Bipolaris infection of the sinuses is made by culture. Bipolaris spicifera and B. hawainensis are then the most common species isolated 5,9 …”