Bipolaris hawaiiensis—caused Phaeohyphomycotic Orbitopathy. A Devastating Fungal Sinusitis in an Apparently Immunocompetent Host

Maskin, Steven L.; Fetchick, Richard J.; Leone, Charles R.; Sharkey, Patrick K.; Rinaldi, Michael G.

doi:10.1097/00002341-199003000-00012

Cited by 8 publications

(16 citation statements)

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“…Culturing was also done when procedures for obtaining specimens were not dangerously invasive. An (20,31). In both, disease involved paranasal sinuses, with direct invasion of surrounding structures.…”

Section: Methodsmentioning

confidence: 99%

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High-dose itraconazole in the treatment of severe mycoses

Sharkey

Rinaldi

Dunn

et al. 1991

Antimicrob Agents Chemother

138

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Eight patients with systemic mycoses and with prior treatment failures were treated with itraconazole (600 mg/day) for a mean duration of 5.5 months. All six patients without AIDS experienced improvement or stabilization of their fungal infections while receiving high-dose itraconazole, although two patients later experienced treatment failures, one by relapse and one by progression, on lower doses. Treatment failures also occurred in the two patients with AIDS and cryptococcal meningitis. The failures were associated with low serum itraconazole concentrations (<2.5 ,ug/ml) in both patients. All other patients had mean trough levels in serum above 5 ,ug/ml. One patient who was improving on 600 mg/day developed a progressive infection after reduction of the dose to 400 mg/day. Side effects included reversible adrenal insufficiency in one patient; severe hypokalemia, mild diastolic hypertension, and rhabdomyolysis in one patient; mild hypokalemia and hypertension in four other patients; and breast tenderness in one patient. The mean decrease in serum potassium during treatment was statistically significant (P = 0.05). Selected patients with severe systemic mycoses may benefit from prolonged high-dose itraconazole treatment. However, 600 mg/day may be approaching the upper limits of acceptable dosing for long-term treatment.

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Section: Methodsmentioning

confidence: 99%

“…The infection also extended into the frontal lobe. A detailed description of the clinical presentations is reported elsewhere (20). The other patient relapsed following courses of AMB and miconazole.…”

Section: Methodsmentioning

confidence: 99%

High-dose itraconazole in the treatment of severe mycoses

Sharkey

Rinaldi

Dunn

et al. 1991

Antimicrob Agents Chemother

138

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“…Orbital infections (44,167,233); criteria for diagnosis include growth in culture with positive microscopy. Intraocular infections (182); criteria for diagnosis include growth in culture with positive microscopy.…”

Section: Species Of Paecilomycesmentioning

confidence: 99%

“…Spread of infection from the sinuses to the orbit is thought to occur in 67 to 85% of orbital infections (15,290) due to the proximity of the sinuses to the orbit (194). Thus, virulent fungal pathogens causing sinusitis can devastate orbital structures by contiguous spread (233). The variable presentations of orbital fungal infections parallel the presentations of paranasal sinus mycoses (192,233), the salient features of which are listed in Table 11.…”

Section: Clinical Features Predisposing Factors and Management Of Smentioning

confidence: 99%

“…The clinical relevance of antifungal susceptibility testing is thought to lie in guiding the clinician in the selection of an appropriate antifungal compound. Such tests have been reported to help in the selection of the appropriate antifungal in different ophthalmic mycoses (161,173,233,234). Unfortunately, many of these reports have not provided details of the test procedures used, the criteria by which MICs were deemed significant, details of the severity of the clinical lesions, or the criteria used for authentic diagnosis of mycotic infection.…”

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confidence: 99%

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Current Perspectives on Ophthalmic Mycoses

2003

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Fungi may infect the cornea, orbit and other ocular structures. Species of Fusarium, Aspergillus, Candida, dematiaceous fungi, and Scedosporium predominate. Diagnosis is aided by recognition of typical clinical features and by direct microscopic detection of fungi in scrapes, biopsy specimens, and other samples. Culture confirms the diagnosis. Histopathological, immunohistochemical, or DNA-based tests may also be needed. Pathogenesis involves agent (invasiveness, toxigenicity) and host factors. Specific antifungal therapy is instituted as soon as the diagnosis is made. Amphotericin B by various routes is the mainstay of treatment for life-threatening and severe ophthalmic mycoses. Topical natamycin is usually the first choice for filamentous fungal keratitis, and topical amphotericin B is the first choice for yeast keratitis. Increasingly, the triazoles itraconazole and fluconazole are being evaluated as therapeutic options in ophthalmic mycoses. Medical therapy alone does not usually suffice for invasive fungal orbital infections, scleritis, and keratitis due to Fusarium spp., Lasiodiplodia theobromae, and Pythium insidiosum. Surgical debridement is essential in orbital infections, while various surgical procedures may be required for other infections not responding to medical therapy. Corticosteroids are contraindicated in most ophthalmic mycoses; therefore, other methods are being sought to control inflammatory tissue damage. Fungal infections following ophthalmic surgical procedures, in patients with AIDS, and due to use of various ocular biomaterials are unique subsets of ophthalmic mycoses. Future research needs to focus on the development of rapid, species-specific diagnostic aids, broad-spectrum fungicidal compounds that are active by various routes, and therapeutic modalities which curtail the harmful effects of fungus- and host tissue-derived factors

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Allergic fungal sinusitis caused by Bipolaris (Drechslera) hawaiiensis

Fryen

Mayser

Glanz

et al. 1999

European Archives of Oto-Rhino-Laryngology

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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.

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Bipolaris hawaiiensis—caused Phaeohyphomycotic Orbitopathy. A Devastating Fungal Sinusitis in an Apparently Immunocompetent Host

Cited by 8 publications

References 0 publications

High-dose itraconazole in the treatment of severe mycoses

High-dose itraconazole in the treatment of severe mycoses

Current Perspectives on Ophthalmic Mycoses

Allergic fungal sinusitis caused by Bipolaris (Drechslera) hawaiiensis

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