Coinfection byAspergillusand Zygomycetes Species in a Case of Acute Rhinosinusitis

Abstract

Invasive mycotic infections can be effectively treated if rapid identification of fungus is obtained. We reported a case of coinfection by Aspergillus and Rhizopus sp. involving nose, paranasal sinuses, orbit, and brain in a 68-year-old known hypertensive male. He was presented to ENT OPD with history of fever and intermittent headache since fifteen days along with history of right-sided nasal obstruction and proptosis since seven days. CT scan of brain and paranasal sinuses showed findings of pansinusitis with cellulitic changes in right orbit. MRI confirmed the same along with features of intracranial extension with focal meningitis in right frontotemporal region. Laboratory parameters did not conclude much except for leucocytosis and hyponatremia. Patient was taken for endoscopic debridement from nose and paranasal sinuses, and tissue was sent for microbiological and histopathological examination. Minced tissue was processed, and after 48 hrs of incubation two types of growth were identified, one was yellowish, granular, and powdery consistent with Aspergillus sp., and another was cottony and woolly consistent with Rhizopus sp. LCB mount confirmed presence of Aspergillus flavus and Rhizopus arrhizus. Patient responded to therapy with IV amphotericin B and surgical debridement. On discharge patient's condition was good.

The successful use of amphotericin B followed by oral posaconazole in a rare case of invasive fungal sinusitis caused by co-infection with mucormycosis and aspergillus

“…that are more commonly seen in diabetic patients, particularly in the setting of DKA as was seen in this patient [1] . Invasive fungal infections of the oro-rhinocerebral area, due to mixed mucormycosis and aspergillosis infections have rarely been reported [2] , [3] , [4] , [5] , [6] .…”

Sinonasal Mucormycosis with Fungal Ball: A Rare Case Report

“…6 Vaidya D also reported a case of 68 years male with headache and proptosis and was diagnosed as having sinonasal mucormycosis and aspergillosis and was managed by surgical debridement and antifungals. 7 Maiorano E et al also reported a case of combined infection with mucormycosis and aspergillosis in a patient with Casleman's disease. 8 Zygomycosis is a serious opportunistic infections that is commonly seen in immunocompromised patients.…”

A treated case of rhinocerebral zygomycosis with aspergillosis: a case report from India

“…Unfortunately, that patient did not respond well to treatment and succumbed to his illness, probably due to a delay in diagnosis and treatment [ 14 ]. Another case was reported from India in Gujarat in 2011, where co-infection of Aspergillus species and Rhizopus species in rhinocerebral sinusitis was contained by antifungal treatment and the patient made a full recovery [ 9 ]. In the current case, prompt diagnosis and treatment also controlled the fatal fungal co-infection, leading to complete recovery of the patient with no sequelae.…”

“…Co-infection of aspergillosis and mucormycosis in sinuses is apparently a rare entity that is difficult to diagnose, posing clinical dilemmas, and very few such cases have been reported with recovery in the literature [ 9 ]. Here, we report an unusual case of rhinocerebral zygomycosis with aspergillosis in a 60-year-old diabetic patient, who recovered completely from this fatal co-infection due to timely diagnosis and treatment .…”