Extrasinonasal infiltrative process associated with a sinonasal fungus ball: does it mean invasive fungal sinusitis?

Kim, Yi Kyung; Kim, Hyung Jin; Kim, Hyo Yeol; Cha, Jihoon; Lee, Jun-Young; Chung, Seung Kyu; Dhong, Hun Jong; Song, Min-Young; Kim, Sung Tae

doi:10.5152/dir.2015.15417

Cited by 17 publications

(9 citation statements)

References 29 publications

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“…Thus, based on our findings, it is reasonable to hypothesize that invasive fungal sinusitis may develop from noninvasive fungus under certain conditions, such as mixed ball. In addition, consistent with our hypothesis, several studies have described the possibility of a progressive disease spectrum from noninvasive fungus to invasive fungal sinusitis …”

Section: Discussionsupporting

confidence: 91%

Diverse phenotypes and endotypes of fungus balls caused by mixed bacterial colonization in chronic rhinosinusitis

Kim

Shin

et al. 2019

Int Forum Allergy Rhinol

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Background:The pathogenic roles of fungus and bacteria in chronic rhinosinusitis (CRS) remain unclear. Recently, we described the bacterial ball, which is distinct from the fungus ball, as an unusual phenotype of bacterial infection. In this study, we investigated the clinical, histopathologic, and immunologic characteristics of sinonasal microorganic materials, including fungus ball and bacterial ball. Methods:In this study, we enrolled 80 CRS patients with sinonasal microorganic materials and 10 control subjects who underwent skull base surgery or endoscopic dacryocystorhinostomy and had no signs or symptoms of nasal inflammation. All specimens were stained with hematoxylineosin, Gomori-methenamine-silver, and Gram stain to identify fungal organisms and Gram-positive/negative bacterial colonies. The expression of tumor necrosis factor (TNF)-α; interleukin (IL)-1β; S100A7; S100A8/A9; and short, palate, lung, and nasal epithelial clone 1 (SPLUNC1) were evaluated by enzyme-linked immunosorbent assay using sinus lavage fluid. Results:We histologically classified sinonasal microorganic materials into the following 4 groups: fungus ball (n = 45); bacterial ball (n = 6); mixed ball (formed by a mixture of fungus and bacteria, n = 27); and double ball (formed by separate fungal and bacterial balls, n = 2). Com-pared with the fungus ball, the mixed ball was more frequently detected in immunocompromised patients (p < 0.0001). In addition, TNF-α expression was significantly higher in fungus and mixed balls than in control, whereas the mixed ball showed higher expression of IL-1β compared with the fungus ball. Moreover, the expression of S100A7 and S100A8/A9 protein in the mixed ball was significantly decreased when compared with the fungus ball, whereas there was no significant difference in SPLUNC1 expression between fungus and mixed balls. Conclusion:Our findings suggest that fungal and bacterial interactions are diverse in CRS. Specifically, the mixed ball is prevalent in CRS with an immunocompromised state and it may decrease epithelial barrier function. C 2019 ARS-AAOA, LLC.C hronic rhinosinusitis (CRS) is characterized by inflammation of the mucosa of the nose and paranasal sinuses with a duration of at least 12 consecutive weeks, and is comprised of 2 subtypes: CRS with nasal polyps (CRSwNP) and CRS without nasal polyps (CRSsNP). 1 To date, several heterogeneous factors, including host of Medicine,

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Section: Discussionsupporting

confidence: 91%

Diverse phenotypes and endotypes of fungus balls caused by mixed bacterial colonization in chronic rhinosinusitis

Kim

Shin

et al. 2019

Int Forum Allergy Rhinol

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“…Few studies have reported on older or immunocompromised patients who developed fulminant disseminated IFS after SFB, suggesting the possibility of SFB progression to IFS 8,18,19 . Conversely, other studies reported that SFB has a very low risk of developing IFS, such as 0% and 0.08% 20,21 . However, the present study found that the incidence of SFB with concurrently diagnosed IFS was 1.6% (10 of 627 patients), which was not low risk.…”

Section: Discussioncontrasting

confidence: 79%

Concurrent diagnosis of sinus fungus ball and invasive fungal sinusitis: A retrospective case series

Assiri

Ryu

Kim

2021

Mycoses

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Background Sinus fungal ball (SFB) is the most common type of non‐invasive fungal sinusitis and develops mostly in immunocompetent individuals, whereas invasive fungal sinusitis (IFS), with high mortality, develops mostly in immunocompromised patients. SFB may progress to IFS depending on the patient's immune status and underlying diseases. Objectives To investigate the possibility of SFB progressing to IFS. Patients/Methods A total of 10 patients histopathologically diagnosed with concurrent IFS and SFB from January 2013 to December 2019 were enrolled. Their clinical characteristics, histopathology and clinical course information were obtained and compared with those of 56 patients with IFS alone and 617 patients with SFB alone. Results Acute, chronic and chronic granulomatous IFS was diagnosed in two (20%), five (50%) and three (30%) patients, respectively. All patients had severe facial pain and/or headache, with the most common comorbidity being diabetes (n = 5, 50%). SFB was identified in the maxillary (60%) and sphenoid (40%) sinuses. The tissue culture was positive for Aspergillus species in five (50%) patients. Eight patients with chronic or chronic granulomatous IFS were successfully treated by debridement with voriconazole, and the two patients with acute IFS and severe neutropenia due to haematologic malignancy died. Compared to patients with IFS alone, patients with combined SFB and IFS were older, female dominant, and commonly had chronic or chronic granulomatous IFS. In addition, they were older and more commonly diabetic and immunocompromised than patients with SFB alone. Conclusions SFB may progress to IFS particularly in elderly and immunocompromised patients.

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“…Because the clinical features of these patients did not differ from those of other patients diagnosed with PNS fungal balls, there was some debate on whether antifungal therapy should indeed be performed in addition to surgery. However, several cases of fungal balls progressing to invasive FRS in immunocompromised patients have been reported [14][15][16]. A prior study reported the case of a patient with sinus fungal ball in the sphenoid, who died 2 weeks after surgery due to carotid invasion; the patient was under long-term steroid therapy for asthma [14].…”

Section: Discussionmentioning

confidence: 99%

Microinvasive Fungal Rhinosinusitis: Proposal of a New Subtype in the Classification

Seo

Seok

Lee

et al. 2020

JCM

Self Cite

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Background: Fungal rhinosinusitis (FRS) with mucosal invasion is not classified by the current criteria, and clinical reports on the topic are limited. The aim of this study was to present our 25-year experience on fungal balls with mucosal invasion that do not appear in the FRS classification. Methods: Of 1318 patients who underwent endoscopic surgery with paranasal FRS between November 1994 and July 2019, 372 underwent mucosal biopsies. Medical chart and pathology review were performed on 13 patients diagnosed as having fungal balls with mucosal invasion without accompanying tissue invasion. Results: Histopathologic findings identified all fungi as belonging to the Aspergillus species. In 13 patients, 7 fungal balls were located in the maxillary sinus, 3 in the sphenoid sinus, and 3 in both the maxillary and ethmoid sinuses. The median age at diagnosis was 67 years (interquartile range (IQR): 62–72), and the sex ratio was 1:2 (4 men and 9 women). Five patients had comorbidities—three with diabetes mellitus and two with hematologic malignancy—all of whom received postoperative antifungal therapy. The median duration of antifungal treatment was 13 weeks (IQR: 8–17). No recurrences occurred during the median follow-up period of 30 months (IQR: 22–43). Conclusions: Patients who have been clinically diagnosed with a fungal ball and showed mucosal invasion but no vascular invasion, based on pathologic findings after surgery, may need a new FRS classification category, such as microinvasive FRS, and adjuvant antifungal treatment may be needed for immunocompromised patients with microinvasive FRS. Key points: Fungal rhinosinusitis with mucosal invasion is different from fungal ball and invasive fungal rhinosinusitis and may be classified in a separate category as microinvasive FRS.

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Extrasinonasal infiltrative process associated with a sinonasal fungus ball: does it mean invasive fungal sinusitis?

Cited by 17 publications

References 29 publications

Diverse phenotypes and endotypes of fungus balls caused by mixed bacterial colonization in chronic rhinosinusitis

Diverse phenotypes and endotypes of fungus balls caused by mixed bacterial colonization in chronic rhinosinusitis

Concurrent diagnosis of sinus fungus ball and invasive fungal sinusitis: A retrospective case series

Microinvasive Fungal Rhinosinusitis: Proposal of a New Subtype in the Classification

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