Current diagnosis and treatment of rhinosinusal aspergilloma (Review)

Vrinceanu,Daniela; Dumitru,Mihai; Patrascu,Oana Maria; Costache,Adrian; Papacocea,Toma; Cergan,Romica

doi:10.3892/etm.2021.10699

Current diagnosis and treatment of rhinosinusal aspergilloma (Review)

Authors:
- Daniela Vrinceanu
- Mihai Dumitru
- Oana Maria Patrascu
- Adrian Costache
- Toma Papacocea
- Romica Cergan
View Affiliations

Affiliations: ENT Department, Bucharest Emergency University Hospital, 010271 Bucharest, Romania, Department of Pathology, ‘Carol Davila’ University of Medicine and Pharmacy, 020021 Bucharest, Romania, Department of Neurosurgery, ‘Sf. Pantelimon’ Hospital, 021661 Bucharest, Romania, Department of Anatomy, ‘Carol Davila’ University of Medicine and Pharmacy, 050474 Bucharest, Romania
Published online on: September 6, 2021 https://doi.org/10.3892/etm.2021.10699
Article Number: 1264
Copyright: © Vrinceanu et al. This is an open access article distributed under the terms of Creative Commons Attribution License.

Metrics: Total Views: 0 (Spandidos Publications: | PMC Statistics: )

Metrics: Total PDF Downloads: 0 (Spandidos Publications: | PMC Statistics: )

Cited By (CrossRef): 0 citations Loading Articles...

Abstract

There are numerous types of sinusitis caused by fungal strains, some of which already colonize the nasal cavity. Mild forms present fungus balls growing inside a preexisting sinus cavity. The invasive type ranges from chronic manifestations to acute aggravated episodes. The latter scenario is encountered in cases with reduced immune responses, such as patients with diabetes, individuals receiving any form of transplant, AIDS cases and chemotherapy patients. Without the control of immunosuppression, the infection is aggravated and extends to the orbit and inside the skull base, regardless of the prompt surgical and medical treatment. This is the most common pathogenic fungus on the nasal sinuses level. It can occasionally enter the sinus cavity during dental procedures. The pathogenesis is enhanced by anaerobic conditions in poorly ventilated sinus cavities. Rhinosinusal aspergilloma has a slow, insidious evolution over months and even years. Our experience revealed the presence of both a dental problem and previous self‑administered antibiotic regimens in almost every case. The initial symptoms are common with sinusitis of dental origin, but aspergilloma should be considered when a patient with a competent immune system does not respond to standard antibiotic treatment. The final diagnosis of rhinosinusal aspergilloma is conducted on a pathology sample with silver staining. The bacteriology exam of the sinus secretion rarely reveals a fungus infection; however, as revealed in our clinical experience, there may be coinfection with other multidrug‑resistant bacteria. Surgical treatment must establish a wide exposure of the sinus cavity and correct drainage regardless of the external, combined or endoscopic approach. Early diagnosis and emergency surgical debridement along with administering systemic antifungal compounds in some cases represent the key to the successful treatment of invasive aspergilloma.

View Figures

View References

1	Neville BW, Damm DD, Allen CM and Bouquot JE: Fungal and protozoal diseases. In: Oral and Maxillofacial Pathology. 2nd edition. Saunders, Philadelphia PA, pp189-211, 2005.
2	Lin SJ, Schranz J and Teutsch SM: Aspergillosis case-fatality rate: Systematic review of the literature. Clin Infect Dis. 32:358–366. 2001.PubMed/NCBI View Article : Google Scholar
3	Nikolaizik WH, Weichel M, Blaser K and Crameri R: Intracutaneous tests with recombinant allergens in cystic fibrosis patients with allergic bronchopulmonary aspergillosis and aspergillus allergy. Am J Respir Crit Care Med. 165:916–921. 2002.PubMed/NCBI View Article : Google Scholar
4	Hartl D, Latzin P, Zissel G, Krane M, Krauss-Etschmann S and Griese M: Chemokines indicate allergic bronchopulmonary aspergillosis in patients with cystic fibrosis. Am J Respir Crit Care Med. 173:1370–1376. 2006.PubMed/NCBI View Article : Google Scholar
5	Kraemer R, Deloséa N, Ballinari P, Gallati S and Crameri R: Effect of allergic bronchopulmonary aspergillosis on lung function in children with cystic fibrosis. Am J Respir Crit Care Med. 174:1211–1220. 2006.PubMed/NCBI View Article : Google Scholar
6	Frisvad JC, Rank C, Nielsen KF and Larsen TO: Metabolomics of aspergillus fumigatus. Med Mycol. 47 (Suppl 1):S53–S71. 2009.PubMed/NCBI View Article : Google Scholar
7	Guarner J and Brandt ME: Histopathologic diagnosis of fungal infections in the 21st century. Clin Microbiol Rev. 24:247–280. 2011.PubMed/NCBI View Article : Google Scholar
8	Arndt S, Aschendorff A, Echternach M, Daemmrich TD and Maier W: Rhino-orbital-cerebral mucormycosis and aspergillosis: Differential diagnosis and treatment. Eur Arch Otorhinolaryngol. 266:71–76. 2009.PubMed/NCBI View Article : Google Scholar
9	Walsh TJ, Anaissie EJ, Denning DW, Herbrecht R, Kontoyiannis DP, Marr KA, Morrison VA, Segal BH, Steinbach WJ, Stevens DA, et al: Treatment of aspergillosis: Clinical practice guidelines of the infectious diseases society of america. Clin Infect Dis. 46:327–360. 2008.PubMed/NCBI View Article : Google Scholar
10	Tamgadge AP, Mengi R, Tamgadge S and Bhalerao SS: Chronic invasive aspergillosis of paranasal sinuses: A case report with review of literature. J Oral Maxillofac Pathol. 16:460–464. 2012.PubMed/NCBI View Article : Google Scholar
11	Sharma OP and Chwogule R: Many faces of pulmonary aspergillosis. Eur Respir J. 12:705–715. 1998.PubMed/NCBI View Article : Google Scholar
12	Warder FR, Chikes PG and Hudson WR: Aspergillosis of the paranasal sinusis. Arch Otolaryngol. 101:683–685. 1975.PubMed/NCBI View Article : Google Scholar
13	Sapp JP, Eversole LR and Wysocki GP: Oral infections. In: Contemporary Oral, Maxillofacial Pathology. 2nd edition. Mosby, St. Louis, MO, pp207-251, 2004.
14	Dayananda BC, Vandana R, Rekha K and Kumar GS: Aspergillosis of the maxillary antrum: A case report. J Oral Maxillofac Pathol. 1:26–29. 2002.
15	Chambers MS, Lyzak WA, Martin JW, Lyzak JS and Toth BB: Oral complications associated with aspergillosis in patients with a hematologic malignancy. Presentation and treatment. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 79:559–563. 1995.PubMed/NCBI View Article : Google Scholar
16	Veress B, Malik OA, el-Tayeb AA, el-Daoud S, Mahgoub ES and el-Hassan AM: Further observations on the primary paranasal aspergillus granuloma in the Sudan: A morphological study of 46 cases. Am J Trop Med Hyg. 22:765–772. 1973.PubMed/NCBI View Article : Google Scholar
17	Samaranayake LP, Keung Leung W and Jin L: Oral mucosal fungal infections. Periodontol 2000. 49:39–59. 2009.PubMed/NCBI View Article : Google Scholar
18	Jeican II, Barbu Tudoran L, Florea A, Flonta M, Trombitas V, Apostol A, Dumitru M, Aluaș M, Junie LM and Albu S: Chronic Rhinosinusitis: MALDI-TOF mass spectrometry microbiological diagnosis and electron microscopy analysis; Experience of the 2nd otorhinolaryngology clinic of Cluj-Napoca, Romania. J Clin Med. 9(3973)2020.PubMed/NCBI View Article : Google Scholar
19	Denning DW: Invasive aspergillosis. Clin Infect Dis. 26:781–803. 1998.PubMed/NCBI View Article : Google Scholar
20	Regezi JA, Sciubba JJ and Jordan RC: Ulcerative conditions. In: Oral pathology-Clinical Pathologic Correlations. 4th edition. Saunders, St. Louis, MO, pp23-74, 2003.
21	Kwon J, Park KH, Park SI and Jin SY: Aspergillosis of the paranasal sinuses-diagnostic significance of the computed tomography. Yonsei Med J. 30:294–297. 1989.PubMed/NCBI View Article : Google Scholar
22	Ciobanu IC, Motoc A, Jianu AM, Cergan R, Banu MA and Rusu MC: The maxillary recess of the sphenoid sinus. Rom J Morphol Embryol. 50:487–489. 2009.PubMed/NCBI
23	DelGaudio JM, Swain RE, Kingdom TT, Muller S and Hudgins PA: Computed Tomographic findings in patients with invasive fungal sinusitis. Arch Otolaryngol Head Neck Surg. 129:236–240. 2003.PubMed/NCBI View Article : Google Scholar
24	Rusu E, Jinga M, Rusu F, Ciurtin C, Enache G, Dragomir A, Cristescu V, Stoica V, Costache A, Cheta D and Radulian G: Statin therapy in patients with diabetes and hepatitis C. Farmacia. 61:1204–1215. 2013.
25	Pasqualotto AC, Xavier MO, Andreolla HF and Linden R: Voriconazole therapeutic drug monitoring: Focus on safety. Expert Opin Drug Saf. 9:125–137. 2010.PubMed/NCBI View Article : Google Scholar
26	Berghi NO, Dumitru M, Vrinceanu D, Ciuluvica RC, Simioniuc-Petrescu A, Caragheorgheopol R, Tucureanu C, Cornateanu RS and Giurcaneanu C: Relationship between chemokines and T lymphocytes in the context of respiratory allergies (Review). Exp Ther Med. 20:2352–2360. 2020.PubMed/NCBI View Article : Google Scholar
27	Stammberger H, Jakse R and Beaufort F: Aspergillosis of the paranasal sinuses; X-ray diagnosis, histopathology, and clinical aspects. Ann Otol Rhinol Laryngol. 93:251–256. 1984.PubMed/NCBI View Article : Google Scholar
28	Rowe-Jones JM and Moore-Gillon V: Destructive noninvasive paranasal sinus aspergillosis: Component of a spectrum of disease. J Otolaryngol. 23:92–96. 1994.PubMed/NCBI
29	Myoken Y, Sugata T, Fujita Y, Fujihara M, Iwato K, Murayama SY and Mikami Y: Early diagnosis and successful management of atypical invasive aspergillus sinusitis in a hematopoietic cell transplant patient: A case report. J Oral Maxillofac Surg. 64:860–863. 2006.PubMed/NCBI View Article : Google Scholar
30	Sungkanuparph S, Sathapatayavongs B, Kunachak S, Luxameechanporn T and Cheewaruangroj W: Treatment of invasive fungal sinusitis with liposomal amphotericin B: A report of four cases. J Med Assoc Thai. 84:593–601. 2001.PubMed/NCBI
31	Peral-Cagigal B, Redondo-González LM and Verrier-Hernández A: Invasive maxillary sinus aspergillosis: A case report successfully treated with voriconazole and surgical debridement. J Clin Exp Dent. 6:e448–e451. 2014.PubMed/NCBI View Article : Google Scholar
32	Herbrecht R, Denning DW, Patterson TF, Bennett JE, Greene RE, Oestmann JW, Kern WV, Marr KA, Ribaud P, Lortholary O, et al: Voriconazole versus amphotericin B for primary therapy of invasive aspergillosis. N Engl J Med. 347:408–415. 2002.PubMed/NCBI View Article : Google Scholar
33	Lee JH, Oh DH and Lee DH: A single small-sized fungus ball in the maxillary sinus: An endoscopic view. Ear Nose Throat J. 99:165–166. 2020.PubMed/NCBI View Article : Google Scholar
34	Lee JH: Endoscopic view of fungus ball in the most posterior ethmoid cell via the supreme meatus. Ear Nose Throat J. 98:319–320. 2019.PubMed/NCBI View Article : Google Scholar
35	Mitroi M, Albulescu D, Capitanescu A, Docea AO, Musat G, Mitroi G, Zlatian O, Tsatsakis A, Tzanakakis G, Spandidos DA and Calina D: Differences in the distribution of CD20, CD3, CD34 and CD45RO in nasal mucosa and polyps from patients with chronic rhinosinusitis. Mol Med Rep. 19:2792–2800. 2019.PubMed/NCBI View Article : Google Scholar
36	Gletsou E, Ioannou M, Liakopoulos V, Tsiambas E, Ragos V and Stefanidis I: Aspergillosis in immunocompromised patients with haematological malignancies. J Buon. 23:7–10. 2018.PubMed/NCBI
37	Jeican II, Trombitas V, Crivii C, Dumitru M, Aluas M, Dogaru G, Gheban D, Junie LM and Albu S: Rehabilitation of patients with chronic rhinosinusitis after functional endoscopic sinus surgery. Balneo and PRM Research Journal. 12:65–72. 2021.
38	Leszczyńska J, Stryjewska-Makuch G, Lisowska G, Kolebacz B and Michalak-Kolarz M: Fungal sinusitis among patients with chronic rhinosinusitis who underwent endoscopic sinus surgery. Otolaryngol Pol. 72:35–41. 2018.PubMed/NCBI View Article : Google Scholar
39	Deutsch PG, Whittaker J and Prasad S: Invasive and non-invasive fungal Rhinosinusitis-A review and update of the evidence. Medicina (Kaunas). 55(319)2019.PubMed/NCBI View Article : Google Scholar