ABSTRACT
INTRODUCTION: Orthognathic surgery can lead to sinus alterations, including sinusitis, attributed to the exposure of maxillary sinuses during Le Fort I osteotomy. Furthermore, being a hospital-based procedure, there is potential risk of complications arising from bacteria prevalent in such environments. This study evaluated maxillary sinusitis occurrence and the presence of multidrug-resistant bacteria in the nasal cavity before and after orthognathic surgery. METHODS: Ten patients with dentofacial deformities underwent Le Fort I osteotomy. Clinical evaluations using SNOT-22 questionnaire were performed, and nasal cavity samples were collected pre-surgery and 3-6 months post-surgery to quantify total mesophilic bacteria and detect Staphylococcus aureus, Acinetobacter baumannii, and Klebsiella pneumoniae. Cone Beam Computed Tomography (CBCT) was performed pre- and post-operatively, and the results were evaluated using the Lund-Mackay system. This study was registered and approved by the Research Ethics Committee of PUCRS (No. 4.683.066). RESULTS: The evaluation of SNOT-22 revealed that five patients showed an improvement in symptoms, while two remained in the same range of interpretation. One patient developed post-operative maxillary sinusitis, which was not detected at the time of evaluation by SNOT-22 or CBCT. CBCT showed a worsening sinus condition in three patients, two of whom had a significant increase in total bacteria count in their nasal cavities. The Brodsky scale was used to assess hypertrophy in palatine tonsils, where 60% of the subjects had grade 1 tonsils, 20% had grade 2 and 20% had grade 3. None of the patients had grade 4 tonsils, which would indicate more than 75% obstruction. Two patients harboured S. aureus and K. pneumoniae in their nasal cavities. Notably, K. pneumoniae, which was multidrug-resistant, was present in the nasal cavity of patients even before surgery, but this did not result in maxillary sinusitis, likely due to the patients' young and healthy condition. CONCLUSION: There was an improvement in signs and symptoms of maxillary sinusitis and quality of life in most patients after orthognathic surgery. However, some patients may still harbour multidrug-resistant bacteria, even if they are asymptomatic. Therefore, a thorough pre-operative assessment is essential to avoid difficult-to-treat post-operative complications.
Subject(s)
Cone-Beam Computed Tomography , Drug Resistance, Multiple, Bacterial , Maxillary Sinusitis , Nasal Cavity , Osteotomy, Le Fort , Humans , Female , Male , Nasal Cavity/microbiology , Nasal Cavity/diagnostic imaging , Maxillary Sinusitis/microbiology , Maxillary Sinusitis/diagnostic imaging , Adult , Young Adult , Acinetobacter baumannii/isolation & purification , Klebsiella pneumoniae/isolation & purification , Adolescent , Staphylococcus aureus/isolation & purification , Dentofacial Deformities/surgery , Dentofacial Deformities/microbiology , Postoperative Complications/microbiology , Postoperative Complications/diagnostic imagingABSTRACT
OBJECTIVE: Optimization of the method of puncture treatment of acute bacterial maxillary sinusitis (ABMS) through the development of original devices for drainage of the maxillary sinus (MS). MATERIAL AND METHODS: Registration and comparative analysis of the results of puncture methods of treatment of 120 patients with ABMS using developed new original devices for drainage of MS with one channels and with two channels in comparison with the Kulikovsky's needle (KN) was carried out. Based on the results of the analysis, the effectiveness of the original devices was assessed. During the clinical study, patients were divided into two groups: in group I, patients underwent of the MS puncture using KN, in group II, using original devices. Groups I and II, depending on the absence or presence of a block of the natural anastomosis MS, was divided into subgroups A and B, respectively. After puncture of the MS, the pain syndrome was assessed by patients using Visual Analogue Scale (VAS) and by doctors - using Touch Visual Pain (TVP) scale. RESULTS: Our study showed that when puncturing the upper jaw with an original needle with one channels and with two channels, compared with the use of KN, there is a decrease in pain (the average VAS score was 1.5±0.3 and 1.7±0.3 points, respectively; the average TVP scale score was 0.9±0.2 and 1.8±0.3 points, respectively, the difference is significant, p≤0.05). Patients of subgroup IB were manipulated with two KN, patients of subgroup IIB manipulated using the original device with two channels without an additional needle (the average VAS score was 3.0±0.4 and 1.3±0.3 points, respectively; the average TVP scale score was 2.7±0.4 and 1.0±0.2 points, respectively, the difference is significant, p≤0.05). The doctors also assessed the devices used for puncture of the upper jaw. As a result of the study, the high efficiency and safety of using new original devices was established.
Subject(s)
Maxillary Sinusitis , Punctures , Humans , Maxillary Sinusitis/microbiology , Maxillary Sinusitis/therapy , Maxillary Sinusitis/diagnosis , Female , Male , Adult , Punctures/methods , Punctures/instrumentation , Middle Aged , Treatment Outcome , Drainage/methods , Drainage/instrumentation , Pain Measurement/methods , Maxillary Sinus/microbiology , Maxillary Sinus/surgery , Acute Disease , Bacterial Infections/therapy , Bacterial Infections/diagnosisABSTRACT
Accidentally extruded root canal filler within the sinuses may induce maxillary sinusitis with fungal mass. The authors describe 2 cases of gutta-percha-induced fungal masses in the left maxillary sinus of 2 women. The lesions were evaluated preoperatively using both computed tomography and magnetic resonance imaging, providing comprehensive insights into the condition. In one patient, the lesion was located such that it could be resected through the middle meatal antrostomy alone. However, the second patient presented with an anteroinferiorly situated lesion that necessitated not only a transnasal approach but also an endoscopic modified medial maxillectomy. Both patients recovered uneventfully after surgery. This case series is the first published report of 2 cases of gutta-percha-induced maxillary sinus fungal masses, with their imaging findings, successfully treated through different routes through transnasal endoscopic surgery. These reports highlight the need for a collaborative approach between dental practitioners and otolaryngologists. In addition to the patient's wishes, surgical interventions must consider the unique characteristics of each case and the potential for collaboration across different medical specialties.
Subject(s)
Magnetic Resonance Imaging , Maxillary Sinus , Tomography, X-Ray Computed , Humans , Female , Maxillary Sinus/surgery , Maxillary Sinus/diagnostic imaging , Maxillary Sinus/microbiology , Endoscopy/methods , Gutta-Percha/therapeutic use , Maxillary Sinusitis/surgery , Maxillary Sinusitis/diagnostic imaging , Maxillary Sinusitis/microbiology , Middle Aged , Root Canal Filling Materials/therapeutic use , Adult , Mycoses/surgery , Mycoses/diagnostic imaging , Natural Orifice Endoscopic Surgery/methodsABSTRACT
OBJECTIVE: Maxillary sinusitis can be a sequela of medication-related osteonecrosis of the jaw (MRONJ). This study aims to characterize the microbiome of maxillary MRONJ with concurrent maxillary sinusitis and radiographic maxillary sinus opacification to determine if there is a relationship between the microbiome of MRONJ and sinus disease. STUDY DESIGN: This retrospective case series was conducted using electronic health records from the University of Pennsylvania and affiliated hospitals. The target population was surgically managed maxillary MRONJ patients. The primary predictor variables were tissue culture results. The primary outcomes were maxillary sinusitis or maxillary sinus opacification. Statistical analysis was performed using chi-squared tests at the 95% confidence interval. RESULTS: Thirty-nine subjects were selected: 25 had sinus opacification and 11 had sinusitis. Resident bacteria were present in 90% of subjects, nonresident bacteria in 74%, and opportunistic organisms in 15%. There were significantly more subjects with chronic sinusitis microbes (79%) than without. There were significantly more gram-positive anaerobes, specifically Propionibacterium, as well as the gram-negative facultative anaerobe, Capnocytophaga, in subjects with concurrent sinusitis. CONCLUSIONS: Maxillary MRONJ with concurrent maxillary sinusitis may be associated with gram-positive anaerobic species, Propionibacterium, and Capnocytophaga colonization. Maxillary MRONJ patients may benefit from sinus evaluation and concurrent surgical intervention.
Subject(s)
Maxillary Sinusitis , Paranasal Sinus Diseases , Sinusitis , Humans , Maxillary Sinusitis/diagnostic imaging , Maxillary Sinusitis/microbiology , Maxillary Sinus/diagnostic imaging , Retrospective Studies , Sinusitis/microbiologyABSTRACT
Individuals with COVID-19 are prone to a variety of infections due to immune dysregulation. The present report presents a case of actinomycotic infection in the maxillary bone and sinus region in a patient with a history of COVID-19. This case report highlights the importance of considering bacterial infections including actinomycosis when encountering destructive lesions resembling more prevalent fungal infections due to different therapeutic medication protocols. In addition, a literature review of the existing reports of similar post-COVID-19 actinomycotic infection is presented.
Subject(s)
Actinomycosis , COVID-19 , Maxillary Sinusitis , Humans , Actinomycosis/diagnosis , Actinomycosis/drug therapy , Actinomycosis/microbiology , COVID-19/complications , Maxillary Sinusitis/complications , Maxillary Sinusitis/microbiologyABSTRACT
BACKGROUND/AIM: The prevalence of chronic sinusitis (CS) in Europe is greater than 10%. The causes of CS are diverse. In some cases, dental treatment in the maxilla as well as fungal infection, such as aspergilloma, can lead to CS. Inadequately treated illnesses, such as type II diabetes, are known risk factors for atypical infections. CASE REPORT: The present case report describes a 72-year-old female suffering from CS in the maxillary sinus. A few years earlier, the patient received endodontic treatment of a maxillary tooth. For further diagnostics a CT-scan was performed showing an obstructed maxillary sinus on the left due to a polypoid tumor. The patient had been suffering from type II diabetes that had been inadequately treated for several years. The patient was surgically treated with an osteoplasty of the maxillary sinus combined with a supraturbinal antrostomy. Histopathological findings revealed an aspergilloma. The surgical therapy was supplemented by antimycotic therapy. In addition, the patient received antidiabetic treatment leading towards stable blood sugar levels. CONCLUSION: Rare entities, such as aspergillomas, can also be the cause of CS. In particular, patients with previous illnesses relevant to the immune system are predisposed for Aspergilloma after dental treatment leading to CS.
Subject(s)
Diabetes Mellitus, Type 2 , Maxillary Sinusitis , Female , Humans , Aged , Maxillary Sinusitis/microbiology , Maxillary Sinusitis/surgery , Diabetes Mellitus, Type 2/complications , Maxillary Sinus/diagnostic imaging , Maxillary Sinus/surgery , Tomography, X-Ray ComputedABSTRACT
PURPOSE: The present study aimed to investigate the diagnostic indicators of odontogenic sinusitis other than computed tomography (CT) findings and the history of dental treatment such as detected bacteria and symptoms. MATERIALS AND METHODS: We performed a retrospective analysis of 87 patients who underwent surgery for unilateral sinusitis between 2016 and 2020 (n = 87). Patients with cysts and fungal sinusitis were excluded from the study. We analyzed the relationship between the presence/absence of CT findings such as periapical lesions and oroantral fistulas; anaerobic bacteria; and symptoms in patients with unilateral sinusitis. RESULTS: There was a significant correlation between the detection of anaerobes and CT findings. Peptostreptococcus sp., Prevotella sp., Streptococcus anginosus group, and Fusobacterium sp. were the most commonly isolated species. Detection of these anaerobic bacteria supports the diagnosis of odontogenic sinusitis. Moreover, ODS often present with symptoms, such as a foul smell and facial pain. CONCLUSIONS: Our results suggest that not only the presence of CT findings such as PAL and OAF, but the detection of anaerobic bacteria, and the presence of any symptoms may aid in the diagnosis of ODS.
Subject(s)
Maxillary Sinusitis , Sinusitis , Bacteria, Anaerobic , Humans , Maxillary Sinusitis/diagnostic imaging , Maxillary Sinusitis/microbiology , Retrospective Studies , Sinusitis/microbiologyABSTRACT
OBJECTIVES/HYPOTHESIS: Acute rhinosinusitis is a frequent common cold-related complication in children. Despite the need for appropriate treatment, its underlying microbiology remains unclear. This study aimed to investigate the microbiology of acute rhinosinusitis in children. STUDY DESIGN: Prospective non controlled study. METHODS: Thirty-one pediatric acute maxillary sinusitis patients with severe symptoms were assessed. The subjects were 17 males and 14 females aged 5 to 14 years (mean age, 9.1 years). Maxillary sinus aspirates were collected and cultured, with subsequent viral and bacterial polymerase chain reaction (PCR) analysis. Bacteria were analyzed using culturing and PCR, and viruses were analyzed using PCR. The PCR kits used identify 18 types of respiratory viruses and 13 types of bacteria. RESULTS: At least one pathogen was detected in 30 of 31 aspirates (97%) using PCR, and none of the aspirates contained respiratory viruses alone. Ten aspirates (32%) contained both viruses and bacteria. The most common viruses detected were rhinovirus (13%) and influenza virus (10%). The most common bacteria were Haemophilus influenzae (45%), Streptococcus pneumoniae (32%), Moraxella catarrhalis (16%), and Chlamydophila pneumoniae (13%). Bacteria were found in 21 of 31 cases (68%) via bacterial culturing. Culturing revealed that H influenzae was the most common pathogen (42%). CONCLUSIONS: In pediatric acute maxillary sinusitis, respiratory bacteria were detected in 65% of the sinus aspirates and both bacteria and viruses in 32%. The most common viruses were rhinovirus and influenza virus, and the most common bacteria were H influenzae and S pneumoniae. Viral and bacterial PCR is useful for accurately investigating the microbiology in pediatric sinusitis. LEVEL OF EVIDENCE: 3 Laryngoscope, 131:E2705-E2711, 2021.
Subject(s)
Maxillary Sinusitis/microbiology , Acute Disease , Adolescent , Child , Child, Preschool , Female , Humans , Male , Maxillary Sinusitis/virology , Polymerase Chain Reaction , Prospective StudiesABSTRACT
PURPOSE: Endodontic disease is one of the most common causes of bacterial odontogenic sinusitis (ODS). Diagnosing ODS of endodontic origin involves otolaryngologists confirming sinusitis, and dental specialists confirming endodontic sources. The purpose of this study was to conduct a multidisciplinary literature review to highlight clinical and microbiological features of ODS, and the most optimal diagnostic modalities to confirm endodontic disease. METHODS: An extensive review of both medical and dental literature was performed by rhinologists, endodontists, and an infectious disease specialist. Frequencies of various clinical and microbiological features from ODS studies were collected, and averages were calculated. Different endodontic testing and imaging modalities were also evaluated on their abilities to confirm endodontic disease. RESULTS: ODS patients most often present with unilateral sinonasal symptoms for over 3 months, purulence on nasal endoscopy, and overt dental pathology on computed tomography (CT). Subjective foul smell, and maxillary sinus cultures demonstrating anaerobes and α-streptococci (viridans group) may be more specific to ODS. For endodontic evaluations, cold pulp testing and cone-beam CT imaging are most optimal for confirming pulpal and periapical disease. CONCLUSION: Diagnosing ODS requires collaboration between otolaryngologists and dental specialists. Clinicians should suspect ODS when patients present with unilateral sinonasal symptoms, especially foul smell. Patients will generally have purulent drainage on nasal endoscopy, and both sinus opacification and overt dental pathology on CT. However, some patients will have subtle or absent dental pathology on CT. For suspected endodontic disease, endodontists should be consulted for at least cold pulp testing, and ideally cone-beam CT.
Subject(s)
Bacterial Infections , Maxillary Sinusitis/diagnosis , Maxillary Sinusitis/microbiology , Pulpitis/diagnosis , Pulpitis/microbiology , Adult , Cone-Beam Computed Tomography , Female , Humans , Male , Middle Aged , Tomography, X-Ray Computed , Viridans Streptococci/isolation & purification , Viridans Streptococci/pathogenicityABSTRACT
Parvimonas micra and Fusobacterium nucleatum are commensal pathogens very rarely isolated simultaneously in clinical specimens. We report a case of chronic maxillary sinusitis caused by these two pathogens, presumably resulting from a co-existing dental infection.
Subject(s)
Firmicutes/classification , Fusobacterium Infections/diagnostic imaging , Fusobacterium nucleatum/classification , Gram-Positive Bacterial Infections/diagnosis , Anaerobiosis , Facial Pain/microbiology , Firmicutes/drug effects , Firmicutes/genetics , Fusobacterium Infections/drug therapy , Fusobacterium Infections/microbiology , Fusobacterium nucleatum/drug effects , Fusobacterium nucleatum/genetics , Gram-Positive Bacterial Infections/drug therapy , Gram-Positive Bacterial Infections/microbiology , Humans , Male , Maxillary Sinusitis/microbiology , Middle Aged , Toothache/microbiology , Toothache/surgery , Treatment OutcomeABSTRACT
BACKGROUND: Schizophyllum commune is a basidiomycete fungus which is widely distributed in nature. Its role as responsible for disease in humans is not well known, partly due to its difficult identification. The incorporation of mass spectrometry techniques (MALDI-TOF) and molecular biology to the laboratories has allowed the description of a greater number of cases. CASE REPORT: In this paper, we present two cases in which S. commune was identified as the causative agent of disease: in the first case an immunocompetent patient suffered from chronic rhinosinusitis, and in the second one a sphenoid sinus infection was diagnosed in an immunocompromised patient. In both cases, S. commune was isolated. Its identification was possible by means of MALDI-TOF and this was confirmed in both patients by amplification and sequencing of the ITS region. CONCLUSIONS: In conclusion, S. commune should be considered a potential causative agent of fungal disease. Currently, MALDI-TOF and sequencing techniques are necessary for its identification.
Subject(s)
Maxillary Sinusitis/microbiology , Mycoses/microbiology , Schizophyllum/isolation & purification , Sphenoid Sinusitis/microbiology , Adult , Aged , Antifungal Agents/pharmacology , Antifungal Agents/therapeutic use , Drug Resistance, Fungal , Foreign Bodies/complications , Humans , Male , Mucocele/complications , Schizophyllum/drug effects , Schizophyllum/pathogenicityABSTRACT
BACKGROUND: Maxillary sinus fungal ball is a common cause of unilateral maxillary sinusitis. Fungal balls or mycetomas are primarily treated with surgery to remove the fungus. However, this assumes the pre-fungal ball sinus cavity was normal and post-surgery patients may suffer from mucostasis in the sinus cavity with persistent symptoms. It is proposed that fungal balls are potentially a feature of impaired mucus clearance as they are a pathology in their own right. METHODS: A case series of consecutive patients undergoing antrostomy for maxillary sinus fungal ball was performed. Patient factors including age, gender, smoking status, comorbidities (allergy, asthma, and reflux), disease specific factors including duration of symptoms, microbiology (bacterial co-infection, Gram-positive and/or Gram-negative) and preoperative radiologic findings (extent of sinus development, and neo-osteogenesis/bone thickness) were collected. The primary outcome was sinus function defined by evidence of a normal functioning maxillary sinus, with the absence of mucostasis or pooling, on endoscopic exam at three months, six months and last follow-up. Endoscopic evaluation of inflammation was also collected. RESULTS: 28 patients (age 58.5 ± 15.5 years, 64.3% female) were assessed. Mucostasis was present at three months in 39.3%, at six months in 32.1%, and 17.9% at last follow-up. There was no comorbidity or radiologic finding that was associated with failure to normalize. Those patients with mucostasis had a higher modified Lund-Mackay endoscopic score at last follow-up (5.0 ± 0.7 v 0.2 ± 0.6, p < 0.01). CONCLUSIONS: Long term post-operative mucostasis occurred in 17.9% of patients following an adequate maxillary antrostomy for treatment of a fungal ball. Patients with mucostasis had persistent mucosal inflammation and a greater need for further surgery (modified medial maxillectomy).
Subject(s)
Invasive Fungal Infections , Maxillary Sinus/surgery , Maxillary Sinusitis/microbiology , Maxillary Sinusitis/surgery , Otorhinolaryngologic Surgical Procedures/methods , Adult , Aged , Cross-Sectional Studies , Endoscopy , Female , Follow-Up Studies , Humans , Inflammation , Male , Maxillary Sinusitis/physiopathology , Middle Aged , Mucociliary Clearance , Treatment OutcomeABSTRACT
RESUMEN Introducción: La patología sinusal inflamatoria e infecciosa puede comprometer la mucosa sinusal maxilar, etmoidal, esfenoidal o frontal, y su etiología es variada. Se ha observado que la patología odontológica es uno de los factores causales de la sinusitis maxilar, con una incidencia del 10% al 40% según diversas series de casos. El diagnóstico y tratamiento se debe realizar de manera interdisciplinaria entre las especialidades de otorrinolaringología y de cirugía maxilofacial. Se elaboró un documento descriptivo sobre la sinusitis odontogénica y orientador sobre su manejo, de acuerdo a una revisión de la literatura. Se realizaron búsquedas en las bases de datos PubMed, Lilacs y Google Académico, utilizando términos relevantes para la sinusitis odontogénica, con el fin de elaborar el documento. Se utilizaron 43 artículos, todos publicados desde el año 1986 hasta la fecha. Se concluye que la sinusitis odontogénica difiere tanto en la clínica como en la microbiología de otras enfermedades sinusales. El tratamiento se basa en el trabajo interdisciplinario e incluye cirugía endoscópica funcional, realizada por el otorrinolaringólogo, en conjunto con el tratamiento odontológico, siendo fundamental la buena comunicación entre ambos equipos.
ABSTRACT Introduction: Infectious and inflammatory sinus diseases have a varied etiology and can be associated to the maxillary, ethmoidal, sphenoidal and frontal sinuses. Dental pathology can be one of the etiological factors associated to maxillary sinus disease, with frequency rates of 10-40%. Diagnosis and treatment require interdisciplinary work, with participation of otorhinolaryngology and oral and maxillofacial surgery. The development of a descriptive document on odontogenic sinusitis and management guidelines according to literature review. Pubmed, Lilacs and Google Academic database were searched using terms relevant to odontogenic sinusitis, in order to prepare the document. 43 articles were used, all published from 1986 onwards. We conclude that odontogenic sinusitis differs clinically and microbiologically from other sinus pathologies. Treatment modalities are based upon interdisciplinary surgery, including functional endoscopic surgery done by otolaryngologists and dental treatment, being fundamental close communication between the two teams.
Subject(s)
Humans , Tooth Diseases/complications , Maxillary Sinusitis/etiology , Maxillary Sinusitis/therapy , Maxillary Sinusitis/diagnostic imaging , Periodontal Diseases/complications , Tomography, X-Ray Computed/methods , Maxillary Sinusitis/surgery , Maxillary Sinusitis/microbiology , Maxillary Sinusitis/drug therapy , Anti-Bacterial Agents/therapeutic useABSTRACT
OBJECTIVE: High-throughput DNA sequencing of the paranasal sinus microbiome has potential in the diagnosis and treatment of sinusitis. The objective of this study is to evaluate the use of high-throughput DNA sequencing to diagnose sinusitis of odontogenic origin. STUDY DESIGN: Case series with chart review. SETTING: Single tertiary care academic medical center. SUBJECTS AND METHODS: A chart review was performed of DNA sequencing results from the sinus aspirates obtained under endoscopic visualization in 142 patients with sinusitis. The identification of any potentially pathogenic bacteria associated with oral flora in a sample was classified as a positive result for sinusitis of odontogenic etiology. The sensitivity, specificity, and predictive values of using high-throughput DNA sequencing to diagnose sinusitis of odontogenic etiology were determined, with the patient's computed tomography sinus scan as the reference standard. On computed tomography scans, an odontogenic source was determined by the presence of a periapical lucency perforating the schneiderian membrane. RESULTS: Seven of the 142 patients enrolled in this study had an odontogenic source based on computed tomography scans. Relative to this reference standard, high-throughput DNA sequencing produced a sensitivity of 85.7% (95% CI, 42.1%-99.6%), a specificity of 81.5% (95% CI, 73.9%-87.6%), a positive predictive value of 19.4% (95% CI, 13.1%-27.7%), and a negative predictive value of 99.1% (95% CI, 94.7%-99.9%). CONCLUSION: This study supports the use of high-throughput DNA sequencing in supplementing other methods of investigation for identifying an odontogenic etiology of sinusitis.
Subject(s)
High-Throughput Nucleotide Sequencing , Maxillary Sinusitis/microbiology , Microbiota , Paranasal Sinuses/microbiology , RNA, Bacterial/isolation & purification , Adult , Female , Humans , Male , Maxillary Sinusitis/diagnostic imaging , Maxillary Sinusitis/therapy , Retrospective Studies , Sensitivity and Specificity , Tomography, X-Ray ComputedSubject(s)
Aspergillosis/therapy , Immunoglobulin G4-Related Disease/complications , Maxillary Sinus/microbiology , Maxillary Sinusitis/microbiology , Nasopharyngeal Diseases/complications , Aspergillosis/diagnosis , Endoscopy , Humans , Immunoglobulin G4-Related Disease/therapy , Maxillary Sinus/surgery , Maxillary Sinusitis/complications , Maxillary Sinusitis/diagnosis , Maxillary Sinusitis/therapy , Nasopharyngeal Diseases/diagnosis , Nasopharyngeal Diseases/therapy , Tomography, X-Ray ComputedABSTRACT
INTRODUCTION: Mucormycosis is a severe infection in renal transplant recipients. Here, we report a case of maxillary sinus mucormycosis in a patient who presented with a facial pain complaint. CASE: A 51-year-old female patient with renal transplantation due to autosomal dominant, polycystic kidney disease and diabetic nephropathy was admitted to our hospital with facial pain and minimal edema of the left half of her face on the 8th month of transplantation. On physical examination, there was only tenderness and slight edema on the left half of the face. On the paranasal computed tomography, extensive soft tissue densities involving septations, filling the left maxillary sinus, extending to the nasal cavity, and obliterating the left osteometeal unit were observed. Because facial pain was not relieved by antibiotics and several, potent analgesic drugs on the second day, mucormycosis infection with bone involvement was suspected. A left maxillary sinus excision was performed. Microscopic examination of the debridement specimen revealed necrotic bone interspersed with fungal hyphae, and culture isolated Rhizopus oryzae. Liposomal amphotericin B was started. The patient was on tacrolimus, prednisolone, and mycophenolate mofetil. Tacrolimus was switched to cyclosporine to regulate serum glucose levels. The left maxillary sinus was washed with liposomal amphoterin B daily and curetted with intervals. The patient started dialysis because of severe renal function loss. The patient was discharged on the 96th day of liposomal amphotericin B. CONCLUSION: It should be kept in mind that mucormycosis may be present in the sinuses even if there is no evidence for nasal, oral, and dental examination in renal transplant patients with facial pain.
Subject(s)
Immunocompromised Host , Kidney Transplantation/adverse effects , Maxillary Sinusitis/immunology , Mucormycosis/immunology , Amphotericin B/therapeutic use , Antifungal Agents/therapeutic use , Facial Pain/etiology , Female , Humans , Maxillary Sinusitis/complications , Maxillary Sinusitis/microbiology , Middle Aged , Mucormycosis/complications , Mucormycosis/drug therapy , Rhizopus/isolation & purificationABSTRACT
Most sinusitis is the result of a periapical infection caused by caries or periodontal disease. The role of bacteria in the initiation of inflammation of the pulp and periapical zones has been well demonstrated. It is well known that colonization of microorganisms in the oral cavity can contribute to the development of pathology of the pulp and periapical organs. Purpose - to study the pathogenesis of maxillary sinusitis, which developed during the treatment of complications of caries of the upper jaw. The study involved 17 patients (mean 40.5±12.7 years) with maxillary sinusitis after treatment of complications of dental caries of the upper jaw. In 8 (47.2%) patients, the species composition of microflora in the sinuses was revealed. Material for the study was taken from the maxillary sinuses during the operative intervention. 24 hours before the operation, antibiotics were discontinued. Identification of isolated aerobic cultures and fungi was carried out using a Vitek 2-compact (BioMérieux, France). The susceptibility of antibiotics to the isolated microorganisms was determined using a Vitek 2-compact bacteriological analyzer. In 9 (53.0%) patients venous blood sampling was carried out in accordance with the recommendations of the Zaporizhzhya laboratory Synevo (Belgium) for the study of general immunity. Aerobic bacteria were sown in 100.0% of patients. Gram-positive flora - staphylococcus and streptococcus (80.0%) and fungi - candida (20.0%). Monocultures were detected in 75.0% of patients, associations - in 25.0%. The maximum bacterial contamination index is 105 CFU, detected in 20.0% of cases; the minimum figure was 103 CFU, was found in 50.0% of cases. High Ig E values (173.3±76.7 IU/ml) and low CIC values (160 OU) indicate the presence of an allergic component in the pathogenesis of the disease and an adequate immune system response to sensitization and inflammation in patients in this group.
Subject(s)
Dental Caries , Maxillary Sinusitis , Bacteria , Dental Caries/microbiology , Humans , Maxillary Sinus , Maxillary Sinusitis/microbiology , MouthSubject(s)
Brain Diseases/diagnostic imaging , Eye Diseases/diagnostic imaging , Maxillary Sinusitis/diagnostic imaging , Mucormycosis/diagnosis , Amphotericin B/therapeutic use , Antifungal Agents/therapeutic use , Blindness/etiology , Blindness/microbiology , Blindness/therapy , Brain Diseases/microbiology , Brain Diseases/therapy , Debridement , Exophthalmos/etiology , Exophthalmos/microbiology , Exophthalmos/therapy , Eye Diseases/microbiology , Eye Diseases/therapy , Fatal Outcome , Female , Humans , Magnetic Resonance Imaging , Maxillary Sinusitis/microbiology , Maxillary Sinusitis/therapy , Middle Aged , Mucormycosis/diagnostic imaging , Mucormycosis/microbiology , Mucormycosis/therapy , Optic Neuritis/diagnostic imaging , Optic Neuritis/microbiology , Optic Neuritis/therapyABSTRACT
Fungus ball is the most common form of non-invasive fungal rhinosinusitis. Aspergillusfumigatus (between 44.8% and 75%) and Aspergillusflavus (14%) are the two most common species recovered. However, recent advances in mycological laboratory methods have enhanced the detection and identification of fungi within fungus balls. Fusarium species, sometimes recovered from other forms of fungal rhinosinusitis such as allergic fungal rhinosinusitis or acute invasive fungal rhinosinusitis, are poorly associated with sinonasal fungus ball. Here, we describe two further cases of a fungus ball due to Fusariumproliferatum and provide the first description of this fungal pathogen with a fungus ball of odontogenic origin. These case reports demonstrate that uncommon fungal species such as Fusarium spp. might be underestimated as agents of sinusal cavity fungus ball. Enhanced mycological detection and diagnostic techniques might give rise, in the near future, to the emergence of new or rare fungal species associated with this clinical entity.
Subject(s)
Fusarium/isolation & purification , Maxillary Sinusitis/microbiology , Mucous Membrane/microbiology , Rhinitis/diagnosis , Sinusitis/diagnosis , Female , Fusarium/pathogenicity , Humans , Maxillary Sinusitis/diagnostic imaging , Middle Aged , Mucous Membrane/surgery , Rhinitis/microbiology , Sinusitis/microbiology , Tomography, X-Ray ComputedABSTRACT
INTRODUCTION: Burkholderia gladioli are non-fermenting, Gram-negative, rod-shaped aerobic bacteria that were first identified as a plant pathogen. Most of the B. gladioli infections reported in the literature have involved immunocompromised adults and newborn infants. B. gladioli in humans is often associated with a poor prognosis. CASE REPORT: We describe the first case of sinonasal infection due to B. gladioli and Staphylococcus aureus in an immunocompetent patient who had recently travelled to the Congo. DISCUSSION: As in the few other reported cases involving immunocompetent patients, the appropriate approach to this multidrug-resistant B. gladioli infection was a combination of surgery and antibiotics chosen in the light of an antibiogram.