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3.
Eur J Ophthalmol ; 30(1): 88-93, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30474397

RESUMO

PURPOSE: To identify the causative microorganism of fungal endogenous endophthalmitis in our tertiary referral uveitis center and review the therapeutic role of pars plana vitrectomy in patients with fungal endogenous endophthalmitis. METHODS: Seven eyes of six cases were identified as fungal endogenous endophthalmitis through positive cultures of ocular fluids and clinical presentations. The final anatomical and functional results were evaluated. RESULTS: Four women (66.7%) and two men (33.3%) underwent vitrectomy. Control of infection was achieved early on in all cases. Candida (71.4%) and Aspergillus (28.6%) species were identified as causative fungi in patients with fungal endogenous endophthalmitis. Two patients were reoperated due to reinfection and retinal detachment, respectively. Visual acuity improved in six eyes (85.7%) and worsened in one eye (14.3%). At the final examination, the retina was flat in all cases. No eye developed phthisis bulbi. CONCLUSION: Candida species are the most common causative organisms of fungal endogenous endophthalmitis in this study. Pars plana vitrectomy in fungal endogenous endophthalmitis may enhance the treatment of infection by removing fungal elements in the vitreous and aid in diagnosis. Vitrectomy may also be an important tool in the management of vision-threatening post-infectious sequelae such as retinal detachment and reinfections.


Assuntos
Aspergilose/cirurgia , Candidíase/cirurgia , Endoftalmite/cirurgia , Infecções Oculares Fúngicas/cirurgia , Vitrectomia/métodos , Adulto , Idoso , Aspergilose/microbiologia , Aspergilose/fisiopatologia , Candidíase/microbiologia , Candidíase/fisiopatologia , Endoftalmite/microbiologia , Endoftalmite/fisiopatologia , Infecções Oculares Fúngicas/microbiologia , Infecções Oculares Fúngicas/fisiopatologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Reoperação , Descolamento Retiniano/cirurgia , Estudos Retrospectivos , Centros de Atenção Terciária , Acuidade Visual/fisiologia , Corpo Vítreo/microbiologia , Adulto Jovem
4.
J Infect Chemother ; 26(2): 175-180, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31735628

RESUMO

OBJECTIVE: Although invasive fungal disease (IFD) is an important complication in allogeneic hematopoietic stem cell transplantation (HSCT), the clinical significance of surgery, including the role of surgical resection for persistent pulmonary fungal disease prior to allogeneic HSCT in the current era with a variety of available antifungal agents, is controversial. We investigated the role of surgical resection. METHODS: We retrospectively investigated six patients who underwent surgical resection of suspected pulmonary fungal disease prior to allogeneic HSCT between April 2007 and June 2016 at our medical center. RESULTS: We present six patients who underwent surgical resection of suspected pulmonary fungal disease prior to allogeneic HSCT. In our case series, three of four patients who were given a presurgical diagnosis of possible IFD were given a proven diagnosis after surgery, including two cases of invasive aspergillosis (IA) and one case of mucormycosis. All surgeries were performed by video-assisted thoracic surgery (VATS) for lobectomy without major complications. Recurrence of IFD was not observed after allogeneic HSCT in any of the six patients. CONCLUSION: Our experience indicated that surgical resection of persistent localized pulmonary lesions of IFD before allogeneic HSCT was helpful for obtaining a definitive diagnosis and might be useful for reducing recurrence after HSCT.


Assuntos
Transplante de Células-Tronco Hematopoéticas , Leucemia/cirurgia , Pneumopatias Fúngicas/cirurgia , Cirurgia Torácica Vídeoassistida/métodos , Adulto , Aspergilose/complicações , Aspergilose/cirurgia , Feminino , Humanos , Infecções Fúngicas Invasivas/complicações , Infecções Fúngicas Invasivas/cirurgia , Leucemia/complicações , Pneumopatias Fúngicas/complicações , Masculino , Pessoa de Meia-Idade , Mucormicose/complicações , Mucormicose/cirurgia , Recidiva , Estudos Retrospectivos , Transplante Homólogo , Adulto Jovem
5.
Interact Cardiovasc Thorac Surg ; 30(3): 491-492, 2020 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-31746990

RESUMO

The latissimus dorsi and serratus anterior muscles are available for reconstruction coverage of thoracic defects. We performed extended latissimus dorsi-serratus anterior chimeric thoraco-myoplasty with a vascular supercharge to maintain sufficient blood supply to the flaps because of a deficiency in the distal blood flow to the flap revealed by an intravenous injection of indocyanine green and simultaneous endobronchial embolization for refractory Aspergillus empyema.


Assuntos
Aspergilose/cirurgia , Aspergillus fumigatus , Empiema/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Retalhos Cirúrgicos , Toracoplastia/métodos , Aspergilose/diagnóstico , Axila , Empiema/diagnóstico , Humanos , Masculino , Pessoa de Meia-Idade , Músculos Superficiais do Dorso , Parede Torácica/cirurgia
7.
Kardiol Pol ; 77(7-8): 670-673, 2019 Aug 23.
Artigo em Inglês | MEDLINE | ID: mdl-31215523

RESUMO

Fungal endocarditis (FE) is an infrequent but a lethal condition. Candida and Aspergillus species are the 2 most commonly implicated pathogenic fungi. Clinical presentation is most often that of a fever of unknown origin, which is hard to differentiate from bacterial endocarditis. The diagnosis of FE is extremely challenging and now shifting towards molecular diagnostic techniques. Rapid and aggressive treatment with a combination of antifungal therapy and surgical debridement is imperative to improve outcomes.


Assuntos
Endocardite/diagnóstico , Micoses/diagnóstico , Aspergilose/diagnóstico , Aspergilose/tratamento farmacológico , Aspergilose/cirurgia , Candidíase/diagnóstico , Candidíase/tratamento farmacológico , Candidíase/cirurgia , Endocardite/tratamento farmacológico , Endocardite/cirurgia , Humanos , Micoses/tratamento farmacológico , Micoses/cirurgia
8.
Acta Otorrinolaringol Esp ; 70(6): 348-357, 2019.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-30773220

RESUMO

BACKGROUND AND OBJECTIVE: to describe the results of the treatment of invasive fungal sinusitis with nasal endoscopic surgery in an immunocompromised paediatric oncological population. METHODS: retrospective study of all patients diagnosed with invasive fungal sinusitis operated in the National Paediatric Oncology Unit between 2012 and 2016. Data taken from their medical history included: epidemiological characteristics, oncological diagnosis, haematological data, symptoms, tomographic studies, surgical interventions, results of pathology and cultures, medications received, complications, evolution and survival. RESULTS: 18 patients were identified, 7 male and 11 female. The average age was 12 years, 13 had a diagnosis of acute lymphocytic leukemia and 5 of acute myeloid leukemia. Seventeen patients presented severe neutropenia at the time of diagnosis. The most frequently identified aetiological agent was Aspergillus in 13 patients. In 16 patients (89%) the disease was controlled with nasal endoscopic surgery. Ten patients died due to unrelated causes throughout the study. DISCUSSION AND CONCLUSIONS: Invasive fungal sinusitis should be considered a medical emergency due to its high mortality. The diagnosis is based on a high index of suspicion in patients with predisposing factors (leukaemia, neutropenia, persistent fever, nasogastric tube) and endoscopic nasal evaluation. Antifungal medical treatment and aggressive nasal endoscopic surgery is indicated regardless of the patient's condition to reduce the fungal burden and associated high mortality. The treatment must be provided by a multidisciplinary team that includes paediatrics, haemato-oncology, infectology and otorhinolaryngology.


Assuntos
Aspergilose/cirurgia , Endoscopia/métodos , Infecções Fúngicas Invasivas/cirurgia , Procedimentos Cirúrgicos Nasais/métodos , Sinusite/cirurgia , Adolescente , Antifúngicos/uso terapêutico , Aspergilose/diagnóstico , Aspergilose/tratamento farmacológico , Criança , Pré-Escolar , Terapia Combinada , Epistaxe/etiologia , Feminino , Febre/etiologia , Humanos , Hospedeiro Imunocomprometido , Infecções Fúngicas Invasivas/diagnóstico , Infecções Fúngicas Invasivas/microbiologia , Leucemia Mieloide Aguda/complicações , Masculino , Equipe de Assistência ao Paciente , Leucemia-Linfoma Linfoblástico de Células Precursoras/complicações , Estudos Retrospectivos , Sinusite/diagnóstico , Sinusite/tratamento farmacológico , Avaliação de Sintomas
9.
Ann Otol Rhinol Laryngol ; 128(4): 300-308, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30584783

RESUMO

OBJECTIVES:: Invasive fungal rhinosinusitis is a rare, life-threatening condition that affects the paranasal sinuses. The standard of care after diagnosis includes surgical debridement and aggressive medical management. Despite treatment, mortality remains unacceptably high. Most data are derived from small cohort experiences, with limited identification of mortality risk factors in the acute setting. The authors used a large national database to better understand clinical factors associated with inpatient mortality for this challenging condition. METHODS:: Using the 2000-2014 National (Nationwide) Inpatient Sample database, the authors identified 979 adult patients with an International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis code of mucormycosis or aspergillosis and a procedure code of sinus surgery. Multivariate imputation by chained equation was performed to account for missing data, followed by multivariate logistic regression to identify predictors of inpatient mortality. RESULTS:: In total, 979 adult patients were identified, with a median age of 57 years. The inpatient mortality rate was 15.8%. The most prevalent comorbidity was hematologic disorders (42.9%). Mucormycosis versus aspergillosis was associated with increased odds of inpatient mortality (odds ratio, 2.95; 95% confidence interval, 2.00-4.34; P < .001). The odds of inpatient mortality were significantly increased between patients with hematologic disorders and those without (odds ratio, 1.92; 95% confidence interval, 1.08-3.39; P = .024). Diabetes (odds ratio, 0.53; 95% confidence interval, 0.34 - 0.80; P = .003) was associated with the lowest odds of inpatient mortality. CONCLUSIONS:: This represents the first population-based study evaluating the factors associated with inpatient mortality. These findings support prior observations demonstrating that the underlying immune dysfunction and type of fungal infection are important predictors of early mortality.


Assuntos
Aspergilose , Infecções Fúngicas Invasivas , Mucormicose , Cirurgia Endoscópica por Orifício Natural , Rinite , Sinusite , Aspergilose/mortalidade , Aspergilose/cirurgia , Comorbidade , Bases de Dados Factuais/estatística & dados numéricos , Desbridamento/métodos , Feminino , Doenças Hematológicas/epidemiologia , Mortalidade Hospitalar , Humanos , Infecções Fúngicas Invasivas/mortalidade , Infecções Fúngicas Invasivas/cirurgia , Masculino , Pessoa de Meia-Idade , Mortalidade , Mucormicose/mortalidade , Mucormicose/cirurgia , Cirurgia Endoscópica por Orifício Natural/efeitos adversos , Cirurgia Endoscópica por Orifício Natural/métodos , Cirurgia Endoscópica por Orifício Natural/mortalidade , Seios Paranasais/microbiologia , Seios Paranasais/cirurgia , Rinite/microbiologia , Rinite/mortalidade , Rinite/cirurgia , Fatores de Risco , Sinusite/microbiologia , Sinusite/mortalidade , Sinusite/cirurgia , Estados Unidos
10.
J Small Anim Pract ; 59(12): 777-782, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30362215

RESUMO

OBJECTIVES: To compare two minimally invasive enilconazole infusion protocols for the treatment of canine sinonasal aspergillosis and evaluate the importance of complete endoscopic debridement in determining first treatment success rate. MATERIALS AND METHODS: Data for 48 dogs with confirmed sinonasal aspergillosis treated with endoscopic debridement followed by per-endoscopic enilconazole infusion were collected. Twenty-four dogs were treated according to the previously published 1-hour infusion protocol and 24 dogs underwent a simplified 15-minute infusion protocol. Completeness of debridement, evaluated as partial or complete at the end of the procedure and outcome after one or several treatments were assessed in all dogs. Multi-variable analysis was performed to derive odds ratios and 95% confidence intervals. RESULTS: The median duration of the simplified protocol - 92∙3 minutes (range 40 to 140) - was substantially shorter than the duration of the previous protocol - 201∙3 minutes (range 120 to 265). First treatment success rates were 58 and 62∙5% for the previous and simplified protocol, respectively. Overall treatment success rate was similar in both groups (96%). Complete debridement was associated with an improved first treatment success rate compared to partial debridement. CLINICAL SIGNIFICANCE: The simplified protocol is a valid alternative approach to the treatment of sinonasal aspergillosis. Completeness of endoscopic debridement before infusion is an important step for the success of treatment in canine sinonasal aspergillosis.


Assuntos
Antifúngicos/administração & dosagem , Aspergilose/veterinária , Doenças do Cão/tratamento farmacológico , Imidazóis/administração & dosagem , Doenças Nasais/veterinária , Administração Intranasal , Animais , Antifúngicos/uso terapêutico , Aspergilose/tratamento farmacológico , Aspergilose/cirurgia , Desbridamento/veterinária , Doenças do Cão/cirurgia , Cães , Endoscopia/veterinária , Feminino , Imidazóis/uso terapêutico , Masculino , Doenças Nasais/tratamento farmacológico , Doenças Nasais/microbiologia , Doenças Nasais/cirurgia , Resultado do Tratamento
12.
Ann Dermatol Venereol ; 145(10): 593-597, 2018 Oct.
Artigo em Francês | MEDLINE | ID: mdl-30093076

RESUMO

BACKGROUND: Contiguous skin inflammation is a poorly described entity. It constitutes a cutaneous manifestation of an underlying ongoing process (infectious, inflammatory or neoplastic). Sinusitis is a known cause. PATIENTS AND METHODS: We report the case of a 70-year-old patient consulting for an ongoing centrofacial inflammatory plaque. Cutaneous biopsy revealed a polymorphic inflammatory infiltrate, and cutaneous microbiological specimens were negative. A facial CT-scan showed left maxillary sinusitis. Intra-sinus samples obtained at surgery showed aspergillus. Voriconazole combined with maxillary sinus surgery resulted in healing of the facial plaque. DISCUSSION: There have been only two published cases of contiguous skin inflammation related to sinusitis but no reported cases caused by aspergillus sinusitis. Herein we report the third case of contiguous skin inflammation associated with sinusitis, which is also the first related to aspergillus sinusitis.


Assuntos
Aspergilose/complicações , Eritema/etiologia , Dermatoses Faciais/etiologia , Sinusite Maxilar/complicações , Idoso , Antifúngicos/uso terapêutico , Aspergilose/tratamento farmacológico , Aspergilose/cirurgia , Diagnóstico Diferencial , Eritema/diagnóstico , Eritema/patologia , Dermatoses Faciais/diagnóstico , Dermatoses Faciais/patologia , Humanos , Inflamação , Linfoma/diagnóstico , Masculino , Sinusite Maxilar/tratamento farmacológico , Sinusite Maxilar/cirurgia , Sarcoidose/diagnóstico , Dermatopatias Infecciosas/diagnóstico , Voriconazol/uso terapêutico
13.
Medicine (Baltimore) ; 97(30): e11650, 2018 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30045315

RESUMO

RATIONALE: Orbital apex syndrome is a complex clinical disorder featuring a collection of cranial nerve deficits characterized by impairment of the extraocular muscles, the ophthalmic branch of the trigeminal nerve, and even the optic nerve. Sino-orbital aspergillosis is rare but aggressive infection. Surgical resection accompanied by antifungal medication is advised currently. PATIENT CONCERNS: We report a 61-year-old woman diagnosed as aspergilloma presenting with the characteristic manifestations and imaging features of orbital apex syndrome. DIAGNOSES: Paranasal sinus tumor was misdiagnosed initially according to magnetic resonance imaging of the orbit. Finally aspergilloma was diagnosed by pathologic report. INTERVENTIONS: The anti-fungal medication, voriconazole, was administered immediately. Surgical excision was also done due to the poor response to medical treatment. OUTCOMES: Postoperative follow-up showed no recurrence of aspergillosis but the vision was lost permanently. LESSONS: Invasive sino-orbital aspergillosis as an aggressive disease with highly invasive patterns and it may be misdiagnosed as tumors. To achieve better prognosis and survival, clinicians should be aware of this distinct manifestation.


Assuntos
Aspergilose/diagnóstico , Doenças dos Nervos Cranianos/microbiologia , Infecções Oculares Fúngicas/diagnóstico , Doenças Orbitárias/microbiologia , Neoplasias dos Seios Paranasais/diagnóstico , Antifúngicos/uso terapêutico , Aspergilose/tratamento farmacológico , Aspergilose/cirurgia , Doenças dos Nervos Cranianos/diagnóstico , Erros de Diagnóstico , Infecções Oculares Fúngicas/tratamento farmacológico , Infecções Oculares Fúngicas/cirurgia , Feminino , Humanos , Imagem por Ressonância Magnética , Pessoa de Meia-Idade , Oftalmoplegia/microbiologia , Doenças Orbitárias/diagnóstico , Neoplasias dos Seios Paranasais/diagnóstico por imagem , Síndrome , Resultado do Tratamento , Transtornos da Visão/microbiologia , Voriconazol/uso terapêutico
17.
Eur J Pediatr Surg ; 28(6): 477-483, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-28946164

RESUMO

BACKGROUND: The incidence of invasive aspergillosis (IA) in children with hematooncological malignancies is increasing as a result of intensive treatment, immunosuppression, and extended use of broad-spectrum antibiotics. Infection of the GI tract by Aspergillus spp. is a rare and fatal complication, which often requires surgical diagnostic and therapeutic exploration. OBJECTIVE: The aim of this study was to determine the characteristics of symptomatic intestinal aspergillosis, diagnosis, treatment, and outcome of pediatric patients with an underlying hemato-oncologic disease. PATIENTS AND METHODS: We analyzed 2,307 German patients with acute lymphoblastic leukemia (ALL) from age 1 to 17 years registered in the AIEOP-BFM ALL 2000 study from 2000 to 2006. All reported adverse events were assessed for symptoms of IA and retrospectively reviewed for any sign or proof of intestinal involvement of IA. RESULTS: In this cohort, IA was reported in 30 of 2,307 patients while intestinal involvement was documented in five patients. Four of these patients had intestinal symptoms and three patients underwent explorative laparotomy. Among clinical cases with IA, gastrointestinal manifestation of IA mostly occurred in adolescent patients (10-16 years). Symptoms varied from abdominal tenderness and pain to constipation. Intestinal aspergillosis was proven by microbiological and histopathological examination and fungal infection was observed macroscopically in the jejunal lumen during surgery. Despite the extended surgery and antifungal therapy, outcome of disseminated IA with intestinal involvement remains poor. CONCLUSION: Surgeons should be aware of surgical complications of intestinal aspergillosis in children with hematooncological diseases requiring exploration and resection. IA is a rare event and still difficult to diagnose due to unspecific abdominal symptoms. Thus, biopsy sampling is of utmost importance to ensure diagnosis, and resection of necrotic or perforated tissue should be attempted early.


Assuntos
Aspergilose/cirurgia , Enteropatias/cirurgia , Leucemia-Linfoma Linfoblástico de Células Precursoras/complicações , Adolescente , Aspergilose/diagnóstico , Aspergilose/etiologia , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Enteropatias/diagnóstico , Enteropatias/etiologia , Masculino , Estudos Retrospectivos , Resultado do Tratamento
18.
Rev. guatemalteca cir ; 23(1): [67-70], ene-dic,2017.
Artigo em Espanhol | LILACS | ID: biblio-884890

RESUMO

La bola fúngica del seno maxilar es una sinusitis fúngica no invasiva. El aumento de pacientes con alguna forma de inmunocompromiso se ha asociado con el aumento en la prevalencia de la enfermedad. Presentamos el caso de un paciente diabético, que consultó durante un año al sistema de salud antes de realizarle el diagnóstico de bola fúngica por Aspergillus en el seno maxilar.


Fungal balls are non invasive sinusits of paranasal sinuses. Rises in the number of immune compromised patents has lead to an increase in prevalence of the disease. We report a case of a diabetc patent, who sought advice for one year before the diagnosis of an Aspergillus fungal ball of the maxillary sinus was made.


Assuntos
Humanos , Masculino , Aspergilose/cirurgia , Sinusite Maxilar/diagnóstico , Doenças dos Seios Paranasais/diagnóstico , Tomografia Computadorizada por Raios X
19.
BMJ Case Rep ; 20172017 Nov 03.
Artigo em Inglês | MEDLINE | ID: mdl-29102972

RESUMO

Invasive aspergillosis is a life-threatening fungal infection, especially in immunocompromised patients. Pulmonary aspergillosis is the most common type of the infection, while urinary tract infection is relatively rare. Here, we describe a case of a 46-year-old man with chronic renal disease presenting with intermittent abdominal pain. The diagnosis of aspergillosis was established by pathological findings of the fungal ball in the bladder. The patient underwent multiple antimicrobial treatments and surgical interventions and was finally cured by posaconazole.


Assuntos
Antifúngicos/uso terapêutico , Aspergilose/diagnóstico , Hospedeiro Imunocomprometido , Insuficiência Renal Crônica , Triazóis/uso terapêutico , Infecções Urinárias/diagnóstico , Antifúngicos/administração & dosagem , Aspergilose/tratamento farmacológico , Aspergilose/cirurgia , Terapia Combinada , Diagnóstico Diferencial , Humanos , Masculino , Pessoa de Meia-Idade , Triazóis/administração & dosagem , Infecções Urinárias/tratamento farmacológico , Infecções Urinárias/cirurgia
20.
Turk Kardiyol Dern Ars ; 45(7): 660-663, 2017 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-28990950

RESUMO

A 3-year-old girl with the diagnosis of chronic granulomatous disease (CGD) was hospitalized for bronchopneumonia and congestive heart failure. Her medical history included methylprednisolone medication for autoimmune gastric outlet obstruction. Computed tomography revealed pneumonic infiltrations and pericardial thickening. A pulsed-wave Doppler recording revealed E/A >1. During a pericardiectomy, multiple islands of thick, firm-walled, fibrinous exudate-containing, small abscess formations were observed. Histopathological evaluation of pericardial tissue revealed granulomatous inflammation. Aspergillus fumigatus was cultured from the abscess. In conclusion, development of constrictive aspergillus pericarditis should be considered in patients with CGD because immediate initiation of antifungal management with aggressive surgical treatment is life-saving.


Assuntos
Aspergilose/etiologia , Aspergillus fumigatus/isolamento & purificação , Doença Granulomatosa Crônica/complicações , Pericardite Constritiva/etiologia , Antifúngicos/administração & dosagem , Antifúngicos/uso terapêutico , Aspergilose/tratamento farmacológico , Aspergilose/cirurgia , Broncopneumonia/diagnóstico por imagem , Broncopneumonia/tratamento farmacológico , Broncopneumonia/microbiologia , Broncopneumonia/cirurgia , Pré-Escolar , Ecocardiografia , Ecocardiografia Doppler de Pulso , Feminino , Doença Granulomatosa Crônica/tratamento farmacológico , Humanos , Interferon gama/administração & dosagem , Interferon gama/uso terapêutico , Pericardite Constritiva/diagnóstico por imagem , Pericardite Constritiva/tratamento farmacológico , Pericardite Constritiva/cirurgia , Pericárdio/patologia , Radiografia Torácica , Proteínas Recombinantes/administração & dosagem , Proteínas Recombinantes/uso terapêutico , Tomografia Computadorizada por Raios X , Voriconazol/administração & dosagem , Voriconazol/uso terapêutico
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