Bola fúngica de cavidades paranasales: serie de casos / Fungus ball of the paranasal sinuses: case series

RESUMEN Introducción La bola fúngica (BF) es una sinusitis fúngica no invasiva, con acumulación extramucosa de conglomerados densos de hifas de hongos en cavidades paranasales (CPN), afectando generalmente a mujeres inmunocompetentes. Objetivo Describir la presentación cínica, diagnóstico y tratamiento de una serie de pacientes con diagnóstico de BF de CPN. Material y método Estudio descriptivo retrospectivo de pacientes con diagnóstico histopatológico de BF sometidos a cirugía endoscópica nasal (CEN) en nuestra institución entre 2010 y 2016. Resultados Se incluyeron 20 pacientes (15 mujeres, 5 hombres), con edad promedio al diagnóstico de 64 años (35-86 años), la mayoría inmunocompetente (85%). El síntoma más frecuente fue dolor facial (8/20). Todos los pacientes fueron estudiados con tomografia computarizada (TC) de CPN, presentando calcificaciones en 70%. La ubicación más frecuente fue el seno maxilar (12/20) y luego esfenoidal (6/20). Se realizó CEN en todos los pacientes, combinándolo con Caldwell Luc en 3 de ellos. Los cultivos intraoperatorios resultaron negativos en el 75% de los pacientes. Conclusión La BF tiene presentación cínica inespecifica. Se sospecha en base a hallazgos imagenológicos en la TC de CPN y se confirma histopatológicamente, dado el bajo rendimiento de los cultivos. La CEN es la herramienta diagnóstico-terapéutica de elección, con baja tasa de recidiva local.

ABSTRACT Introduction A fungus ball (FB) is a non-invasive fungal sinusitis, consisting of extramucosal accumulation of dense fungal hyphae conglomerates, located in paranasal sinuses. It generally affects immunocompetent women. Aim To describe the clinical presentation, diagnosis and treatment in a series of patients diagnosed with FB of paranasal sinuses. Material and method Retrospective descriptive study regarding all patients with a histopathologic diagnosis of FB, who underwent endoscopic sinus surgery (ESS) in our institution between 2010 and 2016. Results Twenty patients (15 women, 5 men) were included, with a mean age at diagnosis of 64 years (35-86 years). Most were immunocompetent (85%). Facial pain was the most frequent symptom (8/20). All patients were studied with a sinus CT, finding paranasal calcifications in 70%. It predominantly involved the maxillary (12/20), and sphenoid sinus (6/20). All patients were treated with ESS, with a combined Caldwell Luc approach in only 3 of them. Intraoperative cultures were negative in 75% of patients. Conclusions Sinus FB has a non-specific clinical presentation. CT findings help suspect it, and it is confirmed with a histopathological study, given the poor efficiency of cultures. ESS is the diagnostic-therapeutic procedure of choice, with a low local recurrence rate.

Isolation of some microorganisms from Iraqi patients with chronic maxillary sinusitis

Maxillary sinusitis is one of the most common infections of humans. Sinusitis can be defined as an inflammation of the membrane lining of any sinus, especially one of the paranasal sinuses. To determine the causative microorganisms of chronic maxillary sinusitis. Forty five chronic sinusitis patients were involved in the present study. Sampling method were sinus specimens [aspiration or injection aspiration]. Haemophilus species, Streptococcus pneumoniae [S.pneumoniae] and Moraxella catarrhalis [M.catarrhalis] were the most frequent isolates; in addition Penicillium and Cladosporium species were isolated from some chronic sinusitis patients. Chronic sinusitis could be caused by either bacterial species or by fungal species; most bacterial isolates were Haemophilus species followed by S.pneumoniae and M.catarrhalis. The incidences of chronic sinusitis were more at patients age [20-29 years] groups

Pediatric sinusitis:symptom profiles with associated atopic conditions.

INTRODUCTION: Sinusitis is a very common disease in childhood. Clinical manifestations in childhood sinusitis are different than in adult. Information in childhood sinusitis in Thailand is limited. We performed a prospective descriptive study to determine clinical characteristics of childhood sinusitis in Thailand MATERIAL AND METHOD: One hundred pediatric patients with clinical diagnosis of sinusitis attending pediatric allergy clinic, pediatric outpatient clinic, and pediatric ENT clinic were recruited. Clinical diagnosis was defined by presence of symptoms indicating upper respiratory infections with exudates at middle meatus by anterior rhinoscopy. Thorough history taking and physical examinations were conducted with findings recording into sinusitis questionnaire. Sinus radiographs were taken in 77 patients and were read blindly a single radiologist who was unaware of clinical conditions of patients. Allergy skin prick tests were performed with a panel of common aeroallergens in Thailand. RESULTS: Age range of the 100 patients were between 1.7 to 12.4 years with a mean (+/- SD) of 6 +/- 2.72 years. History of atopic disease among patients and their families was positive in 49% and 47% respectively. Four most common clinical manifestations were rhinorrhea (95%), nocturnal and productive cough (91%), nasal congestion (74%) and posterior nasal dripping (66%). The three most common signs were obstruction of middle meatus (100%), swelling of turbinates (92%) and granular pharynx (48%). All paranasal sinuses X-rays were abnormal with maxillary sinus being the most commonly involved sinus (99%) followed by ethmoid sinus (91%). The majority of patients had involvement of more than one sinus. Skin prick tests were positive in 53.6%. The two most common sensitizing allergens were dust mites (57.7) and cockroaches (18.6%). CONCLUSION: The presence of symptoms of rhinorrhea, cough, nasal congestion and posterior nasal drip should alert physicians for diagnosis of sinusitis in pediatric patients. Maxillary and ethmoid sinus were the most common sinuses involved. Atopic predisposition is present in up to 53.6% in this population.

Sinusitis en Pediatria / Sinusitis in Pediatry

Se describen 54 ninos con sinusitis, 34 ninas y varones, la edad promedio de presentacion fue 6.5 anos. Las manifestaciones clinicas mas frecuentes fueron la rinorrea y/o tos recurrente. El 91 por ciento presento sinusitis maxilar. Enfermedades asociadas en forma importante fueron la otitis media a repeticion tonsilofaringitis, e hipertrofia de adenoides. Recomendamos sospechar la entidad en ninos que presentan los sintomas descritos. Todos fueron tratados con antibioticos, antialergico oral o corticoide topico, 27 pacientes mejoraron, 21 permanecen igual, uno se curo y 3 desaparecieron del seguimiento.

Incidence of fungal infections in chronic maxillary sinusitis.

A study conducted on seventy-five cases of chronic maxillary sinusitis presenting at the E.N.T. Outpatients' Department of Dayanand Medical College, Ludhiana revealed the presence of fungi in 8 cases. The return fluids of proof puncture and antral lavage of the sinuses were subjected to standard extraction procedures. Methods of isolation and identification of the causal fungi are described. The role of fungi, particularly Aspergillus, as pathogen is discussed in the context of antibiotic and immuno-suppressive therapy and local predisposing factors.

Maxillary sinus radiographs in children with respiratory symptoms

The present study was conducted on 100 children [51 boys and 49 girls] aged from 1-11 years presenting with upper respiratory tract complications at the outpatient clinic of Alexandria University Children's Hospital. Complete opacity of the sinuses was found in 67% of children, moderate opacity in 15%, mild opacity in 8% and concentrin membrane thickening in 6%. Only 13% of children had their maxillary sinus radiograms clear