ABSTRACT
OBJECTIVES: We describe the clinical, radiographic, and histopathologic characteristics of fungus balls. METHODS: We performed a retrospective review of 24 consecutive patients with the diagnosis of a paranasal sinus fungus ball (mycetoma) from 2001 to 2008. RESULTS: We found that 18 of the 24 primarily involved sinuses had bony thickening, and 13 of the 24 had notable dilatation of the ostium. Eleven of the 24 patients were found to have some degree of immunocompromise (from organ transplantation, diabetes, etc). The patient's immune status correlated with the type of fungus involved. (Mucor-like fungi were more common in immunocompetent patients, and aspergillus-like fungi were more common in immunocompromised patients.) Also, there was a predilection for immunocompetent patients to have dilatated ostia, whereas immunocompromised patients were more likely to have a nondilatated ostium (p = 0.019). CONCLUSIONS: Our series of paranasal sinus fungus balls defines a group of patients heretofore poorly described in the literature. Our data reveal an increased incidence in immunocompromised patients. We also found consistent radiographic patterns, correlations between immune status and the fungal pathogen, correlations between ostial enlargement and immune status, and the presence of cranial nerve pareses. These represent new findings that merit further study.
Subject(s)
Aspergillosis/diagnostic imaging , Aspergillosis/pathology , Mucormycosis/diagnostic imaging , Mucormycosis/pathology , Sinusitis/microbiology , Sinusitis/pathology , Adolescent , Adult , Aged , Aged, 80 and over , Aspergillosis/complications , Cohort Studies , Female , Humans , Hyphae , Male , Middle Aged , Mucormycosis/complications , Radiography , Retrospective Studies , Risk Factors , Sinusitis/diagnostic imaging , Young AdultABSTRACT
We describe 2 patients with West Nile virus (WNV) encephalitis who were treated experimentally with interferon (IFN)-alpha. Both patients demonstrated substantial improvement in mentation and speech on the second day of experimental therapy, and neither required endotracheal intubation or admission to the intensive care unit during hospitalization. Moreover, during the 9-month follow-up period, one patient achieved complete recovery, and the other nearly achieved complete resolution of sequelae. To our knowledge, this is the first published report of the use of IFN-alpha to treat WNV encephalitis. Clinical trials are underway to further define the role of this therapy in persons with WNV encephalitis.
