Case Report: Management of Acanthamoeba Rhinosinusitis in a Patient with Chronic Lymphocytic Leukemia.

Infections caused by free-living amoebae pose a significant public health threat owing to growing populations of immunocompromised hosts combined with diagnostic delays, treatment difficulties, and high case fatality rates. Nasopharyngeal infections caused by Acanthamoeba are rare and the optimal treatment is not well established. We report a case of Acanthamoeba rhinosinusitis in a patient with chronic lymphocytic leukemia who presented with headaches and chronic rhinosinusitis refractory to multiple courses of antibiotics. A diagnosis of Acanthamoeba rhinosinusitis was established through broad-range polymerase chain reaction testing on sinus tissue. The patient had a favorable response to treatment, which included surgical debridement, cessation of immunosuppressants, and a three-drug regimen consisting of miltefosine, fluconazole, and sulfadiazine.

Conjunctivitis, rhinitis, and sinusitis in cliff swallows (Petrochelidon pyrrhonota) found in association with Mycoplasma sturni infection and cryptosporidiosis.

Fledgling cliff swallows were cared for at a rehabilitation facility when clinical signs of ocular disease, characterized by conjunctivitis, epiphora, and hyperaemia of palpebrae and nictitans, were recognized. Treatment consisted of topical and oral antibiotic therapy and one topical steroid administration. However, one cliff swallow died and three were killed due to poor therapeutic response. Conjunctival swabs were obtained ante-mortem from the three cliff swallows and were submitted for mycoplasma culture and molecular diagnostics. Heads of the three birds were fixed in 10% neutral buffered formalin and submitted for histopathologic examination of oculonasal tissues. Mycoplasma cultures and molecular evaluation of isolates identified Mycoplasma sturni, but not Mycoplasma gallisepticum, from each specimen. Histopathologic examination revealed lymphoplasmacytic conjunctivitis, rhinitis and infraorbital sinusitis with follicular lymphoid hyperplasia, epithelial hyperplasia, and protozoal stages compatible with Cryptosporidium spp. arranged in and along the apical surfaces of epithelial cells. Identification of concurrent M. sturni and Cryptosporidium spp. infections in these cliff swallows demonstrates an alternative infectious condition that can produce gross and microscopic lesions comparable with those commonly observed in M. gallisepticum infections of house finches and other passerine species. Conjunctivitis associated with M. sturni and Cryptosporidium spp. in cliff swallows may represent an emerging disease risk to a naïve, high-density and colonial species such as colony-nesting cliff swallows.

[Comparative characteristic of different methods of conservative treatment of exudative rhinosinusitis].

The objective of the present study was to evaluate effectiveness of secretolytic, secreto-stimulating therapy in 40 patients presenting with acute rhinosinusitis. It was confirmed that acute inflammation results in suppression of local protective mechanisms acting in nasal cavity mucosa. Secretolytic and anti-inflammatory activity of Sinuforte was shown to induce these mechanisms; there is correlation between this effect and clinical picture of the disease. Parallel analysis of the results of traditional treatment of sinusitis and secretolytic, secretion-stimulating therapy has demonstrated high efficiency of the latter modality in patients suffering acute rhinosinusitis.

Immediate and dual response to nasal challenge with Dermatophagoides pteronyssinus in local allergic rhinitis.

BACKGROUND: Local allergic rhinitis (LAR) is characterized by in situ production of specific IgE (sIgE) antibodies and a positive response to a nasal allergen provocation test (NAPT) in the absence of atopy. OBJECTIVE: The aim of this study was to investigate the immunological mechanisms involved in the immediate and late responses after nasal exposure to Dermatophagoides pteronyssinus (DP) in patients with LAR. METHODS: A total of 40 subjects with LAR to DP were studied and compared with 50 healthy controls. Immediate and late responses to NAPT-DP were assessed using a visual analogue scale of nasal symptoms and acoustic rhinometry. Tryptase, ECP, total and sIgE-DP were measured in the nasal lavage by immunoassay at baseline, 15 min, 1, 6 and 24 h after nasal challenge. RESULTS: NAPT-DP was positive in all patients, with significant increases in tryptase (45%), ECP (65%) and sIgE-DP (25%) (P<0.05). Sixty percent of the LAR patients presented an immediate response to NAPT-DP and 40% a dual response. Immediate responders showed a fast release of tryptase with a peak at 15 min after NAPT-DP, and a progressive increase in nasal ECP and sIgE-DP from 1 to 24 h after challenge, with a peak at 24 h. Dual responders presented persistently higher levels of tryptase from 15 min to 6 h after challenge, and a similar pattern of nasal release of ECP and sIgE-DP to immediate responders. There were no isolated late responders. NAPT-DP was negative in all healthy controls, with no increases in tryptase, ECP, or total and sIgE-DP in nasal secretions. CONCLUSIONS: The results demonstrated the existence of immediate and dual responses to a NAPT with DP in LAR patients, with the local presence of sIgE and mast cell/eosinophil activation.

Rhinitis and disseminated disease in a ferret (Mustela putorius furo) naturally infected with Sarcocystis neurona.

Naturally occurring Sarcocystis neurona infection in a ferret (Mustela putorius furo) with rhinitis and disseminated disease are described for the first time. The ferret exhibited severe rhinitis with intra-lesional S. neurona merozoites and schizonts. Diagnosis was confirmed immunohistochemically by staining with S. neurona-specific antibodies, and by phylogenetic analyses of conserved and variable portions of nuclear ribosomal DNA. On the basis of intense schizogony in the nasal mucosa, we propose the possibility of an olfactory nerve pathway route of infection for S. neurona meningoencephalitis.

[Efficacy and safety of cluster immunotherapy for 154 patients with allergic rhinitis].

OBJECTIVE: To evaluate the efficacy and safety of cluster immunotherapy with Dermatophagoides pteronyssinus for allergic rhinitis. METHODS: One hundred and fifty-four patients with allergic rhinitis to Dermatophagoides pteronyssinus were allocated to receive specific immunotherapy in a 6-week cluster schedule during the incremental-dose phase. Thereafter, these patients received maintenance-dose injection at 6-week intervals until the end of 1 year of treatment. Symptom scores and medication scores were used to evaluate the clinical efficacy and adverse reactions were recorded. A rhinoconjunctivitis quality of life questionnaire (RQLQ) was completed in the baseline and after one year treatment. RESULTS: Cluster immunotherapy significantly reduced the symptom scores and total medication score of patients enrolled (P < 0.01). The immunotherapy group also had a significant improvement in the Rhinoconjunctivitis Quality of Life Questionnaire. During the one-year of treatment, there were 26 systemic adverse reactions (0.75% of all injection) in 9 patients (5.9%) and no fatal systemic reactions occurred. CONCLUSIONS: The cluster immunotherapy is efficacious and safe to treat allergic rhinitis.

Total IgE level in respiratory allergy: study of patients at high risk for helminthic infection

OBJETIVO: Eosinofilia e elevação de IgE sérica são expressões de atopia, contudo há fatores intervenientes como, por exemplo, as parasitoses intestinais. Esta pesquisa verifica a relação entre IgE sérica total, eosinófilos e IgE específica anti-áscaris em indivíduos portadores de asma e/ou rinite alérgica. MÉTODOS: Estudo do tipo transversal em adolescentes portadores de asma e/ou rinite alérgica que foram examinados quanto ao nível sérico de IgE total, de IgE anti-áscaris e de contagem dos eosinófilos sangüíneos. RESULTADOS: Foram analisados 101 pacientes com idade entre 12 e 21 anos. A mediana da IgE foi 660 UI/mL (P25-75 243,5-1500), e a dos eosinófilos foi 510 células/mm³ (P25-75 284-811). A IgE anti-áscaris foi positiva em 73 por cento (74/101) da amostra, mas houve apenas 33,7 por cento (34/101) de positividade ao parasitológico de fezes. Os coeficientes de correlação encontrados foram: 0,34 (p = 0,001) entre IgE total e eosinófilos, 0,52 (p < 0,001) entre IgE total e IgE anti-áscaris e 0,26 (p = 0,01) entre eosinófilos e IgE anti-áscaris. O modelo de regressão linear múltipla final encontrou que IgE anti-áscaris foi fator contribuinte para IgE sérica total com coeficiente de determinação (r2 ajustado) de 0,25 (F = 12,35; p < 0,001), e esse efeito foi independente de contagem de eosinófilos séricos e de parasitose intestinal por helmintos. CONCLUSÃO: Em pacientes com alergia respiratória e IgE sérica total bastante elevada, oriundos de áreas com alto risco de infecção por helmintos, a pesquisa de IgE anti-áscaris como possível fator explicativo pode ser de maior ajuda que a realização do parasitológico de fezes.

OBJECTIVE: Eosinophilia and increased serum IgE levels are indicators of atopy; however, other factors can also play a key role, such as intestinal parasitic infections. This study assesses the relationship between total serum IgE, eosinophil count, and anti-Ascaris IgE in individuals with asthma and/or allergic rhinitis. METHODS: A cross-sectional study was carried out in adolescents with asthma and/or allergic rhinitis. The patients had their total serum IgE, anti-Ascaris IgE and eosinophil count measured. RESULTS: A total of 101 patients aged 12 to 21 years were assessed. Median IgE level was 660 IU/mL (P25-75 243.5-1500), and the eosinophil count corresponded to 510 cells/mm³ (P25-75 284-811). Anti-Ascaris IgE was positive in 73 percent (74/101) of the individuals, but parasitological stool examination yielded positive results in only 33.7 percent (34/101). The correlation coefficients were the following: 0.34 (p = 0.001) between total IgE level and eosinophil count, 0.52 (p < 0.001) between total IgE level and anti-Ascaris IgE, and 0.26 (p = 0.01) between eosinophil count and anti-Ascaris IgE. The final multiple linear regression model pointed out that anti-Ascaris IgE contributed to a total serum IgE level with a coefficient of determination (adjusted R²) of 0.25 (F = 12.35; p < 0.001). This effect occurred regardless of eosinophil count and of the presence of intestinal helminthic infection. CONCLUSION: In patients with respiratory allergy and increased total serum IgE levels living in areas where there is a high risk for helminthic infections, the quantification of anti-Ascaris IgE can be more useful and more insightful than the parasitological stool examination.

Total IgE level in respiratory allergy: study of patients at high risk for helminthic infection.

OBJECTIVE: Eosinophilia and increased serum IgE levels are indicators of atopy; however, other factors can also play a key role, such as intestinal parasitic infections. This study assesses the relationship between total serum IgE, eosinophil count, and anti-Ascaris IgE in individuals with asthma and/or allergic rhinitis. METHODS: A cross-sectional study was carried out in adolescents with asthma and/or allergic rhinitis. The patients had their total serum IgE, anti-Ascaris IgE and eosinophil count measured. RESULTS: A total of 101 patients aged 12 to 21 years were assessed. Median IgE level was 660 IU/mL (P(25-75) 243.5-1500), and the eosinophil count corresponded to 510 cells/mm(3) (P(25-75) 284-811). Anti-Ascaris IgE was positive in 73% (74/101) of the individuals, but parasitological stool examination yielded positive results in only 33.7% (34/101). The correlation coefficients were the following: 0.34 (p = 0.001) between total IgE level and eosinophil count, 0.52 (p < 0.001) between total IgE level and anti-Ascaris IgE, and 0.26 (p = 0.01) between eosinophil count and anti-Ascaris IgE. The final multiple linear regression model pointed out that anti-Ascaris IgE contributed to a total serum IgE level with a coefficient of determination (adjusted R(2)) of 0.25 (F = 12.35; p < 0.001). This effect occurred regardless of eosinophil count and of the presence of intestinal helminthic infection. CONCLUSION: In patients with respiratory allergy and increased total serum IgE levels living in areas where there is a high risk for helminthic infections, the quantification of anti-Ascaris IgE can be more useful and more insightful than the parasitological stool examination.

Successful treatment of Acanthamoeba rhinosinusitis in a patient with AIDS.

Acanthamoeba infection is a rare, difficult-to-treat, and often fatal, opportunistic parasitic infection in immunocompromised hosts, such as patients infected with HIV. We describe an aggressive nasal and sinus infection by Acanthamoeba spp. in a person with AIDS. The resolution of this Acanthamoeba infection was secondary to a multidisciplinary treatment approach involving a combination of surgery as well as high-dose amphotericin B plus 5-fluorocytosine. In the era of the HIV/AIDS pandemic, the present report underscores the need for early identification and prompt aggressive treatment to ensure successful management of this rare but potentially fatal opportunistic infection.

Bronchial responsiveness to methacholine is increased in citrus red mite (Panonychus citri)-sensitive children without asthmatic symptoms.

BACKGROUND: A recent investigation has suggested that citrus red mite (Panonychus citri, CRM) is a common sensitizing allergen among children living around citrus farms. OBJECTIVE: A cross-sectional survey was performed to evaluate the bronchial responsiveness to methacholine in CRM-sensitive children without asthmatic symptoms. SUBJECTS AND METHODS: A total of 375 children living around citrus farms were enrolled in this study. There were 201 boys and 174 girls with a mean age of 12.5 (range 7-16) years. Each subject was evaluated by a questionnaire, a skin prick test with 13 common inhalant allergens including CRM, and a methacholine bronchial provocation test (MBPT). RESULTS: Positive rate of MBPT (PC20-methacholine < 25 mg/mL) was higher in atopic rhinitic and atopic control children than in nonatopic rhinitic and nonatopic control subjects (41.3% and 33.3% vs 17.2% and 15.4%, respectively, both P < 0.05). Slope of dose-response curve (DRS, %/mg/mL) was higher in atopic rhinitic children than in nonatopic rhinitic, atopic control and nonatopic control subjects (14.3 +/- 0.87 vs 9.4 +/- 0.72, 10.0 +/- 1.37 and 9.2 +/- 1.51, P < 0.05, respectively). Both the positive rate of MBPT and the DRS were increased in children with positive skin response to CRM than in those without sensitization (48.2% vs 22.9%, P = 0.0001; 15.6 +/- 1.26 vs 10.2 +/- 0.65, P = 0.0001). CONCLUSION: Bronchial responsiveness is increased in citrus red mite-sensitive children even if they have no asthmatic symptoms.

Acanthamoeba rhinosinusitis: characterization, diagnosis, and treatment.

Nasal and paranasal sinus manifestations are among the most common presentations of the acquired immunodeficiency syndrome (AIDS). Several studies cite that as many as 70% of patients with this disease have symptoms referable to the head and neck, including a 30% prevalence of sinusitis. Although the bacteriology of sinusitis in this population is largely considered comparable to that of immunocompetent patients, several opportunistic pathogens have been identified, particularly when T-cell counts are low. This report identifies Acanthamoeba as a potentially fatal cause of rhinosinusitis in immunosuppressed patients. The pathogenesis, diagnosis, and treatment of this rare entity will be discussed and the literature reviewed.

Spider mite allergy in apple-cultivating farmers: European red mite (Panonychus ulmi) and two-spotted spider mite (Tetranychus urticae) may be important allergens in the development of work-related asthma and rhinitis symptoms.

BACKGROUND: Recent investigations have suggested that the citrus red mite (Panonychus citri) is the most important allergen affecting citrus-cultivating farmers with asthma, allergic rhinitis, or both. OBJECTIVE: We sought to evaluate type I hypersensitivity to spider mites, particularly the European red mite (Panonychus ulmi) and the two-spotted spider mite (Tetranychus urticae), and to determine the relationship between hypersensitivity to spider mites and respiratory dysfunction. METHODS: We performed a cross-sectional survey. Questionnaires were given, and skin prick tests for 11 inhalant allergens common in Korea and 2 species of spider mites (European red mite and two-spotted spider mite) were performed in 725 apple-cultivating farmers in Korea. RESULTS: Results of skin prick tests in the apple farmers indicated that European red mite (23.2%) was the most common sensitizing allergen, followed by Tyrophagus putrescentiae (21.2%), two-spotted spider mite (16.6%), Dermatophagoides farinae (16.3%), D pteronyssinus (14.4%), cockroach (13.1%), and Hop Japanese (Humulus Japonicus) pollen (12.0%). Positive skin responses (mean wheal size >/=3 mm) to one or more of 13 inhalant allergens were found in 48.2% of farmers tested, whereas 40 subjects (8.6%) had an isolated skin response to the spider mites. Among 119 farmers with work-related asthmatic symptoms, the positive skin response rates to European red mite and two-spotted spider mite were 40.4% and 27.0%, respectively. These figures were significantly higher than those found among farmers without work-related symptoms (19.1% and 14.1%, respectively; P <.01). The prevalence of work-related asthma symptoms was higher in farmers with positive skin responses to spider mites than in those with negative skin responses to spider mites and those with positive skin responses to any allergen tested (31.4% vs 15.0% vs 21.0%, respectively; P <.05). CONCLUSION: Spider mites, particularly European red mite and 2-spotted spider mite, are common sensitizing allergens in apple-cultivating farmers. These spider mites may be important causative allergens in the development of work-related respiratory symptoms in these workers.

Non Hodgkins lymphoma of ethmoidal sinus with rhinoorbital myiasis.

A patient with primary non-hodgkins lymphoma of the paranasal sinuses presenting as rhinoorbital myiasis is reported. The myiasis causing species was identified as Chrysomia bezziana Villeneuve. This case demonstrates the extreme destruction caused by myiasis and the inadequacy of therapeutic options available in such patients.

Alergia aos ácaros no Rio de Janeiro: análise prospectiva em 700 pacientes com asma e(ou) rinite / Allergy to the acarus in Rio de Janeiro: prospective analysis in 700 asthmatic and or rhinitc patients

Asma e rinite necessitam estudos epidemiológícos periódicos. Mudanças ambientais modificam as respostas atópicas. Os ácaros sao os principais alérgenos da poeira domiciliar. Os ácaros domésticos sao os aeroalérgenos brasileiros mais importantes e estao presentes na maioria dos lares do Rio de Janeiro (Regiao Sudeste). As condiçoes climáticas locais (calor e umidade) favorecem a grande proliferaçao acarina e a ocorrência perenal da atopia respiratória. Realizamos um estudo prospectivo com 700 pacientes portadores de asma e(ou) rinite no Rio de Janeiro, com a finalidade de documentar a epidemiologia da sensibilizaçao alérgica acarina. Esta investigaçao incluiu testes alérgicos cutâneos (puntura modificada, MT), RAST, análises acarinas microscópicas em amostras de poeira domiciliar e determinaçao antigênica de Der p I e Der f I nestas amostras locais. Concluímos que Dp e Bt sao os ácaros domésticos alergizantes mais importantes da poeira domiciliar do Rio de Janeiro. Sugerimos, baseados nos resultados obtidos em pacientes com reatividade alérgica exclusiva a Bt, que a sensibilizaçao a Bt é um fator de risco para o aparecimento da rinite, com ou sem asma. Documentamos também um aumento local de 9,5 por cento na incidência de alergia a ácaros, nos últimos anos, nos indivíduos portadores de asma e(ou) rinite. A compreensao da alergia acarina é fundamental para prevençao e o tratamento das doenças alérgicas respiratórias. A reduçao da exposiçao ambiental aos ácaros domésticos diminui a morbidade e a mortalidade na atopia respiratória.