1/33. Allergic fungal sinusitis. A report of two cases with diagnosis by intraoperative aspiration cytology.BACKGROUND: Allergic fungal sinusitis (AFS) is a newly recognized form of sinusitis characterized by opacification of the paranasal sinuses by "allergic mucin" (AM) admixed with scattered fungal organisms. AM consists of necrotic, or partially necrotic, eosinophils and Charcot-Leyden crystals suspended in lakes of laminated, mucinous material. AFS is characterized by the absence of bone or soft tissue invasion, purulent exudate or granulomatous inflammation. Clinically, it is important to differentiate AFS from both acute invasive fungal sinusitis and noninvasive mycetoma because the three diseases are treated with different modalities and have different prognoses. Although the radiologic features of AFS are often characteristic, occasionally it may be difficult to exclude neoplasia. CASES: Two cases of AFS, in which intraoperative diagnosis was made on the basis of the presence of both AM and fungal organisms, are reported. CONCLUSION: Cytologic diagnosis of AFS can be made from intraoperative sinus aspirates from the presence of AM and fungal elements. AM and fungi provide presumptive evidence for a noninvasive, allergic fungal disease and can help reassure clinicians intraoperatively and guide clinical management.- - - - - - - - - - ranking = 1keywords = inflammation (Clic here for more details about this article) |
2/33. Treatment of postkeratitis fusarium endophthalmitis with amphotericin b lipid complex.PURPOSE: The authors report the first case of fusarium solani keratitis that progressed to fungal endophthalmitis and was successfully treated with amphotericin b lipid complex (ABLC). METHOD: The case of a 34-year-old immunocompetent woman who developed a contact lens-related F. solani keratitis requiring emergency penetrating keratoplasty (PKP) was analyzed. The immunocompetent patient developed fungal endophthalmitis (anterior chamber tap positive for F. solani three months after PKP) and was eventually treated with ABLC. RESULTS: Systemic amphotericin b (total, 0.42 g) and ketoconazole in addition to topical natamycin and amphotericin did not prove to be effective in eradicating the mycosis in the anterior chamber. Under ABLC treatment (total, 8.79 g), the anterior chamber inflammation resolved completely. No recurrence was observed during an 11-month follow-up after treatment was discontinued. CONCLUSION: ABLC proved to be effective in treating F. solani endophthalmitis. It is an important addition to the ophthalmic armamentarium, and appeared to be a better therapeutic agent than standard amphotericin b in this patient.- - - - - - - - - - ranking = 1keywords = inflammation (Clic here for more details about this article) |
3/33. Curvularia lunata endophthalmitis with secondary keratitis.PURPOSE: To report a case of pseudophakic endophthalmitis with secondary keratitis caused by Curvularia lunata. methods: A 40-year-old man presented with a fluffy mass in the anterior chamber with low-grade delayed postoperative inflammation in the right eye. RESULTS: The anterior chamber and vitreous aspirate demonstrated C. lunata. A large corneal infiltrate developed after aspiration of the mass. Treatment with systemic, topical, and intraocular antifungal agents cleared the vitreous, but the cornea perforated. CONCLUSION: Delayed low-grade infection with a fluffy mass in the anterior chamber after cataract surgery can rarely be a clinical presentation of dematiaceous fungal infection. Secondary keratitis may result after a diagnostic aspiration.- - - - - - - - - - ranking = 1keywords = inflammation (Clic here for more details about this article) |
4/33. Microsphaeropsis olivacea keratitis and consecutive endophthalmitis.PURPOSE: To report a case of fungal keratitis with consecutive endophthalmitis caused by Microsphaeropsis olivacea. methods: Case report. RESULTS: A 51-year-old man developed fungal keratitis and consecutive endophthalmitis after sustaining a penetrating injury to the right eye. Cultures of the aqueous humor yielded M. olivacea. infection resolved after intraocular fungal debridement, intravitreous amphotericin b, and aggressive topical natamycin and oral fluconazole. Persistent, low-grade smoldering corneal and intraocular inflammation required topical corticosteroid therapy. CONCLUSION: M. olivacea is an exceedingly rare ocular pathogen. The intraocular portion of the infection responded quickly to intravitreal antifungal treatment; however, the course was prolonged by smoldering corneal inflammation. Prompt recognition of intraocular spread and aggressive treatment may be beneficial in fungal infections caused by unusual organisms with uncertain virulence.- - - - - - - - - - ranking = 2keywords = inflammation (Clic here for more details about this article) |
5/33. keratitis caused by verticillium species.PURPOSE: To report a case of fungal keratitis caused by verticillium species. methods: A 50-year-old man developed pain, redness, and an infiltrate in his left eye and had no history of trauma. The cornea showed superficial, white, stromal infiltrates and epithelial ulceration with a dendritic margin. The clinical features suggested herpetic keratitis, and the patient was treated with topical antiviral medication. Two weeks later, his condition deteriorated. Examination of the left eye showed stromal infiltrates with a feathery margin and epithelial ulceration with its covering white exudates. Corneal scrapings were taken for direct microscopic examination and culture. RESULTS: Corneal scraping showed the presence of fungal filaments. The fungus was identified as verticillium species. Topical amphotericin b and systemic fluconazole were started after discontinuing the antiviral treatment. Clinically, the inflammation subsided during the 3 weeks after treatment. CONCLUSION: This is a rare case of infectious keratitis caused by verticillium species. Rare species of fungal infection should be considered in the differential diagnosis of stromal keratitis refractive to conventional medical treatment.- - - - - - - - - - ranking = 1keywords = inflammation (Clic here for more details about this article) |
6/33. Macroconidia of fusarium species. An unusual finding in cervical smears.OBJECTIVE: To screen cervical smears for early detection of precancerous and cancerous lesions of the uterine cervix in a hospital-based cancer screening program. STUDY DESIGN: Cervical smears were collected from women attending the gynecology outdoors of various Delhi hospitals. The smears were wet fixed, processed for Papanicolaou staining and screened cytologically. RESULTS: A total of 130,000 satisfactory smears were screened. Benign cellular changes were found in 48%. Of these, 6.9% had evidence of specific infections, while the remainder showed nonspecific, reactive changes due to inflammation/repair. In two cases, unusual, large, crescentic, septate structures were identified. These were labelled macroconidia of fusarium species on the basis of their unique microscopic morphology. The diagnosis was confirmed on fungal culture in one case. The patient responded well to antifungal therapy. CONCLUSION: Cytology is a useful tool for identification of unusual fungi with characteristic microscopic morphology. A prompt cytodiagnosis in these cases can assist clinicians with management.- - - - - - - - - - ranking = 1keywords = inflammation (Clic here for more details about this article) |
7/33. Mycological and histological investigations in humans with middle ear infections.The aim of our investigations was to characterize fungal colonization of the ear in immunocompetent patients. From 1993 to 2000, 128 patients supposed to suffer from otomycosis were included. Mycological examination conducted by direct microscopy and fungal cultures was performed on 139 specimens. Among these, 115 patients suffered from chronic otitis media with persisting tympanum perforation and otorrhea. A further 13 patients had clinical signs of an otitis externa only. Out of 139 samples, fungi were identified in the auditory canal (n = 54), on the tympanic membrane (n = 5), and in the middle ear (n = 5). Two-thirds were as moulds and one-third yeasts. The dominating species were aspergillus niger and candida parapsilosis. Samples from 15 patients supposed to have mastoiditis or cholesteatoma were examined histologically. Fungal hyphae were observed in the middle ear cavity and/or between horny lamellae of cholesteatoma in four patients. In the middle ear of immunocompetent patients chronic-hyperplastic (polypoid) inflammation was detected with increased production of mucus, which probably promotes colonization by pathogenic fungi in the middle ear as well as in the auditory canal. Invasive fungal growth into the subepithelial connective tissue was not observed.- - - - - - - - - - ranking = 1keywords = inflammation (Clic here for more details about this article) |
8/33. Rapid molecular diagnosis of posttraumatic keratitis and endophthalmitis caused by alternaria infectoria.The first case of alternaria infectoria ocular infection is reported. keratitis and endophthalmitis developed after eye-perforating trauma from a lemon tree branch. Two months after surgery and empirical steroid and antibiotic treatment, diagnosis by molecular methods was performed. PCR amplification was positive for a fungus after 4 h. Antifungal treatment with amphotericin b and fluconazole was initiated immediately. dna sequence analysis showed alternaria infectoria to be the causal agent. After topical and systemic administration of antifungal treatment, ocular inflammation disappeared and visual acuity improved. dna typing was found to be a useful tool to achieve early identification of the causal agent.- - - - - - - - - - ranking = 1keywords = inflammation (Clic here for more details about this article) |
9/33. Bilateral recurrent calcareous degeneration of the cornea.PURPOSE: To report clinical, histologic, and electron microscopic findings in several consecutive keratoplasties with recurrent pancorneal calcification in a patient with chronic graft versus host disease and severe keratoconjunctivitis sicca following bone marrow transplantation for chronic myelogenous leukemia. methods: Altogether 5 penetrating keratoplasties were performed in both eyes for descemetocele formation and corneal perforation as well as pancorneal calcification associated with severe visual loss. Histologic examination and electron microscopy were performed on the corneal buttons obtained. RESULTS: histology and electron microscopy confirmed pancorneal extracellular calcium deposition with increasing severity in each consecutive keratoplasty. Calcification was associated with necrosis and inflammation of the corneal stroma. Clinically unsuspected fungal keratitis was observed in 1 specimen. CONCLUSIONS: keratoconjunctivitis sicca, epithelial defects, corneal inflammation, and infection are most probably responsible for the recurrent pancorneal calcification seen in our patient. The role of cytokines in this complication is discussed.- - - - - - - - - - ranking = 2keywords = inflammation (Clic here for more details about this article) |
10/33. Successful treatment of fusarium endophthalmitis with voriconazole and Aspergillus endophthalmitis with voriconazole plus caspofungin.PURPOSE: To report successful treatment of exogenous fusarium and Aspergillus endophthalmitis with new antifungal agents. DESIGN: Interventional case report. methods: Treatment of two cases is reviewed. RESULTS: A 64-year-old man developed post-cataract fusarium moniliforme endophthalmitis. infection persisted despite removal of the intraocular lens, three vitrectomies, and five intravitreal injections of amphotericin. inflammation resolved and vision improved from 20/80 to 20/40 on 6 months of oral voriconazole. A 55-year-old man developed post-cataract intraocular inflammation. After three vitrectomies and removal of the intraocular lens, aspergillus fumigatus endophthalmitis was diagnosed. Intravitreal amphotericin and systemic voriconazole were given, but one week later there were early signs of recurrence. Intravenous caspofungin was added and the eye improved. Caspofungin was continued for 6 weeks and voriconazole for 6 months. Vision improved from counting fingers to 20/80 at 6 months and 20/25 at 23 months. CONCLUSION: Voriconazole is a promising new therapy for fusarium and Aspergillus endophthalmitis. Caspofungin may act synergistically with voriconazole in treating Aspergillus endophthalmitis.- - - - - - - - - - ranking = 1keywords = inflammation (Clic here for more details about this article) |
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