Chronic invasive aspergillosis of the paranasal sinuses in immunocompetent hosts from Saudi Arabia

In immunocompetent patients, paranasal invasive aspergillosis is rare and has a high recurrence rate. Twenty-three cases of paranasal invasive aspergillosis, involving 14 male and nine female immunocompetent patients were reviewed. All patients were cancer-free, HIV-negative, with normal WBC, and none of the patients had received immunosuppressive therapy or corticosteroids. Mean duration of symptoms before diagnosis was 18 months. Aspergillus flavus was the species most frequently isolated. Surgical debridement was performed in all patients followed by antifungal therapy in 18 patients. Mean follow-up duration was 30 months. Fourteen patients relapsed after a mean of 13 months and required an average of 4.3 admissions for repeat surgical evacuation. In a logistic regression model, relapse was not associated with age, duration of symptoms, clinical findings, extent of disease, or mode of therapy. However, patients who were relapse-free tended to have had complete surgical evacuation followed by antifungal therapy.     

Diabetic ketoacidosis and invasive aspergillosis

We report a case of diabetic ketoacidosis associated with invasive aspergillosis and no other known immunodeficiency. Immunologic studies revealed normal serum immunoglobulins and normal absolute numbers of T and B lymphocytes. Mitogenic responses of peripheral blood lymphocytes to multiple antigens (PPD, PHA, Con A, Streptodornase, Streptokinase, Candida) were within normal limits The clinical course was characterized by rapid improvement after control of diabetes and amphotericin therapy. Clinical observations and experimental evidence suggest that decreased granulocyte number and function predispose to invasive aspergillus infection. The pattern of immunodeficiency in the diabetic host is consistent with these abnormalities in that granulocyte function is impaired in diabetic acidosis.     

Epidemiology and prevention of invasive aspergillosis

Aspergillus species are the most common causes of invasive mold infections in immunocompromised persons. This review examines the available information regarding the rising incidence of invasive aspergillosis in different high-risk groups, including persons with acute leukemia, hematopoietic stem cell transplant recipients, and liver and lung transplant recipients. The risk factors for infection in these groups are discussed. Because Aspergillus species are widespread in the environment, it is difficult to link specific sources and exposures to the development of human infections. However, molecular strain typing and other studies indicate that a significant number of Aspergillus infections are now being acquired outside the health care setting, either before patients are admitted to hospital, or after they have been discharged. The role of environmental control measures and antifungal drug prophylaxis in the prevention of hospital- and community-acquired aspergillosis is discussed.     

Laboratory diagnosis of invasive aspergillosis

Invasive aspergillosis occurs in a wide range of clinical scenarios, is protean in its manifestations, and is still associated with an unacceptably high mortality rate. Early diagnosis is critical to a favourable outcome, but is difficult to achieve with current methods. Deep tissue diagnostic specimens are often difficult to obtain from critically ill patients. Newer antifungal agents exhibit differential mould activity, thus increasing the importance of establishing a specific diagnosis of invasive aspergillosis. For these reasons, a range of alternate diagnostic strategies have been investigated. Most investigative efforts have focused on molecular and serological diagnostic techniques. The detection of metabolites produced by Aspergillus spp and a range of aspergillus-specific antibodies represent additional, but relatively underused, diagnostic avenues. The detection of galactomannan has been incorporated into diagnostic criteria for invasive aspergillosis, reflecting an increased understanding of the performance, utility, and limitations of this technique. Measurement of (1,3)-beta-D glucan in blood may be useful as a preliminary screening tool for invasive aspergillosis, despite the fact that this antigen can be detected in a number of other fungi. There have been extensive efforts directed toward the detection of Aspergillus spp DNA, but a lack of technical standardisation and relatively poor understanding of DNA release and kinetics continues to hamper the broad applicability of this technique. This review considers the application, utility, and limitations of the currently available and investigational diagnostic modalities for invasive aspergillosis.     

Drug therapy of invasive candidiasis and aspergillosis

Die Inzidenz invasiver Candida- und Aspergillusinfektionen hat in den letzten Jahren zugenommen, nicht zuletzt wegen der besseren überlebens-chancen von immunsupprimierten Patienten. Hier sind insbesondere Patienten mit malignen h?matologischen Erkrankungen, nach Knochenmarktransplantation und Aids-Patienten zu nennen. Aufgrund verbesserter diagnostischer und therapeutischer M?glichkeiten hat jedoch die Letalit?t invasiver Pilzinfektionen zuletzt abgenommen. Im vorliegenden Beitrag werden die aktuellen therapeutischen Optionen zur Behandlung der invasiven Candidose und Aspergillose zusammengefasst, wobei insbesondere neue gut vertr?gliche Antimykotika vorgestellt werden sollen. Priv.-Doz. Dr. Georg Maschmeyer Medizinische Klinik, Campus Virchow-Klinikum, Universit?tsklinikum Charité, Humboldt-Universit?t, Augustenburger Platz 1, 13353 Berlin, E-Mail: georg.maschmeyer@charite.de     

侵袭性曲霉病诊断新进展

侵袭性曲霉病(invasive aspergillosis,IA)是重度免疫缺陷患者死亡的主要原因之一,对其早期诊断困难是导致临床治疗延误、患者预后差的重要因素.微生物学及组织病理学检查仍是目前诊断IA最基础也是临床普遍采用的方法.近年来,众多研究致力于寻找更早期、更可靠的非培养型诊断方法,以期提高对该病的诊断效率.     

侵袭性肺曲霉病的诊断与治疗

自从19世纪40年代，第1例侵袭性曲霉病（Invasive Aspergillosis）报道后，近年来，随着获得性免疫缺陷综合征（AIDS）以及恶性肿瘤患者的增多，骨髓和器官移植、肿瘤患者的放化疗及免疫抑制剂的应用，侵袭性曲霉病发病率急剧升高。1996年欧洲一项大样本的尸检结果显示，侵袭性曲霉病的发生率在12年内增加了近14倍。     

Multivisceral infarcts are complication of invasive aspergillosis

Aspergillus fumigatus is one of the species of Aspergillus that causes aspergillosis. The clinical picture of invasive-disseminated aspergillosis is generally characterized by fever and respiratory distress that usually follows a fatal course. This form of intensive aspergillosis is suffered by severely immunossuppressed patients. There is another clinical form of severe aspergillosis, aortic aspergillosis, that appears after cardiac surgery. We present two cases of invasive aspergillosis complicated by multiple visceral infarcts involving the liver, spleen, kidneys, pancreas, thiroid and brain. Infarcts were confirmed in necropsy and appeared to be caused by an overwhelming amount of intravascular hiphae, which were observed in the infarcted areas acting forming septic embolus. We believe that multi-visceral infarcts are an underestimated complication of invasive aspergillosis. Given the progressive increase in the population of immunossuppressed patients, clinicians have to aware of all the possible presentations of invasive aspergillosis.     

Successful management of primary invasive pulmonary aspergillosis

We present the successful recovery of an immunocompetent patient with invasive pulmonary aspergillosis in the absence of any previous detectable lung damage or underlying systemic disease.     

侵袭性肺曲霉菌病的临床诊治进展

侵袭性肺曲霉菌病是深部真菌感染性疾病，近年来发病率大大增加，死亡率极高，传统的诊断方法非常困难，治疗效果不佳。近年来，该病在诊断治疗上有很大的进展，本文就此进行综述。