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As such, the diagnosis and management are complex. New survey studies provide some consensus on prevalence and management of this disease in children. Further, we detail treatment options that should be considered.

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Finally, we feature emerging potential treatment options of CRS, including anti-immunoglobulin E, interleukin-5, and interleukin-4 receptor alpha subunit. In patients with hematological malignancies, bronchoalveolar lavage fluid BALF specimens are commonly used for the diagnosis of mold infections. However, it is not clear whether the cell pellet P or the supernatant fraction S of the BALF specimen is optimal for molecular diagnostic testing.

Thus, 99 BALF specimens were collected from 96 hematology patients with or without allogeneic hematopoietic stem cell transplant. Molds would have been missed in 5 and 16 out of 28 samples if only S or P, respectively, was analyzed. No sample was positive by testing of S or P only. Fungal sphenoid sinusitis is easily misdiagnosed in clinic, particularly for patients with normal immunological status. Due to the anatomic characteristics of sphenoid sinus, patients presented with various nonspecific symptoms and complications.

Headache is the most common presentation, but location of headache is not fixed. We intended to analyze 6 cases of headache secondary to the isolated sphenoid sinus fungus ball SSFB which were first diagnosed in the Neurology Department. There was significant female predominance with mean ages of 55 years. They had repeatedly headache history from months to years.

The headache was unilateral and usually on the side of lesions.

Medication of pain relievers worked well in the beginning of SSFB, but not in the late stage of disease. Notably, all patients did not present positive nervous systemic signs. A preoperative computed tomography CT scan or magnetic resonance imaging MRI demonstrated the inflammation in sphenoid sinus. Some cases showed calcification in soft tissue or bone lesions of sinus wall.

All of 6 patients undertook transnasal endoscopic sphenoidotomy without antifungal therapy after operation. Characteristic fungus ball FB was detected after histopathological examination. No headache recurrence was found after average Our results suggested that transnasal endoscopic sphenoidotomy is the treatment of choice to remove the FB in sphenoid sinus with a low rate of morbidity and recurrence.

Establishing rapid diagnoses of invasive aspergillosis IA is priority, given poor outcomes of late therapy. Urine samples were obtained from a cohort of 78 subjects undergoing clinical evaluation for suspected invasive fungal infections, and stored frozen until testing. Urine was processed by centrifugation through desalting columns and exposed to dipsticks.

Western blots were performed on urines from two subjects to characterize mAbreactive antigens. In the sub-group with cancer, sensitivity was Eliminating lung transplant recipients with airway disease increased sensitivity in the non-cancer cohort Semi-quantitative urine assay results correlated with serum galactomannan indices. Western blots demonstrated mAbreactive antigens in urine from cases, ranging between 26 - 35kDa in size. Urine testing using mAb may be used as an aid to diagnose IA in high-risk patients. Objective This study retrospectively evaluated fungal dissemination due to hospital reconstruction and explored effective methods of predicting an outbreak.

Methods Patients suspected of having invasive aspergillosis were tested for Aspergillus galactomannan antigen before and after reconstruction, and the mean values of three months of testing for positive patients were determined. The characteristics of patients with aspergillosis during this period were also assessed. We also discovered that the anteroom to contain dust was not prefabricated and a negative pressure system to remove dust was not used.

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After construction of the unit, no new cases of aspergillosis were diagnosed. Conclusion Many Aspergillus spores may be transiently floating during hospital reconstruction. Therefore, monthly surveillance with frequent serum galactomannan antigen testing to predict outbreaks is necessary. Surveillance of all patients in the hematology ward is especially important.

Reconsideration of prophylactic antifungals may also be necessary during hospital reconstruction. Patients with haematological malignancies are at risk for invasive fungal diseases IFD. A survey was conducted in all Dutch academic haematology centres on their current diagnostic, prophylactic and therapeutic approach towards IFD in the context of azole resistance.

In all 8 centres , a haematologist and microbiologist filled in the questionnaire that focused on different subgroups of haematology patients. Mould-active prophylaxis was given to acute myeloid leukaemia patients during chemotherapy in two of eight centres. All centres used azole prophylaxis in a subset of patients with graft-versus-host disease. A uniform approach towards the diagnosis and treatment of IFD and in particular azole-resistant Aspergillus fumigatus was lacking.

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In , all centres agreed to implement a uniform diagnostic and treatment algorithm regarding invasive aspergillosis with a central role for comprehensive diagnostics and PCR-based detection of azole resistance. A heterogeneous approach towards antifungal prophylaxis, diagnosis and treatment was apparent in the Netherlands. Facing triazole-resistance, consensus was reached on the implementation of a uniform diagnostic approach in all eight centres. This article is protected by copyright. All rights reserved. Co-morbidities, causative microorganisms, radiological findings, and outcomes were evaluated.

Use of systemic corticosteroids hazard ratio: 3.


The treatment course of PNTM was not associated with all-cause mortality. The radiological appearances of six cases of primary fungal granuloma of the paranasal sinuses with involvement of the orbit are described. All were caused by Aspergillus flavus. Bone destruction is common and can be extensive, but is characteristically well defined, especially in the lateral wall of the antrum. The discrepancy between the gross radiological changes and the mild symptoms is a feature very suggestive of the condition.

Associated displaced "floating" teeth, expansion of ethmoids, and intracranial calcification are described and discussed. It is expected that, at least in certain localities where the incidence is significant, the radiologist would be able to help in recognising the earlier cases. In the rest of the cases, the causes are non-dermatophytic fungi such as Aspergillus species. This review aimed to provide information about the current perspectives on MG regarding its clinical characteristics, predisposing factors, laboratory diagnosis, and treatment strategies.

Although the lower extremities were reported to be the most common site of infection, facial involvement has been predominant in the past 5 years. A reliable diagnosis of MG is based on histopathological examination, including fungal culture and molecular analyses. MG should be treated not only with topical agents but also with systemic antifungal agents that are continued until the lesions are completely resolved. In systemic treatment, the most preferred drug is terbinafine, because of its efficacy, side effects, and safety.

Comparatively, galactomannan index and mycological examination yielded only Considering the 13 chronic aspergillosis cases, PCR, galactomannan index and mycological examination yielded Fungal load in BAL evaluated by PCR was able to discriminate between aspergillosis and contamination, but not between invasive and non-invasive forms.

Finally, fungal load was predictive of day mortality, with It is likewise an interesting tool for the diagnosis of non-invasive forms. The characteristics and management of invasive pulmonary aspergillosis IPA in patients with hematologic malignancies are well known, but IPA in patients with solid tumours is not well described. We retrospectively reviewed all Aspergillus-positive cultures at a tertiary cancer center during We identified patients with IPA and solid tumours.

We analyzed the association between clinical features and treatment and week mortality and response to antifungal therapy. Fifty-one patients had lung cancer, 77 had underlying lung disease, 47 received chest radiation and 33 had chronic obstructive pulmonary disease.

In multivariate analysis, a positive fungal stain was associated with lower odds of a successful response odds ratio 0. Blood cultures should also be collected if the shunt terminates in a vascular space ventriculoatrial shunt. Most CNS shunt infections are caused by bacteria. Fungi are more likely to cause shunt infections in immunocompromised patients and those receiving total parenteral nutrition, steroids, or broad-spectrum antibiotics.

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Cranial subdural empyema and cranial epidural abscess are neurosurgical emergencies that are usually caused by bacteria streptococci, staphylococci, aerobic gram-negative bacilli, anaerobes, often polymicrobial; Table II Mycobacteria and fungi are rare causes. Predisposing conditions include sinusitis, otitis media, mastoiditis, neurosurgery, head trauma, subdural hematoma, and meningitis infants.

The pathogenesis of spinal epidural abscess includes hematogenous spread skin, urinary tract, mouth, mastoid, lung infection , direct extension vertebral osteomyelitis, discitis , trauma, or post-procedural complication surgery, biopsy, lumbar puncture, anesthesia.


Spinal epidural abscess is usually caused by staphylococci, streptococci, aerobic gram-negative bacilli, and anaerobes. Nocardia spp, mycobacteria, and fungi may also cause spinal epidural abscess. Spinal subdural empyema is similar to spinal epidural abscess in clinical presentation and causative organisms. Magnetic resonance imaging MRI is the optimal diagnostic procedure for suppurative intracranial thrombophlebitis.

The etiologic agent may be recovered from cerebrospinal fluid and blood cultures. Causative organisms are similar to cranial epidural abscess and cranial subdural empyema. Empiric antimicrobial therapy is usually based on the predisposing clinical condition.

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Recommendations for the laboratory diagnosis of ocular infections are often based on studies where only small numbers of clinical specimens were examined so the evidence base for many recommendations is limited. Studies comparing multiple diagnostic approaches to determine the optimal means for detection of the infectious etiology of keratitis and endophthalmitis are further hampered by small specimen size.

Finally, frequent pretreatment with topical antibacterial agents further complicates laboratory diagnosis of both bacterial conjunctivitis and keratitis [ 26 ]. Consult the laboratory regarding suspicious agents. Corneal scrapings are preferred for keratitis diagnosis. Because ocular infections may involve one or both eyes and etiologies may differ, clinicians must clearly mark specimens as to which eye has been sampled, especially in those patients who have bilateral disease.

Collection of specimens from anatomical structures surrounding the eye is typically performed using swabs Table III The most commonly collected specimens are from the conjunctiva. Cultures for aerobic bacteria and detection of Chlamydia and viruses either by culture or nucleic acid amplification testing NAAT are most commonly performed. Because direct microscopic examination may be useful in preliminary diagnosis of conjunctivitis, obtaining dual swabs, one for culture and one for smear preparation, is recommended. Smears may be made for Gram stain, calcofluor stain for fungi and Acanthamoeba, or direct fluorescent antibody DFA for Chlamydia trachomatis.

Specimens for viral cultures should be submitted on ice, especially if specimen transport is prolonged. Individual laboratories, however, may have validated NAATs for examination of specimens obtained from patients with conjunctivitis and studies suggest that NAATs are more sensitive than cultures. Laboratories that offer such testing must conduct in house validation of these assays before offering NAAT as a diagnostic test.