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VOLUME 11 , ISSUE 3 ( September-December, 2019 ) > List of Articles

RESEARCH ARTICLE

Caseous Rhinosinusitis: Fungal or Bacterial Ball?

Natalia V Boiko

Citation Information : Boiko NV. Caseous Rhinosinusitis: Fungal or Bacterial Ball?. Int J Otorhinolaryngol Clin 2019; 11 (3):64-66.

DOI: 10.5005/jp-journals-10003-1342

License: CC BY-NC 4.0

Published Online: 01-06-2021

Copyright Statement:  Copyright © 2019; The Author(s).


Abstract

Background: The fungal ball is a common type of fungal rhinosinusitis. The fungal ball appears to be unstructured caseous masses revealed during the surgical treatment. Aim and objective: To analyze the contents of the paranasal sinuses in 168 patients with the clinically suspected fungal ball who had undergone functional endoscopic sinus surgery (FESS). Study design: A total of 168 patients aged between 19 and 63 with fungal ball clinical diagnosis admitted to the ENT Department of Rostov State Medical University, Russia, were involved in the study between January 2009 and July 2018. Materials and methods: Tissue samples obtained from the affected sinuses underwent microscopic, microbiological, and histopathological examination. Results: Fungi presence was confirmed in 148 out of 168 patients. In 20 cases, the presence of fungi in the caseous masses, obtained during the operation, was not revealed by any diagnostic method, and in 19 out of 20 patients, different types of bacteria were detected in diagnostically significant titers, most often Bacteroides spp.—in five patients, Staphylococcus spp.—in five patients, Pseudomonas aeruginosa—in three patients, two cases of Klebsiella pneumoniae, and two cases of Actinomyces spp. To characterize such findings, the term “bacterial ball” by analogy with the “fungal ball” was earlier suggested. Conclusion: Caseous masses found during sinus surgery is often considered to be a clinical diagnosis validation. Meanwhile, the said caseous masses may not only manifest a fungal disease, but also bacterial colonization, which determines the postoperative treatment.


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  1. Pulmonary and sinus fungal diseases in non-immunocompromised patients. Lancet Infect Dis 2017;17(11):357–366. DOI: 10.1016/S1473-3099(17)30309-2.
  2. Fungal rhinosinusitis: microbiological and histopathological perspective. J Clin Diagn Res 2017;11(7):DC10–DC12. DOI: 10.7860/JCDR/2017/25842.10167.
  3. Fungal rhinosinusitis: a categorization and definitional schema addressing current controversies. Laryngoscope 2009;119(9):1809–1818. DOI: 10.1002/lary.20520.
  4. Fungus: a role in pathophysiology of chronic rhinosinusitis, disease modifier, a treatment target, or no role at all? Immunol Allergy Clin North Am 2009;29(4):677–688. DOI: 10.1016/j.iac.2009.07.002.
  5. Paranasal sinus mycoses in north India. Mycoses 1998;41(7-8):281–286. DOI: 10.1111/j.1439-0507.1998.tb00339.x.
  6. Mycological profile of fungal sinusitis: an audit of specimens over a 7-year period in a tertiary care hospital in Tamil Nadu. Indian J Pathol Microbiol 2008;51(4):493–496. DOI: 10.4103/0377-4929.43738.
  7. Fungal rhinosinusitis: a retrospective microbiologic and pathologic review of 400 patients at a single university medical center. Int J Otolaryngol 2012;2012:684835. DOI: 10.1155/2012/684835.
  8. A retrospective analysis of 538 sinonasal fungus ball cases treated at a single tertiary medical center in Korea (1996-2015). Int Forum Allergy Rhinol 2017;7(11):1070–1075. DOI: 10.1002/alr.22007.
  9. Evaluation of the prevalence and specificities of asymptomatic paranasal sinus aspergillosis: retrospective study of 59 cases. European Annals of Otorhinolaryngol, Head and Neck Diseases 2015;132:19–23.
  10. Radiologic characteristics of sinonasal fungus ball: an analysis of 119 cases. Acta Radiol 2011;52(7):790–795. DOI: 10.1258/ar.2011.110021.
  11. Radiologic appearances in fungal rhinosinusitis. Otorhinolaryngology Clinics: An International Journal 2009;1(1):15–23. DOI: 10.5005/jp-journals-10003-1002.
  12. Surgical management of fungal rhinosinusitis. Otorhinolaryngology Clinics: An International Journal 2009;1(1):69–75. DOI: 10.5005/jp-journals-10003-1010.
  13. Caseous sinusitis. clinical, x-ray computed, surgical, histopathological, biological, biochemical and myco-bacteriological aspects. Apropos of 33 cases. Ann Otolaryngol Chir Cervicofac 1997;114(4):105–115.
  14. Bioballs causing asymptomatic or recurrent acute rhinosinusitis: two cases. J Rhinol 2016;23(1):55–59. DOI: 10.18787/jr.2016.23.1.55.
  15. Bacterial ball as an unusual finding in patients with chronic rhinosinusitis. Clin Exp Otorhinolaryngol 2018;11(1):40–45. DOI: 10.21053/ceo.2017.00332.
  16. Chronic rhinosinusitis: a microbiome in dysbiosis and the search for alternative treatment options. Microbiology Australia 2016;37(3):149–152. DOI: 10.1071/MA16051.
  17. Bacterial biofilms and the pathophysiology of chronic rhinosinusitis. Curr Opin Allergy Clin Immunol 2011;11(1):18–23. DOI: 10.1097/ACI.0b013e3283423376.
  18. Confocal scanning laser microscopy evidence of biofilms in patients with chronic rhinosinusitis. Laryngoscope 2007;117(7):1302–1306. DOI: 10.1097/MLG.0b013e31806009b0.
  19. Prevalence of biofilms and their response to medical treatment in chronic rhinosinusitis without polyps. Otolaryngol Head Neck Surg 2012;146(4):669–675. DOI: 10.1177/0194599811434101.
  20. Dental plaque as a biofilm and a microbial community - implications for health and disease. BMC Oral Health 2006;6(Suppl 1):14–20. DOI: 10.1186/1472-6831-6-S1-S14.
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