Scientific letter
First case of non-invasive fungal rhinosinusitis by Aspergillus melleus
Primer caso de rinosinusitis fúngica no invasiva por
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class="elsevierStyleTextfn">Scientific letter</span>" "titulo" => "First case of non-invasive fungal rhinosinusitis by <span class="elsevierStyleItalic">Aspergillus melleus</span>" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "92" "paginaFinal" => "93" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Octavio Carretero-Vicario, Isabel Fradejas, Isabel Meana, Ana Perez-Ayala" "autores" => array:4 [ 0 => array:4 [ "nombre" => "Octavio" "apellidos" => "Carretero-Vicario" "email" => array:1 [ 0 => "octaviocarretero91@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Isabel" "apellidos" => "Fradejas" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "Isabel" "apellidos" => "Meana" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 3 => array:3 [ "nombre" => "Ana" "apellidos" => "Perez-Ayala" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Servicio de Microbiología, Hospital Universitario 12 de Octubre, Madrid, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Análisis Clínicos, Hospital Universitario 12 de Octubre, Madrid, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Primer caso de rinosinusitis fúngica no invasiva por" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 597 "Ancho" => 1255 "Tamanyo" => 107513 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A) Sabouraud-chloramphenicol agar colonies incubated for 72<span class="elsevierStyleHsp" style=""></span>h at 30<span class="elsevierStyleHsp" style=""></span>°C. B) Phialoconidia stained with lactophenol blue (× 40) (For interpretation of the references to colour in this figure legend, the reader is referred to the web version of this article).</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Non-invasive fungal rhinosinusitis is a clinical condition with a variable inflammatory response which usually affects immunocompetent patients. This condition typically involves the occupation of multiple sinuses by mucoid material containing fungal hyphae. The main aetiological agents are dematiaceous fungi and <span class="elsevierStyleItalic">Aspergillus</span> spp., particularly <span class="elsevierStyleItalic">A. flavus</span>.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">We describe the case of a 46-year-old immunocompetent woman whose only relevant medical history was endoscopic sinus surgery two and a half years previously for central facial pain, in which mucoid material occupying the left sphenoid sinus was aspirated. Some 22 months after the procedure, the patient reported persistence of the pain, in addition to hyposmia and difficulty breathing through her nose. A CT scan showed complete expansive occupation of the left sphenoid sinus with posterior wall bone erosion and complete occupation of the maxillary sinus, ethmoid cells and frontal sinus on the left side, with underlying polyp. Six months later the patient had repeat endoscopic nasal-sinus surgery, with removal of purulent material from the left maxillary, sphenoid and ethmoid sinuses, which was sent to pathology and microbiology for testing.</p><p id="par0015" class="elsevierStylePara elsevierViewall">Pathology reported mucoid material rich in eosinophils and the presence of septate hyphae.</p><p id="par0020" class="elsevierStylePara elsevierViewall">Microbiology received three samples of pus drained from the left maxillary, sphenoid and ethmoid sinuses, which were seeded in Sabouraud-chloramphenicol agar (bioMerièux) culture media and incubated at 37<span class="elsevierStyleHsp" style=""></span>°C and 30<span class="elsevierStyleHsp" style=""></span>°C. After 72<span class="elsevierStyleHsp" style=""></span>h of incubation, several 4-cm colonies with a yellowish centre and white periphery had grown in the three cultures incubated at 30<span class="elsevierStyleHsp" style=""></span>°C (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>A). Microscopic examination revealed radiate, biseriate conidial heads (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>B).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">Initially, the identification was carried out using MALDI-TOF mass spectrometry (Bruker Daltonics), obtaining a score of 1.8 for <span class="elsevierStyleItalic">Aspergillus ochraceus</span>. To confirm this result, the β-tubulin gene was amplified with conventional PCR, which can discriminate between species of <span class="elsevierStyleItalic">Aspergillus</span>,<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2,3</span></a> and with its subsequent sequencing <span class="elsevierStyleItalic">Aspergillus melleus</span> was definitively identified with 100 % similarity to the sequence deposited in GeneBank® (FJ491523.1).</p><p id="par0030" class="elsevierStylePara elsevierViewall">The patient was discharged home after surgery. She was prescribed antibiotic treatment (amoxicillin-clavulanic acid 875<span class="elsevierStyleHsp" style=""></span>mg/125<span class="elsevierStyleHsp" style=""></span>mg every 8<span class="elsevierStyleHsp" style=""></span>h for 7 days) and nasal lavage with normal saline followed by inhalations of mometasone furoate in each nostril. Four months later, she had made a good recovery.</p><p id="par0035" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Aspergillus melleus</span> belongs to the subgenus <span class="elsevierStyleItalic">Circumdati</span>, section <span class="elsevierStyleItalic">Circumdati</span> and the group <span class="elsevierStyleItalic">Aspergillus ochraceus</span>.<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2,4</span></a> It is a fungus of ubiquitous distribution, found in soil, plantations or food,<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> and has the ability to produce proteolytic enzymes<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> and insecticidal compounds.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> Like other species in the group, it can also produce ochratoxin, although in small quantities.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> To our knowledge, <span class="elsevierStyleItalic">A. melleus</span> has only been described as a human pathogen in certain cases of onychomycosis,<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">8,9</span></a> so the case we describe would be the first case of fungal rhinosinusitis due to <span class="elsevierStyleItalic">A. melleus</span> and the first infection other than an onychomycosis caused by this microorganism.</p><p id="par0040" class="elsevierStylePara elsevierViewall">In terms of therapeutic management, the fact that it was a non-invasive condition in an immunocompetent patient meant that the use of systemic antifungals was not necessary<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a>; the main treatment being the drainage of the mucous material occupying the sinus cavities. Despite this being an immunocompetent patient with no risk factors for an <span class="elsevierStyleItalic">Aspergillus</span> spp. infection, the anatomical alteration of her nasal sinuses in conjunction with the previous surgery may have played a significant role in the infection and proliferation of the fungus.</p><p id="par0045" class="elsevierStylePara elsevierViewall">By way of conclusion, we would like to emphasise on the one hand the importance of nucleic acid amplification techniques to precisely identify the species of the <span class="elsevierStyleItalic">Aspergillus</span> genus, and on the other, to raise the possibility that <span class="elsevierStyleItalic">A. melleus</span> cases are underdiagnosed. This is primarily due to their low severity, which means that very often only empirical treatment is considered necessary and microbiological diagnosis is not requested. Another reason is the difficulty in establishing a definitive diagnosis with techniques other than nucleic acid amplification, such as microscopy or MALDI-TOF, which are much more widely available in microbiology laboratories.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Carretero-Vicario O, Fradejas I, Meana I, Perez-Ayala A. Primer caso de rinosinusitis fúngica no invasiva por <span class="elsevierStyleItalic">Aspergillus melleus</span>. Enferm Infecc Microbiol Clin. 2020;38:92–93.</p>" ] ] "multimedia" => array:1 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 597 "Ancho" => 1255 "Tamanyo" => 107513 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A) Sabouraud-chloramphenicol agar colonies incubated for 72<span class="elsevierStyleHsp" style=""></span>h at 30<span class="elsevierStyleHsp" style=""></span>°C. B) Phialoconidia stained with lactophenol blue (× 40) (For interpretation of the references to colour in this figure legend, the reader is referred to the web version of this article).</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:10 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Fungal rhinosinusitis: a categorization and definitional schema addressing current controversies" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A. Chakrabarti" 1 => "D.W. Denning" 2 => "B.J. Ferguson" 3 => "J. Ponikau" 4 => "W. Buzina" 5 => "H. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 9 | 0 | 9 |
| 2024 October | 51 | 14 | 65 |
| 2024 September | 66 | 18 | 84 |
| 2024 August | 47 | 15 | 62 |
| 2024 July | 78 | 9 | 87 |
| 2024 June | 59 | 4 | 63 |
| 2024 May | 63 | 1 | 64 |
| 2024 April | 47 | 3 | 50 |
| 2024 March | 68 | 8 | 76 |
| 2024 February | 65 | 8 | 73 |
| 2024 January | 79 | 5 | 84 |
| 2023 December | 66 | 8 | 74 |
| 2023 November | 94 | 21 | 115 |
| 2023 October | 72 | 3 | 75 |
| 2023 September | 37 | 5 | 42 |
| 2023 August | 44 | 1 | 45 |
| 2023 July | 36 | 3 | 39 |
| 2023 June | 56 | 2 | 58 |
| 2023 May | 66 | 1 | 67 |
| 2023 April | 49 | 2 | 51 |
| 2023 March | 55 | 4 | 59 |
| 2023 February | 45 | 1 | 46 |
| 2023 January | 39 | 2 | 41 |
| 2022 December | 28 | 8 | 36 |
| 2022 November | 31 | 13 | 44 |
| 2022 October | 38 | 6 | 44 |
| 2022 September | 39 | 11 | 50 |
| 2022 August | 37 | 9 | 46 |
| 2022 July | 25 | 5 | 30 |
| 2022 June | 27 | 8 | 35 |
| 2022 May | 43 | 8 | 51 |
| 2022 April | 23 | 9 | 32 |
| 2022 March | 38 | 7 | 45 |
| 2022 February | 30 | 5 | 35 |
| 2022 January | 40 | 5 | 45 |
| 2021 December | 36 | 9 | 45 |
| 2021 November | 27 | 6 | 33 |
| 2021 October | 65 | 12 | 77 |
| 2021 September | 52 | 9 | 61 |
| 2021 August | 70 | 8 | 78 |
| 2021 July | 30 | 7 | 37 |
| 2021 June | 29 | 10 | 39 |
| 2021 May | 48 | 11 | 59 |
| 2021 April | 78 | 30 | 108 |
| 2021 March | 26 | 15 | 41 |
| 2021 February | 28 | 8 | 36 |
| 2021 January | 12 | 10 | 22 |
| 2020 December | 7 | 6 | 13 |
| 2020 November | 10 | 8 | 18 |
| 2020 October | 6 | 7 | 13 |
| 2020 September | 9 | 10 | 19 |
| 2020 August | 9 | 4 | 13 |
| 2020 March | 2 | 0 | 2 |
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