OBJECTIVE

To present a case of chronic invasive infection rhinosinusitis (CIFRS) complicated by orbital apex syndrome, highlighting the significant diagnostic challenges and delays encountered before establishing the diagnosis.

METHODS

This is a case report.

CASE PRESENTATION

This patient is a 65-year-old diabetic female, status post-kidney transplantation with immunosuppressant use presented with headache and sudden painless vision loss and extraocular limitation of the right eye. Magnetic resonance imaging (MRI) revealed a right-sided ill-defined nasopharyngeal mass, with nasopharyngeal carcinoma as the radiologic consideration. Biopsy revealed bacterial and fungal elements. During admission, antibiotics, antifungals, and tumor debulking was done but symptoms persisted. Histopathology showed reactive inflammatory tissue; hence, a short course of intravenous high-dose steroids was given. Overall health declined and patient eventually expired.

CONCLUSION

This case highlights the importance of maintaining high clinical suspicion for fungal infection despite non-specific radiologic findings in immunocompromised patients with vague, localized symptoms. Prompt recognition and tissue diagnosis are critical for early intervention.

Human ; Female ; Aged: 65-79 Yrs Old ; Mycoses ; Fungal Infection ; Nasopharyngeal Carcinoma

We present a case of Nannizziopsis spp infection in an immunocompromised patient, describe clinical findings, investigation results and treatment. This rare fungal infection is reported in reptiles and humans, but not other mammals. There are only twenty case reports in medical literature to date, most in immunocompromised patients.

A 64-year-old kidney transplant recipient from urban Nigeria presented with a verrucous plaque on his dorsal left hand which has grown rapidly over the two months. He was concerned that it might represent cancer. On further examination he also had a subcutaneous fluctuant masses on his left flank and left upper arm, a fleshy mucosal plaque and a large tender fluctuant swelling over his right tibia. He was clinically well, but in the preceding months he reported haemoptysis and 7 kilograms weight loss.

Skin biopsies from multiple sites showed identical features: suppurative granulomatous inflammation and elongated elements consistent with fungal hyphae. Grocott special staining showed scattered fungal hyphae. Beta-D-glucan was raised at 441.4 pg/mL [3-6 pg/mL]. Subsequent molecular identification confirmed Nanniziopsis spp, likely to be N. guarroi. He was treated with intravenous amphotericin-B for 7 weeks and was then switched to oral posaconazole for one month with complete resolution.

Nannizziopsis is an emerging human pathogenic fungus that predominantly causes disease in immunocompromised individuals. This case highlights the importance of suspecting atypical fungal infection in immunocompromised individuals presenting with polymorphic skin lesions and the critical diagnostic role of skin biopsy and culture.

Human ; Middle Aged: 45-64 Yrs Old ; Fungal Infection ; Mycoses ; Immunosuppression ; Immunosuppression Therapy ; Sub-saharan Africa ; Africa South Of The Sahara

Cross Infection ; microbiology ; therapy ; Drug Resistance, Multiple, Fungal ; Fungi ; classification ; drug effects ; isolation & purification ; Humans ; Mycoses ; microbiology ; therapy ; Patient Care Management ; methods ; Singapore

Adult ; Aged ; Antifungal Agents ; administration & dosage ; adverse effects ; classification ; Candida ; drug effects ; isolation & purification ; Carcinoma ; pathology ; therapy ; Cross Infection ; microbiology ; therapy ; Drug Resistance, Multiple, Fungal ; Female ; Fractures, Bone ; surgery ; Humans ; Male ; Middle Aged ; Mycoses ; microbiology ; therapy ; Patient Care Management ; methods ; Pulmonary Disease, Chronic Obstructive ; complications ; therapy ; Surgical Wound Infection ; microbiology ; therapy ; Symptom Flare Up ; Treatment Outcome

No abstract available.
Aged ; Conjunctiva/*surgery ; Dacryocystorhinostomy/*adverse effects ; Eye Infections, Fungal/diagnosis/*etiology/microbiology ; Female ; Humans ; Keratitis/diagnosis/*etiology/microbiology ; Lacrimal Duct Obstruction/*diagnosis ; Paecilomyces/*isolation & purification ; Recurrence ; Surgical Wound Infection/diagnosis/*etiology/microbiology

PURPOSE: To evaluate the factors affecting treatment outcome of graft infection following penetrating keratoplasty (PKP). METHODS: In this retrospective study, 28 patients who underwent PKP between January 2005 and January 2013 and who were diagnosed with graft infection were classified into a treatment success group or a treatment failure group. Demographic and clinical characteristics, as well as the results of the microbiologic investigation, were analyzed and compared. A subsequent binary logistic regression analysis was performed to identify the prognostic factors affecting treatment outcome. RESULTS: Graft infection occurred at a mean of 38.29 +/- 36.16 months (range, 1 to 96 months) after PKP. Seventeen patients developed bacterial keratitis, and 11 patients developed fungal keratitis. Overall, of the 28 patients, nine (32.1%) were classified in the treatment failure group. Multivariate analysis identified pre-existing graft failure (p = 0.019), interval longer than 72 hours between donor death and PKP (p = 0.010), and fungal infection (p = 0.026) as significant risk factors for treatment failure. CONCLUSIONS: Pre-existing graft failure, extended interval between donor death and PKP, and fungal infection were important risk factors for treatment failure of graft infection following PKP.
Adult ; Aged ; Aged, 80 and over ; Eye Infections, Bacterial/diagnosis/*etiology ; Eye Infections, Fungal/diagnosis/*etiology ; Female ; *Graft Survival ; Humans ; Keratoplasty, Penetrating/*adverse effects ; Male ; Middle Aged ; Prognosis ; Retrospective Studies ; Risk Factors ; Surgical Wound Infection/diagnosis/*etiology ; Treatment Outcome

INTRODUCTIONWorldwide, Candida albicans is the most common Candida species implicated in bloodstream infections. However, the proportion of non-albicans bloodstream infections is increasing. Fluconazole resistance is known to be more common in non-albicans species, but is also reported in C. albicans. This retrospective study was performed to determine the species epidemiology of Candida bloodstream infections in Singapore hospitals, and to perform susceptibility testing to a range of antifungal drugs.

MATERIALS AND METHODSCandida spp. isolated from bloodstream infections from October 2004 to December 2006 were collected from 3 participating hospitals: a tertiary referral hospital (Singapore General Hospital), a secondary referral hospital (Changi General Hospital) and an obstetrics/paediatric hospital [KK Women's and Children's Hospital (KKWCH)]. Isolate collection was also retrospectively extended to January 2000 for KKWCH because of the limited number of cases from this hospital. Isolates were identified by a common protocol, and antifungal susceptibility testing was performed by microbroth dilution (Sensititre One, Trek Diagnostics, United Kingdom).

RESULTSThe most common isolates were C. albicans (37%), C. tropicalis (27%) and C. glabrata (16%). There were differences in species distribution between institutions, with C. parapsilosis and C. albicans predominant in KKWCH, and C. albicans and C. tropicalis predominant in the other 2 institutions. Fluconazole resistance was detected in 3.2% of all Candida spp., and 85.3% were classified as susceptible. All C. albicans and C. parapsilosis were susceptible to fluconazole and voriconazole, while susceptibility to fluconazole was much more variable for C. glabrata and C. krusei.

CONCLUSIONThis study shows that C. albicans remains the predominant Candida species isolated from bloodstream infections in the 3 participating hospitals. However, non-albicans species accounted for nearly two-thirds of all cases of candidaemia. Resistance to fluconazole was uncommon, and was generally confined to C. krusei and C. glabrata.

Antifungal Agents ; pharmacology ; Candida ; classification ; drug effects ; isolation & purification ; Candidiasis ; drug therapy ; epidemiology ; microbiology ; Cross Infection ; epidemiology ; microbiology ; Drug Resistance, Fungal ; drug effects ; Female ; Fungemia ; epidemiology ; microbiology ; Hospitals, University ; Humans ; Microbial Sensitivity Tests ; Retrospective Studies ; Singapore ; epidemiology

The incidence of CNS infection is common in developing countries such as ours, a common complication of which is elevated intraaanial pressure. The deleterious effects of increased ICP in may manifest as severe headache, visual impairment and mortality. Several modalities have been suggested for the management of ICP either medical or surgical. However, for developing countries surgical procedures is not always feasible in most clinical centers due to lack of facilities or experts and as such medical management of ICP becomes the primary mode of treatment. Acetazolamide is an inexpensive, widely available drug that in theory can lower elevated ICP. There are also some anecdotal evidence on its efficacy. This paper aims to assess the efficacy of using acetazolamide in the management of increased ICP. Intensive search of the online medical journals were done using the following keywords: "Acetazolamide", "intracranial pressure", "hydrocephalus", "acetazolamide and increased intraaanial pressure", "cryptococcal meningitis". Five citations were obtained and based on the set inclusion and exclusion criteria, two trials were deemed appropriate for this review. Critical appraisal was done which validated the trials. Overall, the two studies analyzed showed conflicting data regarding the use of acetazolamide in the management of inereased intracranial pressure. The data available from this meta-analysis shows little or no effect in giving acetazolamide for the treatment of increased ICP. This meta-analysis, however is based only on 2 RCTs with a total of 40 patients. There is still a need to conduct studies with bigger sample sizes to provide more conclusive evidence on the utility or non-utility ofacetazolamied in ICP.

Human ; Male ; Female ; Acetazolamide ; Intracranial Pressure ; Musculoskeletal And Neural Physiological Phenomena ; Nervous System Physiological Phenomena ; Cerebrospinal Fluid Pressure ; Hydrocephalus ; Nervous System Diseases ; Central Nervous System Diseases ; Brain Diseases ; Meningitis, Cryptococcal ; Bacterial Infections And Mycoses ; Mycoses ; Central Nervous System Fungal Infection ; Meningitis, Fungal ; Therapeutics ; Therapy ; Treatment Outcome

Adult ; Aged ; Cross Infection ; microbiology ; Drug Resistance, Bacterial ; Drug Resistance, Fungal ; Humans ; Male ; Middle Aged ; Pneumoconiosis ; complications

China ; epidemiology ; Cross Infection ; epidemiology ; Drug Resistance, Fungal ; Female ; Hospitalization ; Humans ; Male ; Microbial Sensitivity Tests ; Mycoses ; epidemiology ; Prevalence ; Respiratory Tract Infections ; microbiology ; Sentinel Surveillance