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A case of aspergillosis of the kidney is described that could not be attributed to any of the factors that classically predispose to fungal infection (immunosuppressive, antibiotic or steroid therapy and diabetes). The patient did have severe obstruction of the ureteropelvic junction, which we believe caused stasis of urine and, in turn, the propagation of a colony of Aspergillus.
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PMID:Aspergillus mycetoma of the renal pelvis associated with ureteropelvic junction obstruction. 90 60

A case of aspergillosis of the sphenoid sinus manifested as an isolated sixth nerve palsy occurred in a 74-year old diabetic woman who had no complaints of headache or symptoms suggestive of sinusitis. A CT scan demonstrated a large mass occupying the sphenoid and ethmoid sinuses extending posteriorly to the clivus. There was a calcific density within the opacified sinus and bony erosion of the sphenoid walls and the sella turcica. The patient underwent a sublabial transseptal sphenoidotomy with removal of necrotic material and debridement of the surrounding tissue. Histologic examination revealed granulation tissue with chronic inflammatory cells and abundant dichotomously branching hyphae. Postoperatively the patient was given amphotericin B and 5-fluorocytosine. Three months later the sixth nerve palsy had completely cleared and the patient had no other complaint. Sphenoid sinus aspergillosis is a rare disease and may have variable clinical manifestations according to involvement of different structures located closely to the sinus. Our patient developed an isolated sixth nerve palsy which was at onset considered to be caused by diabetes. Computerized tomography scans disclosed abnormalities strongly indicative of invasive aspergillosis. It illustrates the need of appropriate work-up in cases of an isolated sixth nerve palsy even in patients with diabetes or other risk factors.
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PMID:[Invasive aspergillosis of the sphenoid sinus and paralysis of the 6th nerve]. 130 68

A 70-year-old woman with diabetes mellitus who was following a therapeutic diet showed an infiltrative shadow in the right upper lung field on chest roentgenogram in April, 1986. She was diagnosed as having pneumonia and was treated for five months with several antibiotics, but the abnormal shadow on chest roentgenograms increased in size. Therefore, she was admitted to our hospital in October 1986. Although tubercle bacilli were not isolated from her sputum or from materials obtained by bronchoscopic examination, we made an initial diagnosis of pulmonary tuberculosis based on the findings of chest roentgenograms, tomographs and CT scanning. In spite of treatment with antituberculous drugs, the infiltrative shadow with cavity on chest roentgenograms continued to increase in size, and the patient developed occasional hemoptysis. Percutaneous needle biopsy was performed in February 1987 to establish a definite diagnosis, and the presence of Aspergillus fumigatus was confirmed by microscopic examination and culture. After treatment with miconazole and 5-FC for 3 to 4 months, the abnormal shadow on the chest roentgenogram gradually disappeared and was almost undetectable one year later. The clinical course of this patient was considered to be strongly indicative of chronic necrotizing pulmonary aspergillosis, which was described by Binder et al. in 1982.
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PMID:[A case of chronic necrotizing pulmonary aspergillosis]. 140 8

Aspergillosis, cryptococcosis and zygomycosis (mucormycosis) are overall the most common systemic mycoses but histoplasmosis is particularly endemic in parts of central USA and other areas worldwide. Orofacial lesions caused by systemic mycoses have rarely been reported in the past though they have been recorded particularly in outdoor workers from geographic areas with a high prevalence of infection and occasionally in immunocompromised individuals. Increasing world-wide travel, and the dramatic increase in numbers of immunocompromised persons, especially those with human immunodeficiency virus (HIV) disease, have been responsible for an increase in reports and other studies of orofacial disease in systemic mycoses and new opportunists are now being recognized. Those in Oral Medicine and Pathology must now be aware of the possibility of a systemic mycosis as the cause of chronic oral ulceration, chronic maxillary sinus infection, or bizarre mouth lesions, especially in patients with HIV disease, lymphoproliferative disorders, or diabetes mellitus, or in those who have been in endemic areas. Diagnosis and management should be undertaken in consultation with a physician with appropriate expertise, as pulmonary and other systemic infection may well be present. This paper reviews the eight main systemic mycoses.
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PMID:Orofacial manifestations of the systemic mycoses. 152 29

An immunodiffusion test was developed for the diagnosis of basidiobolomycosis. When culture filtrate antigen (CFA) from Basidiobolus ranarum was reacted against two human patient and two rabbit antisera, 2 precipitin bands, inner (N) and outer (Y), were revealed for both patient and rabbit antisera. A line of identity was also observed between precipitin bands obtained with patient and rabbit sera. When CFA from B. ranarum (B CFA) was reacted against rabbit sera which contained antibody to Conidiobolus coronatus and Pythium insidiosum, 1 precipitin band corresponding to inner band (N) was observed. This finding showed that B. ranarum, C. coronatus and P. insidiosum shared at least one common antigen. After B CFA was absorbed with Pythium rabbit antiserum, the inner precipitin line that occurred between B CFA and rabbit antisera of Pythium and Conidiobolus disappeared. However, with Basidiobolus rabbit antiserum, the result did not change. The antigens which could be demonstrated by inner (N) and outer (Y) precipitin bands were heat stable at 56 degrees C for 30 min. The titer of the antibodies specific to these antigens decreased as the lesions subsided. When B. ranarum CFA was reacted against sera from 20 apparently normal persons, 20 diabetes mellitus patients, 5 aspergillosis patients, 2 candidosis patients and 3 pythiosis patients, no precipitin band was found. B. ranarum CFA was also treated with each rabbit antiserum specific to Candida albicans, Malassezia furfur and Aspergillus fumigatus. No precipitin bands occurred with any of these antisera. Thus, this test was found to be practical, sensitive and specific, and can be used to monitor patients infected with Basidiobolus ranarum.
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PMID:Immunodiffusion test for diagnosing basidiobolomycosis. 152 27

Mycotic immunodiagnosis was performed in 186 hospitalized patients with different respiratory diseases, mostly considered as tuberculosis and others with a doubtful diagnosis. Crude histoplasmin, coccidioidin, paracoccidioidin, blastomycin, candidin, aspergillin, and sporotrichin, as well as purified polysaccharide-protein complexes (PPC) of Histoplasma capsulatum, Coccidioides immitis, and Paracoccidioides brasiliensis were used as antigens. Immune tests used included skin test (ST), gel immunodiffusion (ID), counterimmunoelectrophoresis (CIE), complement fixation (CF), and ELISA. A possible association with candidosis was observed in 17% of patients with tuberculosis and diabetes; one presumptive paracoccidioidomycosis, one confirmed aspergillosis, and six cases of active histoplasmosis were determined. Candidin ST showed 29% of positive reactions with an increased frequency in patients between 31 and 55 years of age. CF test showed the highest positivity percentages with crude antigens, specially for Candida antigen (26.3%) and histoplasmin (18.2%). Cross reactions were evident with crude antigens but decreased when PPC's were used in ELISA.
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PMID:Efficiency of crude and purified fungal antigens in serodiagnosis to discriminate mycotic from other respiratory diseases. 174 92

Aspergillosis with fatal outcome are usually pulmonary invasive aspergillosis with or without dissemination, developed in patients with severe immunosuppression. We report a fatal case of bronchial necrotizing aspergillosis in a young woman with diabetes mellitus, who developed similar lesions to "Semi-invasive Aspergillosis", so-called "Chronic Necrotizing Pulmonary Aspergillosis". This aspergillosis was complicated by large pulmonary artery aneurysms requiring an hemostatic lobectomy. These aneurysms, secondary to the bronchial lesions, contrast with infectious aneurysms (so-called mycotic) secondary to septic embols. They differ from Rasmussen's aneurysms, due to tuberculosis, by their size, fusiform shape and extent. Lesions of vessels' walls and parietal fungal invasion in the vicinity of an endo-bronchial aspergilloma explain the vascular rupture. The multiplicity of these aneurysms, showed on C T Scan, is responsible for death by post-surgical recurrence of hemoptysis.
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PMID:[Fatal hemoptysis during bronchial aspergillosis with multiple pulmonary artery aneurysms]. 238

The authors observed 167 cases of E.N.T. mycoses over a 14-year period (1974-1988) in the E.N.T. Departments of the Abidjan University Hospitals in the Ivory Coast, and in two private health institutions in the city. The majority of cases involve candidiasis (91 cases, or 54.5%), followed by aspergillosis (72 cases, 43.1%) and rhinoentomophtorosis (4 cases, 2.4%). Men are more affected than women (125 as against 42). Men suffering from rhinoentomophtorosis are, for the most part, farmers. Among the contributory factors, we found respectively the abuse of antibiotics, either alone or in association with corticoids for general or local use (ear drops), bathing in lagoons, and diabetes. Bacterial infection is often associated with these mycoses--mainly streptococci and staphylococci aurei. Clinical signs are dominated by pruritus, dull pains, a feeling of fullness in the ear, or of burning in the pharynx. An association of systemic Miconazole and Amphotericin B (local use) has given the best results for candidiasis and aspergillosis. For rhinoentomophtorosis, treatment was long, and even disappointing, until the use of Ketoconazole which may without doubt be considered as the medicament of choice.
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PMID:[Mycoses in otorhinolaryngology. Apropos of 167 cases]. 255 Oct 27

Primary renal aspergillosis has been reported only five times previously. We report the first case with primary renal aspergillosis where reconstructive and not extirpative surgery was used. Patients who have predisposing factors such as diabetes, malignancies, or immunosuppression represent the primary target for fungal infection. In these patients the clinical picture of nonspecific and fungal pyelonephritis are similar. Therefore fungal infections should be considered in the differential diagnosis of urinary tract infections.
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PMID:Primary renal aspergillosis. 267 56

Principal characteristics of clinical and paraclinical pictures of nasosinusal aspergillosis (NSA) in 35 patients are analyzed and allow distinction of three main types of this nasosinusal fungal lesion. Localized, non-invasive nasosinusal aspergillosis (NINSA) is frequently of dental origin and presents as a chronic maxillary sinusitis resistant to conventional treatment. Serology is negative or non-significant for Aspergillus and recovery is complete after surgery. Invasive nasosinusal aspergillosis (INSA) affects debilitated patients (diabetes, immunodepression, malignant blood disease...), and presents with bone destruction, extension to orbit, base of skull and intracranial region, following an acute or subacute course with positive serology for Aspergillus. Early, wide surgical eradication is combined with local and general antifungal therapy but prognosis is poor. Allergic nasosinusal aspergillosis (ANSA), of more recent description, combines chronic sinusitis with severe nasosinusal polyposis, and specific histologic and immunologic features. Its course is favorable with corticoid therapy but long-term results are unknown.
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PMID:[Nasosinusal aspergillosis. Apropos of 35 cases]. 356 45


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