Breakthrough Acute Necrotizing Invasive Fungal Rhinosinusitis by Alternariaalternata in a Patient with Acute Lymphoblastic Leukemia on Anidulafungin Therapy and Case-Based Literature Review
Abstract
:1. Introduction
2. Case Report
3. Mycological Workup
3.1. Culture
3.2. PCR
3.3. Antifungal Susceptibility Testing
4. Discussion
Author, Year of Publication (Reference) | Country, Study Period | Gender/Age (Years) | Predisposing Factors | Signs | Histopathology | Culture | Treatment | Outcome(Months Post-Surgery) |
---|---|---|---|---|---|---|---|---|
Morrison, 1993 [16] | USA, 1984 | M/38 | CML BMT (47 days pre-infection) Neutropenia | Bloody crust on nasal septum, necrotic appearing | Septate branching fungal hyphae invading the involved sinonasal tissue with areas of necrosis and vascular invasion | Alternaria spp. | Surgical debridement AMB therapy WBC transfusions | Died due to respiratory and graft failure; no sign of infection at autopsy (3 weeks) |
Morrison, 1993 [16] | USA, 1985 | M/25 | ALL BMT (27 days pre-infection) Profound neutropenia | Superficial ulcer on nasal septum | Septate branching fungal hyphae invading the involved sinonasal tissue with areas of necrosis and vascular invasion | Alternaria spp. | Surgical debridement Antifungal therapy (AMB+5-FC) WBC transfusions | Alive (NA) |
Morrison, 1993 [16] | USA, 1985 | M/13 | ALL BMT (15 days pre-infection) Profound neutropenia | Necrotic black lesion on nasal septum | Septate branching fungal hyphae invading the involved sinonasal tissue with areas of necrosis and vascular invasion | Alternaria spp. | Surgical debridement AMB therapy WBC transfusions | Alive (NA) |
Morrison, 1993 [16] | USA, 1985 | F/26 | AML BMT (14 days pre-infection) Profound neutropenia | Small dark crust on middle turbinate | Septate branching fungal hyphae invading the involved sinonasal tissue with areas of necrosis and vascular invasion | Alternaria spp. | Surgical debridement AMB therapy | Alive (NA) |
Morrison, 1993 [16] | USA, 1985 | F/37 | Aplastic anemia BMT (15 days pre-infection) Profound neutropenia | Black plaque on nasal septum | Septate branching fungal hyphae invading the involved sinonasal tissue with areas of necrosis and vascular invasion | Alternaria spp. | Surgical debridement AMB therapy | Died of aspiration pneumonia due to nasal bleeding; no sign of infection at autopsy (5 days post-surgery) |
Wiest, 1993 [18] | USA, 1985 | M/31 | Acquired immunodeficiency syndrome | Black, necrotic-appearing lesion on the mucosa of the right nasal septum | Necrotic tissue with acute inflammation. Numerous, large, irregular septate hyphae | A. alternata | Surgical debridement AMB therapy | Died; no sign of infection at autopsy (8) |
Morrison, 1993 [16] | USA, 1989 | F/39 | CLL BMT (27 days pre-infection) | Septal pallor, blood crusts in nose | Septate branching fungal hyphae invading the involved sinonasal tissue with areas of necrosis and vascular invasion | Alternaria spp. | Surgical debridement AMB therapy | Alive (NA) |
Iwen, 1997 [19] | USA, 1985–1994 | F/35 | AML Profound neutropenia (30 days pre-infection) | Nasal necrosis | Pigmented, branching and septated moniliform hyphae | Alternaria spp. | Surgical debridement AMB therapy (25 days) | Alive (NA) |
Chen, 2004 [17] | USA, 2003 | F/56 | AML Chemotherapy-induced neutropenia | Anterior nasal septal necrotic lesion with the overlying mucosa being slightly edematous and having a dusky appearance. | Multiple small fragments of squamous mucosa with ulceration and necrosis mixed with blood clot. Numerous hyphae elements with microconidia. | A. alternata | Surgical debridement AMB therapy | Died due to bacterial sepsis, but multiple cultures of nasal sinus content were negative (3) |
Park, 2005 [15] | USA, 2000–2004 | Pediatric patient | Hematologic malignancy Profound neutropenia | Necrosis | NA | A. alternata | Surgical debridement Antifungal therapy | NA |
Park, 2005 [15] | USA, 2000–2004 | Pediatric patient | Hematologic malignancy Profound neutropenia | Necrosis | NA | A. alternata | Surgical debridement Antifungal therapy | NA |
Rabagliati, 2009 [20] | Chile, 2004–2008 | Adult patient | Hematologic malignancy Chemotherapy-induced neutropenia | NA | NA | Alternaria spp. | Surgical debridement VRC therapy | NA |
Montone, 2011 [32] | USA, NA | F/51 | AML | NA | Invasion of fungal forms into submucosal tissue with frequent areas of tissue necrosis and angioinvasion | Alternaria spp. | NA | NA |
Ardeshirpour, 2014 [14] | USA, 1994–2007 | F/6 | ALL Profound neutropenia (41 days pre-infection) | NA | NA | Alternaria spp. | Surgical debridement Antifungal therapy (AMB+CAS+VRC) G-CSF | Died from recurrent ALL, but without infection (2) |
Ardeshirpour, 2014 [14] | USA, 1994–2007 | F/11 | AML Profound neutropenia (23 days pre-infection) | NA | NA | Alternaria spp. | Surgical debridement Antifungal therapy (AMB,+CAS+VRC) G-CSF | Alive (53) |
Ardeshirpour, 2014 [14] | USA, 1994–2007 | F/9 | AML Profound neutropenia (13 days pre-infection) | NA | NA | Alternaria spp. | Surgical debridement Antifungal therapy (AMB+CAS+VRC) G-CSF | Alive (48) |
Ardeshirpour, 2014 [14] | USA, 1994–2007 | M/11 | ALL Profound neutropenia (16 days pre-infection) | NA | NA | Alternaria spp. | Surgical debridement Antifungal therapy (AMB/L-AMB+ITC) G-CSF, WBC transfusions | Died from Scopulariopsis spp. throughout central nervous system (4) |
Ardeshirpour, 2014 [14] | USA, 1994–2007 | M/2 | ALL Profound neutropenia (22 days pre-infection) | NA | NA | Alternaria spp. | Surgical debridement Antifungal therapy (AMB+ITC) G-CSF, WBC transfusions | Alive (32) |
Ardeshirpour, 2014 [14] | USA, 1994–2007 | F/4 | AML Profound neutropenia (8 days pre-infection) | NA | NA | Alternaria spp. | Surgical debridement Antifungal therapy (AMB+ITC) WBC transfusions | Alive (37) |
Ardeshirpour, 2014 [14] | USA, 1994–2007 | F/13 | ALL Profound neutropenia (16 days pre-infection) | NA | NA | Alternaria spp. | Surgical debridement Antifungal therapy (AMB+ITC) G-CSF, WBC transfusions | Alive (24) |
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Laboratory Parameters | On the Day of ALL Diagnosis (22/6) | On the Day of FRS Diagnosis (14/7) |
---|---|---|
CRP (mg/L) | 332 | 88.8 |
Glucose (mg/dL) | 105 | 119 |
Urea (mg/dL) | 35.3 | 22.6 |
White Blood Cells (109/L) | 24.8 | 0.33 |
Neutrophils (109/L) | 0.23 | 0.16 |
Lymphocytes (109/L) | 18.30 | 0.16 |
Monocytes (109/L) | 6.07 | 0.01 |
Basophils (109/L) | 0.15 | 0 |
Red Blood Cells (1012/L) | 3.5 | 2.67 |
Hemoglobin (g/L) | 10.3 | 7.9 |
Hematocrit (%) | 29.8 | 22.4 |
Platelet (103/μL) | 70 | 56 |
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Tyrellis, G.; Siopi, M.; Leventakou, D.; Delides, A.; Maragkoudakis, P.; Korres, G.; Apostolopoulou, C.; Gouloumi, A.-R.; Pappa, V.; Pournaras, S.; et al. Breakthrough Acute Necrotizing Invasive Fungal Rhinosinusitis by Alternariaalternata in a Patient with Acute Lymphoblastic Leukemia on Anidulafungin Therapy and Case-Based Literature Review. J. Fungi 2022, 8, 879. https://doi.org/10.3390/jof8080879
Tyrellis G, Siopi M, Leventakou D, Delides A, Maragkoudakis P, Korres G, Apostolopoulou C, Gouloumi A-R, Pappa V, Pournaras S, et al. Breakthrough Acute Necrotizing Invasive Fungal Rhinosinusitis by Alternariaalternata in a Patient with Acute Lymphoblastic Leukemia on Anidulafungin Therapy and Case-Based Literature Review. Journal of Fungi. 2022; 8(8):879. https://doi.org/10.3390/jof8080879
Chicago/Turabian StyleTyrellis, Giorgos, Maria Siopi, Danai Leventakou, Alexander Delides, Pavlos Maragkoudakis, George Korres, Christina Apostolopoulou, Alina-Roxani Gouloumi, Vasiliki Pappa, Spyros Pournaras, and et al. 2022. "Breakthrough Acute Necrotizing Invasive Fungal Rhinosinusitis by Alternariaalternata in a Patient with Acute Lymphoblastic Leukemia on Anidulafungin Therapy and Case-Based Literature Review" Journal of Fungi 8, no. 8: 879. https://doi.org/10.3390/jof8080879