ObjectiveTo observe the clinical characteristics of patients with visual impairment caused by fungal sphenoid sinusitis and analyze the influencing factors related to visual prognosis. Methods A retrospective clinical study. From January 2006 to December 2020, 44 patients (55 eyes) with visual impairment caused by fungal sphenoid sinusitis confirmed by imaging and pathological examination in the Department of Ophthalmology of Beijing Tongren Hospital were included in the study. Patients was first diagnosed in the Department of Ophthalmology due to monocular or binocular vision loss, or binocular diplopia, limited eye movement and ptosis. All patients underwent visual acuity examination and fundus color photography. CT examination of paranasal sinus or orbit was performed in 37 cases; magnetic resonance imaging (MRI) of paranasal sinus, brain or orbit was performed in 34 cases. All patients underwent endoscopic sinus opening combined with intrasinus lesion clearance; 14 cases were treated with antifungal drugs after operation. The average follow-up time was 59.61±37.70 months. Comparison of clinical characteristics between invasive and non-invasive fungal sphenoid sinusitis were by χ2 test or Fisher exact test. The influencing factors with P＜0.2 in univariate analysis were selected for multivariate regression analysis. ResultsAmong the 44 patients, there were 19 males and 25 females; the ratio of male to female was 1:1.3; the average age of visual symptoms was 61.48 ± 12.17 years; 23 cases (52.3%, 23/44) suffered from immune dysfunction, including 21 cases of diabetes mellitus. The visual acuity decreased in 33 cases (44 eyes) (75.0%, 33/44). There were 15 cases of binocular diplopia with eye movement disorder (34.0%, 15/44), including 6 cases with visual impairment. The visual acuity of the affected eye was no light perception-0.8. There were 35 cases with headache (79.5%, 35/44). Nasal symptoms were found in 14 cases (31.8%, 14/44). There were 40 and 4 cases of Aspergillus and Mucor infection in sphenoid sinus, respectively. Among the 37 cases who underwent CT examination of paranasal sinus or orbit, there were soft tissue filling in the sinus cavity, including 19 cases of high-density calcification in the sinus cavity (51.4%, 19/37); bone defect of sinus wall were in 24 cases (64.9%, 24/37). There were 26 cases (70.3%, 26/37) of sinus wall osteosclerosis. MRI of paranasal sinus, brain or orbit was performed in 34 cases. T1WI of sphenoid sinus lesions showed low signal, high signal and equal signal in 14, 10 and 9 cases, respectively; T2WI showed high signal, low signal and equal signal in 13, 16 and 2 cases respectively. After enhancement, the lesions were strengthened in 11 cases, no obvious enhancement in 23 cases, and the surrounding mucosa was thickened and strengthened. The lesions involved the orbital apex and cavernous sinus in 18 and 16 cases, respectively; orbital apex and cavernous sinus were involved in 12 cases. Six months after operation, visual acuity was significantly improved in 27 eyes (65.9%, 27/41); visual acuity did not improve in 14 eyes (34.1%, 14/41). Multivariate regression analysis showed that the change of sinus wall osteosclerosis was associated with higher visual acuity improvement rate (odds ratio= 0.089, 95% confidence interval 0.015-0.529, P=0.008). ConclusionsFungal sphenoid sinusitis related visual impairment is relatively common in elderly female patients with low immune function; monocular vision loss with persistent headache is the most common clinical symptom; imaging findings of sphenoid sinus lesions are an important basis for diagnosis. Sphenoid sinus opening combined with sinus lesion clearance is an effective treatment. After operation, the visual acuity of most patients can be improved. The prognosis of visual acuity was relatively good in patients with hyperplasia and sclerosis of sphenoid sinus wall bone.
ObjectiveTo explore the value of bronchoscopy alveolar lavage cytology in diagnosis of pulmonary fungus infection and distinguishing colonization from true fungal infections.
MethodsA retrospective analysis was conducted on the patients with positive fungi results in bronchoalveolar lavage cytology admitted in Shanghai Xinhua Hospital between January 2009 and December 2013.Clinical,radiological,bronchoalveolar lavage and histopathology findings were recorded and analyzed.
ResultsFungi were found in alveolar lavage fluid in 60 cases.The most common fungal organism identified was Aspergillus,followed by Candida and Cryptococcosis.Twenty-seven cases (45.00%) by lung biopsy pathology were diagnosed as pulmonary fungal infection and 33 cases (55.00%) were diagnosed as lung bacteria colonization.Aspergillus was found in 35 cases (58.33%),as pathogenic bacteria in 12 cases (34.28%),and colonization bacteria in 23 cases (65.72%).Candida was found in 13 cases (21.67%),as pathogenic bacteria in 3 cases (23.08%),and colonization bacteria in 10 cases (76.92%).Ten cases of Cryptococcus and 2 cases of pulmonary sporozoan were all as pathogenic bacteria.Most cases of Aspergillus and Candida in cytological specimens presented as a pulmonary mass or endobrochial growth and were diagnosed as carcinomas in biopsy specimens,so bacteria colonization should be considered in these cases first of all.All cases of Pneumocystis with bilateral ground glass infiltrates and cryptococcosis with parenchymal mass lesion in radiology represented true infection.The coincidence rate of bronchoscopy alveolar lavage cytology and histopathology was 45%.
ConclusionAspergillus and Candida species are the most common fungal organisms in the bronchoscopy alveolar lavage.Fluid cytological examination is an important diagnostic modality for pulmonary mycoses,however it is important to correlate with clinical,bronchoscopy and biopsy findings for accurate diagnosis and appropriate management.
Objective To investigate the risk factors for end-stage liver disease (ESLD) complicated with fungal esophagitis (FE). Methods The clinical data of ESLD patients who underwent gastroscopy during their hospitalization in the Second Affiliated Hospital of Chongqing Medical University between January 1, 2017 and December 31, 2023 were retrospectively analyzed. The ESLD patients with FE were selected as the study group, and the ESLD patients without FE during the same period were included as the control group by 1∶2 propensity score matching method. Multivariate logistic regression model was used to analyze the risk factors of ESLD complicated with FE. Results A total of 75 ESLD patients with FE and 150 ESLD patients without FE were enrolled. There was no significant difference in age, gender, decompensated cirrhosis, liver cancer, diabetes mellitus, or etiology of ESLD between the two groups (P>0.05). Multivariate logistic regression analysis showed that longer hospital stay [odds ratio (OR)=1.115, 95% confidence interval (CI) (1.069, 1.164)], with invasive procedures [OR=10.820, 95%CI (4.393, 26.647)], and higher total bilirubin [OR=1.015, 95%CI (1.005, 1.024)] were risk factors for ESLD complicated with FE (P<0.05). In the study group, 41 patients were treated with antifungal drugs, and 4 of them developed invasive fungal infection. Among the 34 patients who did not receive antifungal drugs, 10 developed invasive fungal infection. Conclusions ESLD patients with longer hospital stay, worse liver function, and invasive procedures are more likely to develop FE, and regular gastroscopy should be performed. Once FE is found, active antifungal treatment should be taken to reduce the occurrence of invasive fungal infection and improve the prognosis of patients.
Objective To investigate the fungal species distribution, liability factors, therapy and prevention of fungal septicemia.Methods A time-matched case-control study was conducted in 30 patients fromApril 2011 to November 2012 with fungal septicemia. Results Of the pathogens in 30 cases with fungal septicemia, 43.3% was Candida albicans, 23.3% was Candida tropicalis, and 10% was Candida parapsilosis. All 30 cases with fungal septicemia were hospital acquired. Malignant hematological system disease( 33.3% ) , COPD( 23.3% ) , and diabetes ( 20.0% ) were the main predisposing diseases. Broadspectrumantibiotic use( 86.7% ) , endovascular prosthesis( 60.0% ) , parenteral alimentation( 53.3% ) were the major risk factors. All 30 cases received systemic anti-fugal therapy. The efficacy rate of amphotericin B therapy was higher than that of fluconazol ( P =0.002) and voriconazole( P = 0.006) . 13 cases( 43.3% ) were cured or significantly improved, and 17 cases( 56.7% ) were dead. Conclusions The most frequently fungi was Candida albicans in fungal septicemia. Malignant hematological system disease and COPD were main predisposing diseases. Broad-spectrumantibiotic use and parenteral alimentation were independent risk factors. Anti-fugal therapy with amphotericin B can achieve better prognosis. Early diagnosis, controlling risk factors, and earlier empirical antifungal therapy are keys to reduce mortality of fungal septicemia.
