Misdiagnosis of fungal infections of the orbit

Simmons, Brittany A.; Kupcha, Anna C.; Law, James J.; Wang, Kai; Carter, Keith D.; Mawn, Louise A.; Shriver, Erin M.

doi:10.1016/j.jcjo.2022.04.007

Cited by 3 publications

(3 citation statements)

References 31 publications

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“…Oculomycosis is a leading cause of ocular morbidity and blindness, mostly misapprehended by ophthalmic clinicians as ocular infections of bacterial origin 32 . Such clinician misdiagnosis and mistreatment of ocular microbial infections culminate in antimicrobial resistance which is of a public health concern due to negative patient outcomes (delays in healing and prolonged hospitalisation increases nancial cost of treatment and reduce overall quality of life) and system (prolonged stay of patients increases the ophthalmic workload and places pressure on the limited resources) level repercussions 33,34 .…”

Section: Discussionmentioning

confidence: 99%

Elucidating fungal etiology and multi-drug resistance in oculomycosis and bioprospecting native medical plants as candidates for antifungal therapy

Badu,

Boateng,

Junior

et al. 2024

Preprint

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Despite their debilitating impact on eye health, it is unclear the fungal pathogens implicated in oculomycosis; and the efficacy of clinically used antifungal therapy among ophthalmic clinicians, especially from Ghana, remains enigmatic. Here we use a comprehensive clinical and laboratory data to fill this evidence gap. About ten percent (9.36%) of the ocular specimen was positive for fungal culture with the predominant fungal etiology being Candida albicans. Multi-drug resistance was observed for clinically utilized antifungal agents; amphotericin B, and fluconazole, itraconazole, terbinafine. Alternatively, ethanolic extracts of native medicinal plants, Cinnamomum verum and Syzygium aromaticum, demonstrated potent fungistatic and fungicidal activity against clinically recovered ocular fungal isolates including the common implicating etiology, Candida albicans. Overall, this study broadens our current understanding of the pathogenesis of oculomycosis, and the repercussions of clinically available antifungal treatment therapy. Leveraging on the results of the preliminary medicinal plant screening, we propose further characterization and mechanistic studies to illuminate the bioactive ingredient in plant extracts and their potential mechanism of action for clinical translation.

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Section: Discussionmentioning

confidence: 99%

Elucidating fungal etiology and multi-drug resistance in oculomycosis and bioprospecting native medical plants as candidates for antifungal therapy

Badu,

Boateng,

Junior

et al. 2024

Preprint

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“…IFOI can have devastating effects if there is delayed diagnosis and initiation of appropriate treatment. Misdiagnosis is common, with incorrect diagnoses ranging from bacterial OC and sinusitis to inflammatory conditions, such as non-specific orbital inflammation [ 4 ]. IFOI typically occurs via contiguous spread from the paranasal sinuses and increases mortality compared to orbit-sparing disease [ 8 , 9 ].…”

Section: Discussionmentioning

confidence: 99%

“…Delayed diagnosis and initiation of selective antifungal therapy can have disastrous implications [ 1 ]. Misdiagnosis of IFOI is common as a range of infective and inflammatory conditions may mimic its clinico-radiological presentation [ 3 , 4 ]. Bacterial orbital cellulitis (OC) may occur secondary to acute sinusitis and clinical presentation may be similar to IFOI.…”

Section: Introductionmentioning

confidence: 99%

Radiological differentiation between bacterial orbital cellulitis and invasive fungal sino-orbital infections

Ang,

Lim,

Chaggar

et al. 2024

Int Ophthalmol

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Purpose Invasive fungal orbital infections (IFOI) may be difficult to differentiate from sinogenic bacterial orbital cellulitis (OC). This study investigates the features differentiating OC from IFOI on magnetic resonance imaging (MRI). Methods Retrospective study of adult patients with sinogenic OC and IFOI with pre-intervention MRI. Patients without post-septal involvement, non-sinogenic OC (e.g.: secondary to trauma) and poor-quality scans were excluded. Independent Sample’s t test and Fisher’s exact test were conducted with p < 0.05 deemed statistically significant. Results Eleven cases each of OC (Mean age: 41.6 ± 18.4 years-old, Male: 10) and IFOI (Mean age: 65.0 ± 16.6 years-old, Male: 9) between 2006 and 2023. IFOI patients were older, more likely immunocompromised and had a lower mean white-cell count (p value = 0.005, 0.035 and 0.017, respectively). The ethmoid and maxillary sinuses were most commonly involved in both entities. Pre-septal and lacrimal gland involvement were more common in OC (p = 0.001 and 0.008, respectively). Infiltrative OC orbital lesions were poorly demarcated, whilst those in IFOI were expansile/mass-like invading the orbit from the adjacent paranasal sinuses. Specific IFOI features included loss-of-contrast-enhancement (LoCE) of paranasal sinus tissues with orbital extension. Extra-orbital and -sinonasal extension indicative of IFOI included contiguous skull base or pterygopalatine fossa involvement, retro-antral and masticator space stranding and vasculitis. Conclusion This study describes the key MRI features of IFOI including differentiating markers from OC. These specific features, such as LoCE of the paranasal and orbital soft tissues, the location and pattern of contiguous soft-tissue involvement, provide expedient identification of IFOI which necessitate early surgical intervention for microbiological confirmation of an invasive fungal pathology.

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Elucidating fungi pathogens and multi-drug resistance in oculomycosis, and bioprospecting native plants as antifungal therapy

Badu,

Boateng,

Junior

et al. 2024

Preprint

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Background Ocular mycoses have a debilitating impact on ocular health and quality of life. However, the burden and etiology of ocular mycoses and the efficacy of clinical antifungal agents used in the management of ocular fungal infections remain unclear. The study assesses the prevalence of ocular fungal pathogens and multi-drug resistance patterns, and further explored native medicinal plants as a source of antifungal agents in Ghana. Methods In this multicenter, cross-sectional study, biographic, medical, and ophthalmic data were collected using a structured questionnaire, and conjunctival swabs and corneal samples were collected for microbiological characterization and antifungal susceptibility testing. Patient demographic and clinical data were stratified by sex and differences were tested using chi-squared analysis. Microbiological data were presented as proportions, means, and standard deviations. Bivariate logistic regression was used to test the association between patient characteristics and the likelihood of isolating fungal pathogens from the eyes of persons with presenting eye infections. Results Approximately ten percent (9.36%) of ocular specimens were positive for fungal culture with the predominant fungal etiology being Candida albicans. Multi-drug resistance was observed for clinically used antifungal agents; amphotericin B and fluconazole, itraconazole, terbinafine. Alternatively, ethanolic extracts of Cinnamomum verum (C. verum) and Syzygium aromaticum (S. aromaticum), demonstrated potent fungistatic and fungicidal activity against the common implicated pathogen, Candida albicans (C. albicans). Conclusion Overall, the study broadens our understanding of the pathogenesis of ocular mycoses in Ghana and the implications of clinical use of antifungal treatments. Leveraging on the medicinal plant screening, we propose characterization of the bioactive compound(s) in C. verum and S. aromaticum for clinical translation into ocular antifungal therapeutics.

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Misdiagnosis of fungal infections of the orbit

Cited by 3 publications

References 31 publications

Elucidating fungal etiology and multi-drug resistance in oculomycosis and bioprospecting native medical plants as candidates for antifungal therapy

Elucidating fungal etiology and multi-drug resistance in oculomycosis and bioprospecting native medical plants as candidates for antifungal therapy

Radiological differentiation between bacterial orbital cellulitis and invasive fungal sino-orbital infections

Elucidating fungi pathogens and multi-drug resistance in oculomycosis, and bioprospecting native plants as antifungal therapy

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