The spectrum of orbital aspergillosis: a clinicopathological review

Levin, Leonard A.; Avery, Robin K.; Shore, John W.; Woog, John J.; Baker, Ann Sullivan

doi:10.1016/s0039-6257(96)80004-x

Cited by 164 publications

(135 citation statements)

References 97 publications

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“…Keratitis following occupational trauma (85,120,398) or surgery (142,361), orbital lesions (172,201,213), dacryocystitis (200,213), scleritis (31), and endophthalmitis (367,375) Scedosporium (S. apiospermum…”

Section: Aspergillus (A Fumigatus a Flavus A Terreus)mentioning

confidence: 99%

“…Ocular fungal infections, or ophthalmic mycoses, are being increasingly recognized as an important cause of morbidity and blindness; certain types of ophthalmic mycoses may even be life-threatening (213,435). Keratitis (corneal infection) is the most frequent presentation (363), but the orbit, lids, lacrimal apparatus, conjunctiva, sclera, and intraocular structures may also be involved (Fig.…”

Section: Introductionmentioning

confidence: 99%

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Current Perspectives on Ophthalmic Mycoses

2003

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Fungi may infect the cornea, orbit and other ocular structures. Species of Fusarium, Aspergillus, Candida, dematiaceous fungi, and Scedosporium predominate. Diagnosis is aided by recognition of typical clinical features and by direct microscopic detection of fungi in scrapes, biopsy specimens, and other samples. Culture confirms the diagnosis. Histopathological, immunohistochemical, or DNA-based tests may also be needed. Pathogenesis involves agent (invasiveness, toxigenicity) and host factors. Specific antifungal therapy is instituted as soon as the diagnosis is made. Amphotericin B by various routes is the mainstay of treatment for life-threatening and severe ophthalmic mycoses. Topical natamycin is usually the first choice for filamentous fungal keratitis, and topical amphotericin B is the first choice for yeast keratitis. Increasingly, the triazoles itraconazole and fluconazole are being evaluated as therapeutic options in ophthalmic mycoses. Medical therapy alone does not usually suffice for invasive fungal orbital infections, scleritis, and keratitis due to Fusarium spp., Lasiodiplodia theobromae, and Pythium insidiosum. Surgical debridement is essential in orbital infections, while various surgical procedures may be required for other infections not responding to medical therapy. Corticosteroids are contraindicated in most ophthalmic mycoses; therefore, other methods are being sought to control inflammatory tissue damage. Fungal infections following ophthalmic surgical procedures, in patients with AIDS, and due to use of various ocular biomaterials are unique subsets of ophthalmic mycoses. Future research needs to focus on the development of rapid, species-specific diagnostic aids, broad-spectrum fungicidal compounds that are active by various routes, and therapeutic modalities which curtail the harmful effects of fungus- and host tissue-derived factors

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Section: Aspergillus (A Fumigatus a Flavus A Terreus)mentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Current Perspectives on Ophthalmic Mycoses

2003

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“…Fungal keratitis is one of the major causes of the ulcerative and sight-threatening infection of the cornea but its incidence is usually underestimated in the community (Levin et al, 1996;Yohai et al, 1994). Even the trivial trauma of a dust particle falling on the cornea may disrupt the integrity of the corneal epithelium, predisposing to mycotic keratitis.…”

Section: Indian Scenariomentioning

confidence: 99%

“…The microbial cultures were considered as positive when it satisfies at least one of the following criteria (Levin et al, 1996): Growth and isolation of the same organism from more than one solid medium, Confluent growth in one solid medium at an inoculated site with direct microscopy findings (staining and morphology with Gramstain, KOH preparation) Growth and isolation of the similar organism repeatedly from the same scrapings. All laboratory methods were performed following standard protocols (Levin et al, 1996;Yohai et al, 1994;Rao, 1989).…”

Section: Fungal Identificationmentioning

confidence: 99%

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Fungal Keratitis – Study at a Tertiary Eye Care Hospital in Hyderabad

Venkatesh¹,

Rao²,

Rao³

2018

Int.J.Curr.Microbiol.App.Sci

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Sino-orbital Aspergillosis in Acquired Immunodeficiency Syndrome

Johnson¹,

Casiano²,

Kronish

et al. 1999

Arch Ophthalmol

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To describe the clinical features, causes, imaging characteristics, treatment, and outcome of patients with the acquired immunodeficiency syndrome (AIDS) and sino-orbital aspergillosis.Design: Records of 5 patients were reviewed. Results of imaging and histopathologic examinations and clinical courses of the patients were studied.Results: There were 3 women and 2 men (mean age, 34.0 years). All had received a diagnosis of AIDS, and mean CD4 + cell count was 0.014 ϫ 10 9 /L (14 cells/mm 3 ). Computed tomographic scanning exhibited heterogeneous, enhancing sino-orbital soft tissue lesions with bony erosion, and magnetic resonance imaging disclosed soft tissue masses hypointense on T 1 -and T 2 -weighted images. The infection involved 1 or more paranasal sinuses, with extension into the right orbit in 3 patients and into the left orbit in 2. Patients were treated with aggressive surgical debridement and intravenous antifun-gal agents. In addition, local irrigation of amphotericin B was performed in 3 patients. Aspergillus fumigatus was found to be the cause in all 5 patients. Intracranial extension developed in 4 patients, and all subsequently died. The 2 longest surviving patients were the only ones being treated with protease inhibitors. Three patients had a history of frequent marijuana smoking.Conclusions: Sino-orbital aspergillosis is a progressive, relentless, and usually fatal opportunistic infection of advanced AIDS. Patients are first seen with longstanding headache and proptosis with minimal external inflammatory signs. Marijuana smoking may increase the risk for development of sino-orbital aspergillosis in these patients. Aggressive surgical and medical treatment, combined with newer combination therapies using protease inhibitors, may improve the longevity of these patients.

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The spectrum of orbital aspergillosis: a clinicopathological review

Cited by 164 publications

References 97 publications

Current Perspectives on Ophthalmic Mycoses

Current Perspectives on Ophthalmic Mycoses

Fungal Keratitis – Study at a Tertiary Eye Care Hospital in Hyderabad

Sino-orbital Aspergillosis in Acquired Immunodeficiency Syndrome

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