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Polish Journal of Radiology 2021To assess differentiating features between bacterial, , and skull base osteomyelitis (SBO) with regard to clinical presentation and imaging appearances.
PURPOSE
To assess differentiating features between bacterial, , and skull base osteomyelitis (SBO) with regard to clinical presentation and imaging appearances.
MATERIAL AND METHODS
A literature search was performed in April 2020 for studies on SBO with a minimum sample size of 10 patients. Studies that reported presenting symptoms, cross-sectional imaging findings, complications, and mortality were included in the analysis. The quality of included articles was tested using the Quality Assessment of Diagnostic Accuracy Studies 2 tool. A data extraction form was used to retrieve relevant parameters from each of the articles.
RESULTS
Thirteen articles were included in the final analysis. Diabetes mellitus was the most common predisposing factor (12.5-91.0%). Presenting complaints in all bacterial SBO studies were otogenic, while fungal SBO patients had nasal/ocular complaints. Rates of mortality and surgical intervention in the fungal group were 50-100% and 50%, respectively, as compared to the bacterial group - 7-87% and 10%, respectively. On imaging, the site of initial infection in bacterial SBO was the external auditory canal, while in fungal SBO it was the paranasal sinus. The incidence of orbital extension was < 5% in bacterial and 44-70% in fungal SBO, among which had rates of 65-70%. Bone erosion was less extensive in bacterial SBO, and the patterns differed. The highest incidence of vascular involvement and non-enhancing lesions (23-36%) was seen in showed highest sino-cranial extension (52-55%) and homogenous bright enhancement.
CONCLUSIONS
Systematic analysis of the clinico-radiological parameters in each of the studies revealed differences in presentation, clinical course, extension, bone erosion, and enhancement.
PubMed: 34136049
DOI: 10.5114/pjr.2021.106470 -
International Forum of Allergy &... Sep 2021The accuracy of diagnoses of acute invasive fungal rhinosinusitis (AIFRS) based on frozen sections has been questioned. (Meta-Analysis)
Meta-Analysis
BACKGROUND
The accuracy of diagnoses of acute invasive fungal rhinosinusitis (AIFRS) based on frozen sections has been questioned.
METHODS
PubMed, the Cochrane Central Register of Controlled Trials, Embase, Web of Science, SCOPUS, and Google Scholar were used for data sources. True-positive, true-negative, false-positive, and false-negative data were extracted for each study. Methodological quality was evaluated using the Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2) Tool.
RESULTS
Nine prospective and retrospective studies were included. The diagnostic odds ratio of intraoperative frozen section in AIFRS was 124.4717 (95% confidence interval [CI], 75.5168-205.1623). The area under the summary receiver operating characteristic curve was 0.906. The sensitivity, specificity, and positive predictive value were 0.8337 (95% CI, 0.7962-0.8655), 0.9858 (95% CI, 0.9330-0.9971), and 0.9822 (95% CI, 0.8905-0.9973), respectively. The correlation between sensitivity and the false-positive rate was 0.437, indicating a lack of heterogeneity. In subgroup analysis, the "per patient" subgroup tended to show higher diagnostic accuracy than the "per specimen" subgroup. Regarding fungal species, the frozen biopsy of aspergillus showed higher sensitivity than that of mucor (0.8103 vs. 0.7544).
CONCLUSION
Positive frozen sections are reliable and facilitate early intervention in AIFRS. Collecting multiple specimens during surgery will decrease the rate of false-negative results.
Topics: Frozen Sections; Humans; Prospective Studies; Retrospective Studies; Sensitivity and Specificity; Sinusitis
PubMed: 33773087
DOI: 10.1002/alr.22797 -
Mycoses Jul 2016Fungi in the order Mucorales cause acute, invasive and frequently fatal infections in susceptible patients. This study aimed to perform a systematic review of all... (Review)
Review
Fungi in the order Mucorales cause acute, invasive and frequently fatal infections in susceptible patients. This study aimed to perform a systematic review of all reported mucormycosis cases during the last 25 years in Iran. After a comprehensive literature search, we identified 98 cases in Iran from 1990-2015. The mean patient age was 39.8 ± 19.2 years. Diabetes was the most common underlying condition (47.9%), and 22.4% of the patients underwent solid organ or bone marrow transplantation. The most common clinical forms of mucormycosis were rhinocerebral (48.9%), pulmonary (9.2%) and cutaneous (9.2%). Eight cases of disseminated disease were identified. Overall mortality in the identified cases was 40.8%, with the highest mortality rate in patients diagnosed with disseminated infection (75%). The mortality rate in rhinocerebral infection patients was significantly lower (45.8%). Rhinocerebral infection was the most common clinical manifestation in diabetes patients (72.9%). Patients were diagnosed using various methods including histopathology (85.7%), microscopy (12.3%) and culture (2.0%). Rhizopus species were the most prevalent (51.7%), followed by Mucor species (17.2%). Sixty-nine patients were treated with a combination of surgery and antifungal therapy (resulting survival rate, 66.7%). Owing to the high mortality rate of advanced mucormycosis, early diagnosis and treatment may significantly improve survival rates. Therefore, increased monitoring and awareness of this life-threatening disease is critical.
Topics: Adult; Antifungal Agents; Dermatomycoses; Diabetes Complications; Female; Humans; Invasive Fungal Infections; Iran; Lung Diseases, Fungal; Male; Middle Aged; Mucorales; Mucormycosis; Rhizopus; Survival Rate; Young Adult
PubMed: 26906121
DOI: 10.1111/myc.12474 -
Revista Iberoamericana de Micologia 2015Mucormycosis is usually an acute angioinvasive infections, which leads to non-suppurative necrosis and significant tissue damage. It represents 1.6% of all the invasive... (Review)
Review
Mucormycosis is usually an acute angioinvasive infections, which leads to non-suppurative necrosis and significant tissue damage. It represents 1.6% of all the invasive fungal infections and predominates in immunosuppressed patients with risk factors. Incidence has been significantly increased even in immunocompetent patients. Due to finding a case of disseminated mucormycosis caused by Rhizomucor pusillus in a young immunocompetent patient, a systematic review was carried out of reported cases in PubMed of mucormycosis in immunocompetent adults according to the main anatomic locations, and especially in disseminated cases. A review of the main risk factors and pathogenicity, clinical manifestations, techniques of early diagnosis, current treatment options, and prognosis is presented. Taxonomy and classification of the genus Mucor has also been reviewed.
Topics: Agricultural Workers' Diseases; Antifungal Agents; Combined Modality Therapy; Dermatomycoses; Fungemia; Fungi; Humans; Immunocompetence; Incidence; Mucormycosis; Opportunistic Infections; Respiratory Tract Infections; Risk Factors; Soil Microbiology
PubMed: 25543322
DOI: 10.1016/j.riam.2014.01.006