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Inflammatory, Hypersensitivity and Immune Lung Diseases, including Parasitic Diseases.
Published in Fred W Wright, Radiology of the Chest and Related Conditions, 2022
When a cavity is formed within an area of lung infected by aspergillosis, or the organism secondarily infects a pre-existing cavity, fronds of mycelial tissue may form and hang like stalactites from the inner lining of the cavity. These tend to fall into the cavity forming a sea-weed or sponge-like mass. CT may show small air-filled spaces within such a fungus ball, and occasionally calcified flecks may be seen within it. A fungus ball may also form when infected infarcted 'sponge-like' lung separates from its surroundings.
Drug delivery in pulmonary aspergillosis
Published in Anthony J. Hickey, Heidi M. Mansour, Inhalation Aerosols, 2019
Sawittree Sahakijpijarn, Jay I. Peters, Robert O. Williams
Aspergilloma is the most common form of aspergillosis infection and also one of the noninvasive forms of Aspergillus lung disease (1). In cases of aspergilloma, a fungus ball is described as a chronic, extensive colonization of Aspergillus in a pulmonary cavity and rarely in an area of cystic bronchiectasis. A fungus ball is composed of inflammatory cells, fibrin, mucus, tissue debris, and fungal hyphae (13). The fungus ball generally develops in cavities affected by preexisting cavitary lung diseases such as tuberculosis, sarcoidosis, bronchiectasis, bronchial cysts and bulla, ankylosing spondylitis, neoplasm, or pulmonary infection (14,15). Inadequate drainage leads to the growth of Aspergillus on the wall of these cavities, which in turn causes the movement of the fungus ball within the cavity (15). This movement does not invade the surrounding lung parenchyma or blood vessels (15–17). However, local invasion may occur in rare cases, and this leads to invasive pulmonary aspergillosis or a subacute, chronic necrotizing aspergillosis (6,14).
Fungal Rhinosinusitis
Published in John C Watkinson, Raymond W Clarke, Louise Jayne Clark, Adam J Donne, R James A England, Hisham M Mehanna, Gerald William McGarry, Sean Carrie, Basic Sciences Endocrine Surgery Rhinology, 2018
A fungal ball is a dense accumulation of extramucosal fungal hyphae, usually within one sinus, most commonly the maxillary sinus.2 Although the most common organism in a fungal ball is Aspergillus, the cultures are often negative and other fungal species have also been identified.2 Fungal balls are seen more commonly in immunocompetent, middle-aged and elderly females, often with a history of previous dental procedure, especially dental fillings.2
Specific imaging findings in the course of sinus fungus ball progression to chronic invasive fungal rhinosinusitis
Published in Acta Oto-Laryngologica Case Reports, 2023
Tomotaka Hemmi, Kazuhiro Nomura, Mika Watanabe, Yuki Numano, Risako Kakuta, Mitsuru Sugawara
The CT findings in our patient are, in part, textbook examples of SFB. Calcification spot or intralesional hyperdensity on CT is a typical finding suggestive of SFB [9]. Especially in SFB in the maxillary sinus, sclerosis of the lateral sinus wall, erosion of the inner sinus wall, and irregular surface of the material were reported as characteristic findings [10]. From the formation of the fungus ball and bone thickening, was can assume that the patient had been affected by SFBs for some time. Meanwhile, erosion of the posterior wall suggested invasive ness of the lesion. The probability of progression from SFBs to IFRS is estimated to be 0%-1.6%, with some variation shown among reports [11–13]. Assari et al. suggested that SFBs may progress to IFRS, particularly in elderly and immunocompromised patients [13]. All previous reports described the chronological transition from SFB to IFRS and lacked evidence of the moment of transition. In our patient, only the posterior wall of the maxillary sinus evolved to CIFRS, and the remaining maxillary sinus stayed an SFB. Interestingly, our 81-year-old patient was not immunocompromised and did not fit the typical CIFRS background.
Early diagnosis of aspergillosis in asthmatic and rheumatoid arthritis patients by Aspergillus galactomannan antigen assay: a case-control study in Karbala providence
Published in Journal of Asthma, 2022
Ali Abdul Hussein S. Al-Janabi, Roaa Noori Ali
From the results of this study, aspergillosis as indicated by GM was found higher among apparently healthy male individuals than in other patient groups. This could be illustrated by two possible explanations; the first is that individuals had an early development of aspergillosis without a specific symptom and the second is that a GM test may give a false-positive result. In general, individuals with a good immune system are often under the risk of aspergillosis. Patients with either RA or RA and asthma are more susceptible to acquired aspergillosis, especially aspergilloma or fungal ball (13). Aspergillus fumigatus was diagnosed as a causative agent of pleural aspergillosis in healthy individuals without any predisposing factors or lung pathology (14). This was also noticed with invasive aspergillosis caused by Aspergillus niger which was diagnosed in immunocompetent individuals (13). Aspergilloma is usually encouraged to develop when the inhaled fungal spore grows in lung cavities resulting from previous diseases such as TB and sarcoidosis (2). Thus, antibodies against such undetectable infections give a positive result in healthy individuals. Otherwise, ELISA for GM is more specific to detect early invasive aspergillosis with 90% sensitivity and 84% specificity (15). On the other hand, a false-positive result for the GM serological tests was recorded by many studies. These results may be associated with the presence of fungal infections with other than Aspergillus types or may relate to treatment with antibiotics (16). About 12% of invasive aspergillosis gave a false-positive for GM by ELISA (17).
Update on current approaches to diagnosis and treatment of onychomycosis
Published in Expert Review of Anti-infective Therapy, 2018
Aditya K. Gupta, Rachel R. Mays, Sarah G. Versteeg, Neil H. Shear, Vincent Piguet
The most common symptoms of onychomycosis are discolouration (white, black, yellow or green) and thickening (hyperkeratosis) of the nail. The nail bed can also become infected and white or yellow patches can be present on the nailbed or scaly skin adjacent to the nail. Onychomycosis generally does not cause bodily pain; however, if left untreated the infection can worsen and the skin can become sore and inflamed. Sporadically, dermatophytids may manifest as a red, itchy, scaly, circular rash. Another presentation of onychomycosis is a dermatophytoma. This is characterized by abundant fungal filaments, large spores, or both, compacted and forming a fungal ball [14,15]. The presence of fungus is confirmed by microscopically observing via potassium hydroxide (KOH) preparation or chlorazol black E in nail samples from patients with suspected onychomycosis or clinically, by observing a linear band or a rounded mass of white or yellowish color.