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LETTER TO EDITOR
Year : 2007  |  Volume : 28  |  Issue : 2  |  Page : 113-114
 

Invasive aspergillosis of sinus in an HIV seropositive patient


Department of Microbiology, Lokmanya Tilak Municipal Medical College and General Hospital, Sion, Mumbai, India

Correspondence Address:
V P Baradkar
Department of Microbiology, L.T.M.M.C and L.T.M.G.H, Sion, Mumbai - 400 022
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0253-7184.39021

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How to cite this article:
Baradkar V P, Mathur M, Rathi M, Kumar S. Invasive aspergillosis of sinus in an HIV seropositive patient. Indian J Sex Transm Dis 2007;28:113-4

How to cite this URL:
Baradkar V P, Mathur M, Rathi M, Kumar S. Invasive aspergillosis of sinus in an HIV seropositive patient. Indian J Sex Transm Dis [serial online] 2007 [cited 2020 Aug 14];28:113-4. Available from: http://www.ijstd.org/text.asp?2007/28/2/113/39021


Sir,

Invasive aspergillosis of sinuses has emerged as an increasing cause of morbidity and mortality in the immunocompromised patients. [1]

It is usually seen in the patients with one or more predisposing factors such as neutrophil defects, corticosteroid therapy, HIV infection, diabetes mellitus, alcoholism, trauma, and advanced age. [2]

Aspergillus fumigatus is the commonest species followed by Aspergillus flavus. [3] Here, we report a case of invasive aspergillosis of localized invasive sinusitis caused by A. flavus in a HIV seropositive patient.

A 61-year-old female presented with pain in nose, polypoid growth, and epistaxis since one week. On examination, there was mucopurulent discharge through nose. The patient was HIV seropositive. There was no past history of diabetes, hypertension, jaundice, asthma, and allergy. Patient's routine hematological investigations were within normal limits. Computed tomography (CT) scan of paranasal sinuses showed soft tissue density in maxillary, ethmoidal, and sphenoid sinuses with mucosal thickening. In the light of CT scan findings, differential diagnosis of mucormycosis or malignancy was considered. Biopsies were taken from nasal polypoid growth. A direct wet mount and potassium hydroxide (KOH) mount were examined under microscope, which revealed aseptate hyphae. Gram-stained smear also showed Gram positive aseptate hyphae. Repeat sample was taken. It was processed for Gomori's methamine silver staining (GMS) and cultured on Sabouraud's dextrose agar (with and without antibiotics), and incubated at 25 and 37șC, respectively. On the third day of incubation, all culture tubes showed yellowish green granular colony covering the entire surface of agar slants. Lactophenol cotton blue mount (LPCB) from fungal colonies revealed typical picture of Aspergillus vesicles born on conidiophores and covered entirely on their surface with sterigmata and conidia. The growths were identified as those of A. flavus. Our findings were supported by histopathological slide stained with hematoxylin and eosin, which showed hyphae as well as fruiting head of Aspergillus. Surgical debridement was done and Amphotericin B was started. The patient responded to this line of treatment.

 
   References Top

1.Schwartz S, Theil E. CNS-aspergillosis: Are there new treatment options? Mycoses 2003;46:8-14.  Back to cited text no. 1    
2.Denning DW. Aspergillus species. In: Mandell GL, Bennett JE, Dolin R, editors. Mandell Douglas and Bennett's principles and practice of infectious diseases. Churchill Livingstone: Pennsylvania; 2000. p. 2674-85.  Back to cited text no. 2    
3.Sood S, Sharma R, Gupta S, Pathak D, Rishi S. Neuroaspergillosis in immunocompetent patient. Indian J Med Microbiol 2007;25:67-9.  Back to cited text no. 3    




 

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