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Rhinocerebral aspergillosis
M Kameswaran1, A al-Wadei, P Khurana
1Department of Otolaryngology, King Saud University, College of Medicine, Abha, Saudi Arabia.
Abstract:
Aspergillosis is increasingly being recognised as a common fungal infection of the paranasal sinuses. Although the disease is almost endemic in neighbouring Sudan, there are few reported cases from the Kingdom of Saudi Arabia. We report four cases of sinus aspergillosis with involvement of the skull bases and/or intracranial spread; a condition we have termed rhinocerebral aspergillosis. Invasive aspergillosis in our subgroup of patients occurs in otherwise healthy patients with normal immune status, quite unlike most reported cases in the western literature. The causative agent in all our patients was identified as aspergillus flavus, similar to patients reported from Sudan. This is again at variance with the case reports from other geographical locations, where aspergillus fumigatus is the commonest causative agent. Saudi Arabia would appear to represent a distinct geographical enclave, together with Sudan, where rhinocerebral aspergillosis of the sinuses and skull base may be more common than has previously been realised.
Insights
Rhinocerebral aspergillosis, a fungal sinus infection, is increasingly recognized, particularly in Saudi Arabia and Sudan. Unlike Western cases, it affects healthy individuals, with Aspergillus flavus being the common pathogen.
Area of Science:
- Mycology
- Infectious Diseases
- Otolaryngology
Background:
- Aspergillosis is a fungal infection affecting paranasal sinuses, with increasing recognition globally.
- Few cases of sinus aspergillosis have been reported in Saudi Arabia, despite its endemicity in neighboring Sudan.
Observation:
- This study reports four cases of sinus aspergillosis with skull base and/or intracranial spread, termed rhinocerebral aspergillosis.
- Unlike typical invasive aspergillosis in Western literature, these patients were immunocompetent.
Findings:
- The causative agent in all reported cases was Aspergillus flavus, consistent with Sudanese reports.
- This contrasts with other regions where Aspergillus fumigatus is the predominant species.
Implications:
- Saudi Arabia, along with Sudan, may represent a distinct geographical region where rhinocerebral aspergillosis is more prevalent than previously thought.
- These findings highlight the need for increased awareness and diagnosis of this condition in immunocompetent individuals in this region.