Journal of subClinical Investigations©

Clinical Environmental Epidemiology in the News

  American Clinical Researchers at Advances Against Aspergillosis 4th
medical mycology and clinical reseach investigators michale gray, j dumanov, dennis hooper, ritchie shoemaker, g mauluf
Dr Michael Gray M.D. shares the findings, diagnosis and treatment involving A. terreus with clinicians at Advances Against Aspergillosis 4th

February 4-6, 2010. Advances Against Aspergillosis 4th, Rome, Italy. The bi annual meeting of over 500 scientists, medical researchers, environmental investigators and clinicians was represented by U.S. researchers from Arizona, Maryland, Texas and New Jersey. Dr. Michael Gray, MD was invited to present a clinical case report involving Aspergillus terreus. Dr Gray with research associates Americans R. Shoemaker, D. Hooper, J. Dumanov-clinical research histopathologist, and G. Maulf reporting the pathology, diagnosis and treatment in a case originally diagnosed as a cancer. Researchers using diagnostic medical mycological, genomic and toxicological methods concluded that a sphenoid sinus mycoses was the result of chronic exposure to the A. terreus and other fungal pathogens. Interestingly there were were three other case reports involving A. terreus. The emergence of this highly select specie of fungi as an increasingly recognized pathogen is primarily due to genomic methods. This diagnosis could have only been achieved through the collaborative pathology, toxicology and highly integrated joint clinical research work and studies of the certified clinical industrial hygienist investigators.

Keywords: allergy, asthma, diagnosis of fungal allergy, infectious mold, cancer, Immunoglobulin E sensitivity, IgE, mold, rhinitis, Aspergillus, Alternaria, Cladosporium, indoor allergens, contact dermatitis, Sc, subClincal investigations, CCIH

ABSTRACT

OCCUPATIONAL SPHENOID MYCETOMA WITH ASPERGILLUS TERREUS (4.4x6.3CM) RESOLVED WITH INTRANASAL CYCLOSPORIN/VORICONAZOLE THERAPY

M .R. Gray 1 , D. Hooper 2 , G. Maluf 3 , M.J.Dumanov 4 , R. Shoemaker 5

1 Progressive Healthcare Group, POB 2050, Benson, Arizona, 85602,

2 Realtime Laboratories, 300 Bee Street, Dallas, Texas

3 Benson, Hospital, 452 South Ocotillo, Benson, Arizona, 85602

4 Mycological Institute - subClinical Research Group, New Jersey,USA, EU

5 Chronic Fatigue Center, Pocomoke, Maryland

 

Purpose: To successfully treat a 4x6 centimeter sphenoid sinus Aspergillus mycetoma medically in a 55 year old female patient, LJ, who was also suffering from mixed mold mycotoxicosis after being occupationally exposed to multiple amplified colonies of Aspergillus, Penicillium, and Stachybotrys in her workplace for five years.

Methods: After multiple formalin fixed paraffin block biopsy samples tested positive for Aspergillus  using multivalent DNA probes, voriconazole and cyclosporin were used in combination by intranasal instillation four times a day to treat a sphenoid mycetoma which had been initially misdiagnosed, and unsuccessfully treated, as an esthesioneuroblastoma with cisplatin, etoposide, and radiation.  Voriconazole and cyclosporin intranasal treatment was continued after resolution of the mycetoma was confirmed by rhinosinoscopy until two consecutive sphenoid sinus saline lavage samples separated by three month intervals were negative for Aspergillus DNA by PCR assays, again utilizing multivalent Aspergillus probes.  Mycotoxicosis treatment protocols utilizing charcoal, bentonite clay, cholestyramine, and multiple antioxidants were used simultaneously with the nasal antifungal therapy.  These treatments remain ongoing, as urine mycotoxin assays continue to be positive in the parts per billion range.

Results: The patient's sphenoid sinus mycetoma has completely resolved.  Multiple signs and symptoms of mycotoxicosis have abated, though some abnormalities continue.  The patient's clinical status has improved dramatically, although she remains partially impaired with continuing neurologic, endocrine, immune system, and pulmonary abnormalities.

Conclusions: Sphenoid sinus Aspergillus mycetoma can be treated medically with a combination of voriconazole and cyclosporin when they are administered by the intranasal route.  The required duration of antifungal therapy can be determined by the utilization of DNA by PCR utilizing multivalent DNA probes

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