Erica Ortiz

Chronic GVHD: predictive factor for rhinosinusitis in bone marrow transplantation

INTRODUCTION Bone marrow transplantation (BMT) is a treatment option for hematological diseases and immunodeficiency. It is frequently used today. BMT predisposes patients to upper airway infections and its complications, such as rhinosinusitis (RS). Chemotherapy, radiotherapy, viral infections, antibiotic therapy, graft versus host disease (GVHD) are rhinosinusitis predisposing conditions. AIM to investigate RS frequency in this population and its relationship to GVHD; to try and establish the best treatment for RS in these patients. METHOD ENT evaluation of two groups. One group with 35 patients (gI) and another with 24 patients (gII), before and after BMT. They were treated with antibiotics, maxillary sinus punction or endoscopic sinusectomy. RESULTS none of them had RS before BMT. 42.8% from gI had RS and 34% had GVHD; in the gII, 58% had RS and 25% had GVHD. 49% from both groups had RS and 30.5% had GVHD. There was significantly more RS in chronic GVHD patients. Surgery was used to treat RS in chronic GVHD patients who underwent BMT. CONCLUSION RS frequency was 49%; GVHD is a predisposing condition to RS; sinusectomy may be necessary to control RS in GVHD patients.

Sinonasal disorders in hematopoietic stem cell transplantation.

INTRODUCTION hematopoietic stem cell transplantation (HSCT) is associated with more respiratory infections due to immunosuppression. OBJECTIVE this study aimed to verify the frequency of rhinosinusitis after HSCT, and the association between rhinosinusitis and chronic graft vs. host disease (GVHD) and type of transplantation, clinical treatment, surgical treatment, and survival. METHODS this was a retrospective study in a tertiary university hospital. A total of 95 patients with hematological diseases undergoing HSCT between 1996 and 2011 were selected. RESULTS chronic myeloid leukemia was the most prevalent disease. The type of transplant most often performed was the allogenic type (85.26%). The frequency of rhinosinusitis was 36%, with no difference between the autologous and the allogenic types. Chronic GVHD occurred in 30% of patients. Patients with GVHD had a higher frequency and recurrence of rhinosinusitis, in addition to more frequent need for endoscopic sinusectomy and decreased overall survival. CONCLUSION there was a higher frequency of rhinosinusitis in HSCT and GVHD. The type of transplant does not appear to predispose to the occurrence of rhinosinusitis. GVHD seems to be an aggravating factor and requires a more stringent treatment.

Microbiology of rhinosinusitis in immunosupressed patients from the University Hospital

UNLABELLED Immunosuppressed patients are often susceptible to upper airway infections, especially those of the paranasal sinuses. These can sometimes jeopardize treatment success and even lead to a fatal outcome. OBJECTIVE To study the paranasal microbiology of immunosuppressed patients with clinical evidence of rhinosinusitis, and compare it with that from immunocompetent patients. MATERIAL AND METHOD Retrospective study, in which 42 immunosuppressed and 16 immunocompetent patients were selected. All had clinically evident acute or recurrent rhinosinusitis and were submitted to ethmoidal or sphenoid sinusectomy or maxillary sinus puncture to gather material for microbiological cultures. RESULTS There were 92% positive cultures, and 21% were negative. Of the positive cultures, 38% were bacterial, with P. aeruginosa being the most frequent agent; 64% were fungal, which occurred in the most immunocompromised patients. In the immunocompetent group, there were 62. 5% positive cultures and 37. 5% negative ones. All the positive ones were bacterial, with no fungi. CONCLUSIONS Transplant recipients were prone to develop bacterial rhinosinusitis by Gram positive and Gram negative agents, the most common of the latter being Pseudomonas aeruginosa. Fungal infections occurred in the severely immunosuppressed, and it was absent in immunocompetent patients.

DECH crônica: fator preditivo para rinossinusite no transplante de medula óssea

INTRODUCTION: Bone marrow transplantation (BMT) is a treatment option for hematological diseases and immunodeficiency. It is frequently used today. BMT predisposes patients to upper airway infections and its complications, such as rhinosinusitis (RS). Chemotherapy, radiotherapy, viral infections, antibiotic therapy, graft versus host disease (GVHD) are rhinosinusitis predisposing conditions. AIM: to investigate RS frequence in this population and its relationship to GVHD; to try and establish the best treatment for RS in these patients. METHOD: ENT evaluation of two groups. One group with 35 patients (gI) and another with 24 patients (gII), before and after BMT. They were treated with antibiotics, maxillary sinus punction or endoscopic sinusectomy. RESULTS: none of them had RS before BMT. 42.8% from gI had RS and 34% had GVHD; in the gII, 58% had RS and 25% had GVHD. 49% from both groups had RS and 30.5% had GVHD. There was significantly more RS in chronic GVHD patients. Surgery was used to treat RS in chronic GVHD patients who underwent BMT. CONCLUSION: RS frequence was 49%; GVHD is a predisposing condition to RS; sinusectomy may be necessary to control RS in GVHD patients.

Histological features of the nasal mucosa in hematopoietic stem cell transplantation.

BACKGROUND Immunosuppression is the leading cause of recurrent sinus infections after hematopoietic stem cell transplant (HSCT), with increased incidence of sinusitis in patients with chronic graft versus host disease (GVHD). Histological descriptions of the oral mucosa, lung ciliary epithelium, and intestinal mucosa related to HSCT have been described. However, few have described the nasal mucosa. We, therefore, sought to elucidate the histological and ultrastructural features of the nasal mucosa in patients after HSCT to better understand the pathophysiology of the immune response. METHODS Uncinate processes from 24 HSCT patients and 12 immunocompetent patients were subjected to histological analyses via light and transmission electron microscopy (TEM). RESULTS TEM revealed aberrant cilia structure, altered mitochondria quantity, microvilli, and cytoplasm vacuolization. All HSCT patients with rhinosinusitis had significant loss or absence of cilia (p = 0.018). Apoptotic bodies were increased and Goblet cells decreased in nasal epithelium from patients with chronic GVHD (p = 0.04). CONCLUSION This tissue destruction likely enhances pathogen penetration resulting in recurrent infection.Background Immunosuppression is the leading cause of recurrent sinus infections after hematopoietic stem cell transplant (HSCT), with increased incidence of sinusitis in patients with chronic graft versus host disease (GVHD). Histological descriptions of the oral mucosa, lung ciliary epithelium, and intestinal mucosa related to HSCT have been described. However, few have described the nasal mucosa. We, therefore, sought to elucidate the histological and ultrastructural features of the nasal mucosa in patients after HSCT to better understand the pathophysiology of the immune response. Methods Uncinate processes from 24 HSCT patients and 12 immunocompetent patients were subjected to histological analyses via light and transmission electron microscopy (TEM). Results TEM revealed aberrant cilia structure, altered mitochondria quantity, microvilli, and cytoplasm vacuolization. All HSCT patients with rhinosinusitis had significant loss or absence of cilia (p = 0.018). Apoptotic bodies were increased and Goblet cells decreased in nasal epithelium from patients with chronic GVHD (p = 0.04). Conclusion This tissue destruction likely enhances pathogen penetration resulting in recurrent infection.

Prognostic value of sinus CT scans in hematopoietic stem cell transplantation

UNLABELLED Hematopoietic Stem Cell Transplant (HSCT) causes immunosuppression and predisposition to sinusitis. CT scans are complementary exams used in the diagnosis of sinusitis; however, its use in every patient is questionable. AIM to check the usefulness of ordering a CT scan prior to HSCT and to study the relationship between anatomical variations and sinusitis. METHOD prospective study in which we performed paranasal CT scans before and after HSCT, using the Lund and Mackay score. RESULTS 77.5% and 61% of CT scans showed no evidence of sinus disease before and after HSCT. CT staging was not associated with sinusitis after HSCT. Anatomical variations were related to radiographic disease severity, but not to development of sinusitis after HSCT. There was no relation between pre-CT staging and sinusitis after BMT. CONCLUSION CT scans are not useful for all patients before HSCT. Anatomical variation is not a predictive feature to sinusitis but it can determine its severity.

Rhinosinusitis: evidence and experience. A summary

as Mild, Moderate or Severe. Disease severity isclassified through the Visual Analog Scale (VAS) (Fig. 1), from0 to 10cm. The patient is asked to quantify from 0 to 10 thedegree of discomfort caused by the symptoms; zero meaningno discomfort, and 10, the greatest discomfort. Severity isthen classified as follows: Mild: 0---3 cm; moderate: >3---7 cm;Severe: >7---10cm.

Rhinosinusitis in hematopoietic stem cell-transplanted patients: influence of nasosinus mucosal abnormalities?

IntroductionRhinosinusitis is characterized by inflammation extending from the mucosa of the nasal cavity into the paranasal sinuses. There are some aggravating features, such as immunosuppression, that can cause the nasal mucosal inflammation to linger for a long period, resulting in chronic or recurrent episodes. Such immunosuppression is the major feature of patients undergoing a hematopoietic stem cell transplant (HSCT); rhinosinusitis prevalence is higher in this group compared to immunocompetent patients. Nasal epithelial abnormalities have been described in, and may have some influence over, recurrent sinus infections among those patients. However, it is not clear whether rhinosinusitis can trigger mucosal abnormalities or whether a preexisting vulnerability for sinusitis recurrence is more likely. The objective of the study was to verify the influence of rhinosinusitis on nasal epithelial damage in patients undergoing hematopoietic stem cell transplantation.MethodA total of 30 allogeneic HSCT patients were divided into two groups: 24 patients with chronic or recurrent rhinosinusitis and 6 patients without rhinosinusitis. These patients underwent a biopsy of the uncinate process that was analyzed by transmission electron microscopy and optical microscopy.ResultsThe nasal mucosa analysis by optical microscopy showed no significant abnormalities. The ciliary orientation was obviously normal in the transplanted patients without rhinosinusitis. There was a trend toward a difference in the amount of cilia (decreased) and the primary modification of the ultrastructure of transplanted patients with rhinosinusitis.ConclusionHSCT patients, with and without rhinosinusitis, showed no significant histological abnormalities, except for ciliary disorientation and a possible decrease in ciliary and ultrastructural abnormalities in HSCT patients with rhinosinusitis.

Sinonasal Ultrastructure of the Hematopoietic Stem Cell Transplant and Chronic Graft-versus-host Disease with Rhinosinusitis

Introduction: It is believed that immunosuppression is the sole cause for the occurrence of rhinosinusitis in hematopoietic stem cell transplant (HSCT). There is a high incidence of sinusitis in recipient patients, especially in those with Chronic Graft Versus Host disease (GVHD). Histopathological abnormalities were described in recipients’ sinus mucosa compared to immunocompetent patients. There were also mucosal abnormalities related to cytotoxicity in the transplanted patients with chronic GVHD but no difference in ultrastructure between HSCT patients with and without GVHD, except for increased goblet cells in patients without GVHD. The relation between the sinonasal mucosa abnormalities of these patients and rhinosinusitis is not well established yet. Objective: To verify the ultrastructure of the sinonasal mucosa of HSCT with and without GVHD with rhinosinusitis to understand the cause of high Sinusitis incidence. Method: prospective study with statistical analysis of data obtained from the evaluation of the uncinate process mucosa of patients transplanted with (16) and without GVHD (8) with rhinosinusitis by transmission electron and optical microscopy. Results: Of the patients, 47% (14) had only 1 or 2 episodes, and 33% had more than 3 episodes of rhinosinusitis. Only the presence of microvilli was significantly higher in patients without GVHD. There was no significant difference in the amount of cilia, ciliary ultrastructure, squamous metaplasia, goblet cells, vacuolization, density of the inflammatory infiltrate, intraepithelial lymphocytes, eosinophils, mucous glands, apoptotic corpuscles intraepithelial basement membrane thickness, edema and subepithelial fibrosis between groups. There was a significant decrease of cilia with Powered by Editorial Manager® and ProduXion Manager® from Aries Systems Corporation higher recurrence of rhinosinusitis. Conclusion: There was an increase in microvilli HSCT without GVHD with rhinosinusitis, and the ultrastructure and histological changes of HSCT with and without GVHD did not change with the recurrence of rhinosinusitis. However, there was a decrease of cilia in the epithelium of the sinonasal HSCT with higher recurrence of rhinosinusitis.

Sinunasal ultrastructure of the transplant hematopoietic stem cell and chronic graft-versus-host disease with rhinosinusitis

Background It is believed that immunosuppression is the sole cause for the occurrence of rhinosinusitis in hematopoietic stem cell transplant (HSCT). There is a high incidence of sinusitis in recipient’s patients, especially those with Chronic Graft Versus Host disease (GVHD). Histopathological abnormalities were described in recipient’s sinus mucosa comparing to the immunocompetents patients. There are also mucosal abnormalities related to the cytotoxicity in the transplanted patients with chronic GVHD, but no difference in ultrastructure between HSCT patients with and without GVHD, except increased goblet cells in patients without GVHD. The relation between the sinunasal mucosa abnormalities of patients with and without GVHD and rhinosinusitis is not well established yet. Objective To verify the ultrastructure of the sinunasal mucosa of HSCT with and without GVHD with rhinosinusitis in order to understand the cause of high sinusitis incidence in recipients with and without GVHD. Method A preliminary prospective study with statistical analysis of data obtained from the evaluation of the mucosa of the uncinate process by transmission electron microscopy of those recipients with (10) and without GVHD (9) with rhinosinusitis. Results 93% of transplanted patients with GVHD and 62% of those without GVHD had 2 or more rhinosinusitis. Only the presence of microvilli was significantly increased in patients without GVHD. There was no significant difference in the cilia number, cilia ultrastructure, squamous metaplasia, goblet cells or citoplasmatic vacuolization between those groups. Conclusion The recurrence of rhinosinusitis seems to be higher in chronic GVHD patients, however no abnormalities were found in the ultrastructure of their sinunasal mucosa, except increased microvilli in those without GVHD. This is a preliminary study and an increased sample might modify statistical analysis, as well as the comparison of recipients without rhinosinusitis.