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Background Pathogenesis of canine fungal rhinitis is still not fully understood. Treatment remains challenging, after cure turbinate destruction may be associated with persistent clinical signs and recurrence of fungal rhinitis can occur. Alterations of the nasal microbiota have been demonstrated in dogs with chronic idiopathic rhinitis and nasal neoplasia, although whether they play a role in the pathogenesis or are a consequence of the disease is still unknown. The objectives of the present study were (1) to describe nasal microbiota alterations associated with fungal rhinitis in dogs, compared with chronic idiopathic rhinitis and controls, (2) to characterize the nasal microbiota modifications associated with successful treatment of fungal rhinitis. Forty dogs diagnosed with fungal rhinitis, 14 dogs with chronic idiopathic rhinitis and 29 healthy control dogs were included. Nine of the fungal rhinitis dogs were resampled after successful treatment with enilconazole infusion. Results Only disease status contributed significantly to the variability of the microbiota. The relative abundance of the genus Moraxella was decreased in the fungal rhinitis (5.4 ± 18%) and chronic idiopathic rhinitis (4.6 ± 8.7%) groups compared to controls (51.8 ± 39.7%). Fungal rhinitis and chronic idiopathic rhinitis groups also showed an increased richness and α-diversity at species level compared with controls. Increase in unique families were associated with fungal rhinitis (Staphyloccaceae, Porphyromonadaceae, Enterobacteriaceae and Neisseriaceae) and chronic idiopathic rhinitis (Pasteurellaceae and Lactobacillaceae). In dogs with fungal rhinitis at cure, only 1 dog recovered a high relative abundance of Moraxellaceae. Conclusions Results confirm major alterations of the nasal microbiota in dogs affected with fungal rhinitis and chronic idiopathic rhinitis, consisting mainly in a decrease of  Moraxella . Besides, a specific dysbiotic profile further differentiated fungal rhinitis from chronic idiopathic rhinitis. In dogs with fungal rhinitis, whether the NM returns to its pre-infection state or progresses toward chronic idiopathic rhinitis or fungal rhinitis recurrence warrants further investigation.

Computed tomography (CT) is the imaging method of choice for evaluating the canine nasal cavity, being invaluable in determining disease extent, guiding sampling, and planning treatment. While predictions of pathology type can be made, there is significant overlap between CT changes noted in neoplastic, inflammatory, and infectious nasal disease. Recent years have seen remarkable advancement in computer-aided detection systems in human medicine, with machine and deep learning techniques being successfully applied for the identification and accurate classification of intranasal pathology. This study aimed to develop a neural network pipeline for differentiating nasal pathology in dogs using CT studies of the head. A total of 80 CT studies were recruited for training and testing purposes. Studies falling into one of the three groups (normal nasal anatomy, fungal rhinitis, and intranasal neoplasia) were manually segmented and used to train a suite of neural networks. Standard accuracy metrics assessed performance during training and testing. The machine learning algorithm showed reasonable accuracy (86%) in classifying the diagnosis from an isolated scan slice but high accuracy (99%) when aggregating over slices taken from a full scan. These results suggest that machine learning programmes can accurately discriminate between intranasal pathologies based on canine computed tomography.

A 4‐year‐old male castrated mixed breed dog was admitted to the Veterinary Medical Center of the University of Tennessee College of Veterinary Medicine for evaluation of unilateral nasal discharge. Discharge had been present for 2 months, with progression from purulent to hemorrhagic discharge after empiric treatment by the primary veterinarian 6 weeks prior to referral. The dog had a history of seizures starting at 1 year of age that were controlled with phenobarbital. Computed tomography and magnetic resonance imaging of the head yielded diagnoses of a left‐sided meningoencephalocele with extension of the olfactory bulb into the caudal nasal passage and destructive rhinitis and frontal sinusitis consistent with aspergillosis. Rhinoscopy was performed to collect diagnostic samples, debride fungal plaques, and guide clotrimazole cream application. Biopsies revealed suppurative rhinitis with abundant aspergillosis, with Aspergillus sp. confirmed on fungal culture. Postoperatively, the patient was treated with a short course of oral posaconazole. Stertorous breathing was noted 4 months following treatment. Recheck sinoscopy and rhinoscopy revealed one fungal plaque in the left nasal cavity and small, hyperemic turbinates. Treatment was repeated, resulting in resolution of clinical signs. Repeat rhinoscopy 1 month later had no evidence of residual disease. Seizures recurred 3 years after the second treatment and were medically managed by the primary care veterinarian. This case report describes a rare case of nasal aspergillosis complicated by a meningoencephalocele. Despite the large cribriform plate defect resulting in exposure of the meninges and olfactory bulb, repeated debridement and topical antifungal treatment were well tolerated by this patient. There was no recurrence in signs for 3 years, after which the dog was lost to follow‐up.

This is a case of Conidiobolus lamprauges rhinitis in a Goldendoodle, that was presented for evaluation of sneezing, coughing, lethargy, as well as right-sided epistaxis and clear ocular discharge. Computed tomography revealed a large amount of soft tissue within the right nasal passage that obscured the osseous turbinates from the right maxillary canine tooth to the right side of the choanae. Biopsies revealed eosinophilic granulomas with variable number of basophilic to negatively staining, septate, fungal hyphae with non-parallel walls and irregular branching that were subsequently determined to be Conidiobolus lamprauges via panfungal PCR and sequencing. Complete and sustained resolution of clinical disease was achieved after 75 days of systemic antifungal therapy. This report describes for the first time, important clinical features of a dog with nasal conidiobolomycosis that will facilitate its recognition, prognostication, and treatment in clinical practice.

Chronic inhalation of fungi and fungal components has been linked to the development of respiratory disorders, although their role with respect to the pathogenesis of acute respiratory virus infection remains unclear. Here, we evaluate inflammatory pathology induced by repetitive administration of a filtrate of the ubiquitous fungus, Alternaria alternata, and its impact on susceptibility to infection with influenza A. We showed previously that A. alternata at the nasal mucosae resulted in increased susceptibility to an otherwise sublethal inoculum of influenza A in wild-type mice. Here we demonstrate that A. alternata-induced potentiation of influenza A infection was not dependent on fungal serine protease or ribonuclease activity. Repetitive challenge with A. alternata prior to virus infection resulted proinflammatory cytokines, neutrophil recruitment, and loss of alveolar macrophages to a degree that substantially exceeded that observed in response to influenza A infection alone. Concomitant administration of immunomodulatory Lactobacillus plantarum, a strategy shown previously to limit virus-induced inflammation in the airways, blocked the exaggerated lethal response. These observations promote an improved understanding of severe influenza infection with potential clinical relevance for individuals subjected to continuous exposure to molds and fungi.

Fungal infections are a subset of infectious processes that an otolaryngologist is required to be familiar with. They can be encountered in otology, rhinology and head and neck surgery. The presence of fungal rhinosinusitis is well recognised by otolaryngologists, but the classifications and appropriate management are not so well understood. The prevalence of fungal sinus disease is thought to be have been increasing in recent decades There is speculation that this may be due to increased awareness, antibiotic overuse and increased use of immunosuppressant medications. Added to this, there has been a large amount published on the role of fungi as a causative organism in chronic rhinosinusitis. Given the importance of fungal rhinosinusitis in clinical practice, we aim to review the classification and current management strategies based on up-to-date literature.

Background Early diagnosis of acute invasive fungal rhinosinusitis (AIFRS) is vital to improving outcomes in immunocompromised patients. This study evaluated the impact of a systematic protocol with nasal endoscopy and biopsies to early detect AIFRS in immunocompromised patients. Additionally, we compared the accuracy of frozen-section biopsy and culture with formalin-fixed paraffin-embedded (FFPE) biopsy. Methods Retrospective cohort in a Tertiary Referral Hospital. Patients with the suspected diagnosis of AIFRS were evaluated following a standardized protocol, including serial nasal endoscopies and biopsies when necessary. The sensitivity and specificity of frozen-section biopsy and culture were also compared with FFPE. Results The mortality rate related to AIFRS of this standardized cohort (13/43) was 30.2%. Better outcomes were observed in patients with disease limited to the turbinates and in those with higher peripheral neutrophils count. Frozen-section biopsy positivity correlated with FFPE findings for fungi detection ( p-value  < 0.0001), with a sensitivity of 90.6%, specificity of 72.7%, and accuracy of 86.0%. Conclusion Implementation of this standardized protocol was related to a considerably low mortality rate among patients with suspected AIFRS at our Institution. Frozen-section biopsy revealed high accuracy to diagnose AIFRS. The current protocol including frozen-tissue biopsy improved the evaluation and survival rates of immunocompromised patients with presumed AIFRS.

We report an invasive mycosis case in Japan caused by Bjerkandera adusta, a fungal species not previously reported as a causative pathogen of invasive mycosis. B. adusta was identified by using phylogenetic analysis. Voriconazole was used successfully for treatment. Immunodeficient patients may be susceptible to infection by rare causative fungi.

ObjectivesTo investigate MRI features in discriminating chronic invasive fungal rhinosinusitis (CIFRS) from sinonasal squamous cell carcinomas (SNSCC).MethodsMRI findings of 33 patients with CIFRS and 47 patients with SNSCC were retrospectively reviewed and compared. Multivariate logistic regression analysis was performed to identify significant imaging features in distinguishing between CIFRS and SNSCC. The ROC curves and the AUC were used to evaluate diagnostic performance.ResultsThere were significant differences in cavernous sinus involvement (p < 0.001), sphenoid sinus involvement (p < 0.001), meningeal involvement (p = 0.024), T2 signal intensity (p = 0.006), and enhancement pattern (p < 0.001) between CIFRS and SNSCC. Multivariate logistic regression analysis identified cavernous sinus involvement (odds ratio [OR] = 0.06, 95% confidence interval [95% CI] = 0.02–0.20) and sphenoid sinus involvement (OR = 0.14, 95% CI = 0.05–0.45) as significant indicators for CIFRS and T2 isointensity to gray matter (OR = 4.44, 95% CI = 1.22–16.22) was a significant indicator for SNSCC. ROC curve analysis showed the AUC from a combination of three imaging features was 0.95 in differentiating CIFRS and SNSCC.ConclusionsMRI showed significant differences between CIFRS and SNSCC features. In immunocompromised patients, a sinonasal hypointense mass on T2WI with septal enhancement or loss of contrast enhancement, and involvement of cavernous sinus, sphenoid sinus, and meninges strongly suggest CIFRS.Key Points• Chronic invasive fungal rhinosinusitis (CIFRS) is often difficult to distinguish from sinonasal squamous cell carcinomas (SNSCC) in clinical practice.• Cavernous sinus and sphenoid sinus involvement appear to be significant indicators for CIFRS. T2 isointensity to gray matter appears to be a significant indicator for SNSCC.• Loss of contrast enhancement and septal enhancement can be used to distinguish CIFRS from SNSCC with a high degree of specificity.