Creative Biolabs has significant experience in the development of new drug discovery. We perform both standard and customized experiments to exploit new drug candidates for the treatment of numerous fungal diseases. We ensure any of the services we offer are scalable, compliant and able to promote the development of global clients’ programs.
What is Granulomatous Invasive Fungal Rhinosinusitis?
Granulomatous invasive fungal rhinosinusitis (GIFRS) is a subcategory of chronic invasive fungal rhinosinusitis that belongs to invasive fungal rhinosinusitis. It has a gradual onset and has been noted to occur mainly in the Sudan, India, and Pakistan. In contrast to acute invasive FRS, GIFRS often affects immunocompetent patients which are characterized by the presence of submucosal granulomatous inflammation, rare fungal hyphae, and extensive fibrosis. Studies have shown that the most common associated fungal organism of GIFRS is A. flavus.
Symptoms of GIFRS
GIFRS has a gradual onset and takes a chronic course, usually over many months, and sometimes years. Generally, symptoms of GIFRS may consist of proptosis or an enlarging mass within the nose, orbit, or paranasal sinuses. Clinically, it can present as an enlarging mass that affects the cheek, orbit, nose, and paranasal sinuses characterized on histopathologic examination by noncaseating granulomas with a foreign body or Langerhans giant cells and considerable fibrosis. If there is an intracranial invasion, it tends to have scarce symptoms due to the slow growth.
Fig.1 Chronic granulomatous fungal rhinosinusitis with (A) extensive granulomatous process on hematoxylin and eosin stain(X400), (B) fungal hyphae inside giant cells on periodic. (Chatterjee, 2009)
Diagnosis of GIFRS
Diagnosis of GIFRS is difficult as it is often initially mistaken for malignancy based on a mass-like appearance. Generally, the diagnosis is made on histopathology of the biopsy taken or mass removed during surgery. Histopathologically, a granulomatous response is seen with considerable fibrosis. Non-caseating granuloma with a foreign body or Langhan’s types of giant cells may be seen, sometimes with vasculitis, vascular proliferation, and perivascular fibrosis. Furthermore, molecular technique extraction of fungal DNA and ITS sequencing help in clinching the diagnosis. In situ hybridization or immunohistochemistry may also help in diagnosis, although these tests are not readily available.
Treatment of GIFRS
Treatment of GIFRS is a combination of using antifungal agents and surgical therapy. Amphotericin B is the most commonly used antifungal drug, which is administered after surgery. Usually, endoscopic surgery is not sufficiently radical for sure, although occasionally the disease is caught early following complete removal of disease endoscopically. Timely management is effective. Recurrence is rare after prolonged antifungal therapy, which should be for a minimum of 6 months, if possible.
During the past years, Creative Biolabs has successfully established advanced technology platforms for potential antifungal drug exploiting. Based on years of experience, now we can offer comprehensive antifungal drug discovery package services using numerous approaches, including target identification and validation, hit identification, and hit to lead. Except for GIFRS, we also help our global customers develop new drug candidates for the treatment of other fungal diseases. For more detailed information, please feel free to contact us.
Reference
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