Chronic Aspergillosis of paranasal sinuses: A case report

Dr. Sahil Gupta BAMS, MHA (Ayurvedic Allergist)
Institute of Applied Food Allergy®
www.iafaforallergy.com

Fungal infections can be treated with high success rate by various Ayurveda treatment measures.  Dr. Sahil Gupta the well known Ayurveda Allergist of IAFA have successfully treated thousands of fungal infection cases. Sinusitis aspergilliosis treatment is one among IAFA’s successful Ayurvedic measure which assures complete cure.  This blog is a case study of Sinusitis aspergillosis successfully treated by Dr. Sahil Gupta. 

Abstract

Sinusitis aspergillosis currently constitutes the most common cause of opportunistic fungus infectious in immunocompromisedpatients[1]. Any type of paranasalaspergillosis may progress to more aggressive disease illustrating the importance of early recognition of this increasingly encountered disease.There is no direct correlation for aspergillosis in ayurveda. On close observation and detailed analysis of the clinical features and upasayaandanupasaya in patients, it  can be correlated to dushtapratishyaya (chronic sinusitis)and there istridoshadushti with kapha predominance which plays a  major role in pathophysiology. Therefore the aim of treatment is to removethedoshadushti, preventing further vitiation and promoting the nourishment of dhathus.The case study being presented is of a 48yr old male patient suffering from aspergillosis.Nasyakarma(installation of medicine through nasal passage)is used as  thebest choice of treatment along with suitable internal medications  The radiological  results revealed the healing process of the soft tissue and there was much symptomatic relief for the patient .

Key words: Aspergillosis, DushtaPrathishyaya, Nasya

Introduction

The term “Aspergillosis” refers to an illness due to allergy, airway or lung invasion, cutaneous infection, or extrapulmonary dissemination caused by species of Aspergillus. The most frequent site of human infection is the lung. Sinusitis is a common disorder affecting approximately 20% of the population at some time during their lives. Fungal sinusitis constitutes 6-9% of all the rhinosinusitis. Aspergillus is the most common fungus affecting paranasalsinuses .Worlwide,A. fumigatus is the most common species, followed by A. flavus. The maxillary sinus is the most common sinus to be affected[2].

Fungal infections of the paranasal sinuses need to be recognised in order to avoid significant mortality and morbility.Diagnosis of paranasal sinus aspergillosis can be made by history, clinical examination, radiography, nasal endoscopy and additional tests for allergy, aspirin sensitivity, bacteriology, and pulmonary function tests[3].

According to Ayurvedic perspective its features can be correlated to Dushtaprathishyaya(chronic sinusitis)in which severe headache, nasal obstruction, heaviness, altered olfaction, nasal congestion, mucous production, altered secretion and blockage are the chief events.Since it is a tridoshaja condition with kapha predominant symptoms,theayurvedic approach of management is multifaceted and can involve a combination of detoxification processes through samana(palliative) and sodhana(purificatory) mainly using tikshna(sharp),ushna(hot), kaphahara(nature of pacifying kapha)dravyas.

With the objective of understanding better pathogenesis of the disease, the author presents a case report.

Figure 1.- Extra-oral photograph showing swelling on right side of face

Case Report

A 48year male patient, visited in OPD on date: 08/8/2019 with the following details:

Patient name: Mr.Surender Singh

UID No.:2019/3712

Date of admission: 26/08/2019

  • The patient presented with history of nasal obstruction, mouth breathing and snoring, head ache, pain and swelling along right maxillary region,  since 3 months aggrevated since 2 weeks. The patient gave history of scanty seropurulent, odourless nasal discharge from nasal cavity.
  • He denied epistaxis, excessive sneezing, or trauma to nose. History of recurrent upper respiratory infections including fever, cough, sputum production, ear discharge, earache, tinnitus, vertigo, ataxia and asymmetry of face or facial pain were negative. 
  • He had no history of tuberculosis, diabetes mellitus, asthma, use of corticosteroids, other immunosuppressants or prolonged antibiotic therapy.
  • Vital parameters were normal. 
  • Examination of Nose revealed  deviation of nasal septum to right side.
  • Clinical examination of ears and throat was normal, 
  • Swelling and tenderness were present on right maxillary region.
  • NCCT  P.N.S imaging (MRI) dated 22/5/2019revealed  right intra orbital and pre /retro antral soft tissue suggestive of right maxillary aspergilloma,  mild right maxillary sinusitis, and ‘S’ shaped DNS

Figure.2-NCCT P.N.S imaging (MRI) Dated 22/5/2019

  • Hematological parameters were not suggestive of inflammatory pathology. Kidney function test and liver function tests were normal. Urine did not show any protein or glucose and culture did not show any growth. Blood culture was sterile. Chest Xray was normal. The patient was presumed to be immunocompetent as the patient was not reactive for HIV and had no diabetes mellitus, neutropenia, evidence of hematologic or any other malignancy in the body, or any concurrent infections

Management

Treatment Started Dated on 8/8/2019

  • Changeriswarasa(Oxalis corniculata) 30ml bd
  • Arogyavardhinivati 500mg bd
  • Gandhakarasayana  500mg bd
  • Satyanashiswarasa(Argemonemexicana)60ml bd
  • Nasya karma(installation of medicine through nasal passage) with Anuthailam ,steam inhalation with neem(Azadirachtaindica) and thulsi(Ocimumsanctum)

Continued till 10/11/ 2019 and again NCCT  P.N.S imaging (MRI) was repeated on  Dated 14/11/2019 resulted in 

1) F/U/C/O Right maxillary aspergilloma –Present study reveals right intra orbital and pre/retro antral soft tisuue described.

2) B/L maxillary and right sphenoid mild sinusitis and

3) S shaped DNS noted

Figure.3-NCCT P.N.S imaging (MRI) Dated 14/11/2019

Treatments continued Dated on: 22/11/2019

  • Chrangeriswarasa(Oxalis corniculata) 30ml bd
  • Arogyavardhinivati 500mg bd
  • Gandhakarasayana  500mg bd
  • Tab Livomyn500mg bd
  • Satyanashiswarasa(Argemonemexicana) 60ml bd
  • Nasya karma(installation of medicine through nasal passage) with Anuthailam ,steam inhalation with neem(Azadirachtaindica) and thulsi(Ocimumsanctum)
  • Brahma rasayana 2tsp bd

Treatments again continued Dated on: 22/03/2020

  • Bhumiamla(Phyllanthusneruri),swaras added and all other same medicines continued

After treatment patient got symptomatic relief in May 2020 and again NCCT  P.N.S imaging (MRI) was repeated Dated on 30/05/2020 resulted in 

  • Small well defined lobulated soft tissue along the superior, anterior and lateral walls of  right maxilla.No interval change is seen as compared to previousCT- s/o healed changes
  • Mild bilateral maxillary and right sphenoidal sinusitis Mild ‘S’shaped DNS

Figure.4-NCCT  P.N.S imaging (MRI) Dated 30/5/2020

On 11/6/2020 treatment continued for a month to attain complete recovery as well as to add rejuvenation. The rejuvenation therapy will guide the process of fast recovery to the internal tissues along with improving the immune system.

  • SwarasaofBhumiamla(Phyllanthusneruri),TulasiPanchaang(Ocimumsanctum), Aswagandha root (Withaniasomnifera), Shireesha(Albizialebeck), Charngeri(Oxalis corniculata)  –   each 10ml bdNasya(installation of medicine through nasal passage)continued
  • Sitopaladichurnam 3g bd
  • Abhraka(Mica)bhasma 0.625mg bd
  • Yasad(Zinc)bhasma 0.625mg bd
  • Steam inhalation with neem (Azadirachtaindica)  andtulsiarka (Ocimumsanctum).

Discussion

In Ayurveda as Dushtapratishyaya(chronic sinusitis)  is a chronic condition of Dosha accumulation in particular nasa(nose) and shira(head); which happens   mainly due to sanga(stagnation) type of srothodushti[4]. Oral drug administration like arogyavardhinivatihelpedin  the actions like  pachana(digestive),dipana(enkindles digestion),pathya (wholesome for channel), malashuddhikari (cleaning of waste materials from body), increase kshudha (appetizer), Sarvarogaprashamani  helped in reduction of inflammation and infection[5].Drugs like charngeri(Oxalis corniculata), satyanashi (Argemonemexicana), bhumiamla(Phyllanthusneruri), sireesha(Albizialebeck) etc having pachana(digestive)action  helped in  relieving nasaavarodha(nasal obstruction) due to oedema and nasasrava(nasal discharge) due to infection and over activity of mucous secreting glands. When both inflammation and infection are checked; the sinuses get proper drainage and ventilation. As a consequence shirshoola(head ache) was reduced.

AnuTaila works as strotoshodhaka(cleansing of channels) due to its katu(pungent), tikta(bitter) rasa, laghu(lightness), ruksha(dry)guna, ushnavirya(hot potency) and katuvipaka(bio-transformative phase of rasa)[6], it possess a good spreading capacity through minute channels. It increases general and local immunity as it is indriyadardhyakaratva(strength to sense organs),balya(enhance strength), brimhana(improves nourishment), preenana(nurturing body). These immunomodulation will reduce inflammatory process in nasal cavity and sinuses.The drug cause local irritation which liquefy purulent discharge and ultimately expelled out. Bacteriostatic property of ingredients will arrest the secondary infection.

Rasayana(rejuvenative) preparationswere selected for internal medication, as it is indicated for peenasa(Catarrh) and also having ,anti-inflammatory and immunomodulatory effect.

Conclusion

We can conclude that Nasya along with oral medication is effective in management ofaspergillosiswhich was not much relived by allopathic medical intervention. After the completion of initial stage of treatment, the patient must be given with Rasayanatreatment(rejuvenation measures like intake of Brahma Rasayana, Chyavanprasham etc.)  to improve the immune system.

Ayurveda has its own treatment modalities and rasayana therapies to increase the immune power of the body and thus avoiding the recurrence of the disease. With the ayurvedicmanagementbyDr. Sahil Gupta at Institute of Applied Food Allergy®, patientgot relief from the disease and could skip the burden and risks of surgeries.

References

  • Garcia-Reija M, Crespo-Pinilla J, Labayru-Echeverria C, Espeso-Ferrero A, Verrier-Hernandez A. Invasive maxillary aspergillosis: report of a case and review of the literature. Medicina oral.Med Oral 2002;7:200–205. [PubMed] [Google Scholar]
  • Sharma D, Mahajan N, Rao S, Khurana N, Jain S. Invasive maxillary aspergillosis masquerading as malignancy in two cases: utility of cytology as a rapid diagnostic tool. J Cytol.2012;29:194–6. [PMC free article] [PubMed] [Google Scholar]
  • Singh, N., Bholodia, N.H. 2005. Allergic fungal sinusitis-earlier diagnosis and management. J. Laryngol. Otol., 119: 875 881
  • Vagbhata. AshtangaHridaya with sarvangaSundariArunadatta commentary of Arundatta and ayurvedarasayana commentary of Hemadri, Ed.By Pt. SadashivaShastriParadakara.Varanasi; ChaukhambaSurbharatiPrakashana; 2007. 293p
  • ArogyavardhiniVati Benefits, Uses, Dosage & Side Effects, [Home page on internet]. Downloaded on 12/09/2016. Available at- https://www.ayurtimes.com
  • Agnivesha, Charaka Samhitha, with Hindi Commentary by Pt. KashinathaShashtri and Dr. GorakhaNathaChaturvedi, Varanasi, ChaukhambhaBharti Academy, Reprint, chikitsasthana, Trimarmiya, verse, 2009; 152: 747.

Article Written By: Dr. Sahil Gupta, Ayurvedic Allergist