El-Morsy S M, Khafagy Y W, El-Naggar M M, Beih A A
Department of Otorhinolaryngology, Faculty of Medicine, Mansoura University, Egypt.
J Laryngol Otol. 2010 Feb;124(2):152-60. doi: 10.1017/S0022215109991204. Epub 2009 Dec 8.
This study investigated allergic fungal rhinosinusitis cases, and aimed to compare the detection of fungi in sinus aspirate by culture and by polymerase chain reaction assay, and to relate the presence of fungi in the nasal sinuses to the type of fungal allergen causing disease.
Sixty-eight cases of allergic fungal rhinosinusitis underwent fungal culture and polymerase chain reaction assay for universal fungal, aspergillus and bipolaris DNA. Aspergillus-specific immunoglobulin E levels were measured in sinus aspirate, and total serum immunoglobulin E levels were calculated. A control group of 10 cases was included in the study.
Of the 68 allergic fungal rhinosinusitis cases, only 42 (61.7 per cent) had positive fungal cultures; of the 10 controls, only three (30 per cent) had positive cultures. Species from the dematiaceous family were most commonly grown, being isolated in 30 cases (71.4 per cent). Bipolaris was the most commonly isolated species (18 cases) followed by curvularia (11 cases) and alternaria (one case). Polymerase chain reaction assay detected fungal DNA in all the allergic fungal rhinosinusitis cases and also in four controls (40 per cent). Ten patients (of 68; 14.7 per cent) were positive for Aspergillus fumigatus specific immunoglobulin E. The mean concentration of this immunoglobulin was 11.32 +/- 4.12 IU/ml in patients and 0 IU/ml in controls, a statistically significant difference.
Detection of fungal DNA in nasal aspirate by polymerase chain reaction was superior to fungal cultures as a method of detecting fungal growth. In allergic fungal rhinosinusitis, fungal growth is not always accompanied by an allergic reaction.
本研究对变应性真菌性鼻-鼻窦炎病例进行调查，旨在比较通过培养和聚合酶链反应检测鼻窦抽吸物中真菌的情况，并将鼻窦中真菌的存在与引起疾病的真菌变应原类型相关联。
68例变应性真菌性鼻-鼻窦炎患者接受了针对通用真菌、曲霉菌和双极霉DNA的真菌培养及聚合酶链反应检测。检测鼻窦抽吸物中曲霉菌特异性免疫球蛋白E水平，并计算血清总免疫球蛋白E水平。研究纳入了10例患者作为对照组。
68例变应性真菌性鼻-鼻窦炎患者中，仅42例（61.7%）真菌培养呈阳性；10例对照组患者中，仅3例（30%）培养呈阳性。暗色孢科真菌最常培养出，30例（71.4%）被分离出。双极霉是最常分离出的菌种（18例），其次是弯孢霉（11例）和链格孢（1例）。聚合酶链反应检测在所有变应性真菌性鼻-鼻窦炎病例以及4例对照组患者（40%）中检测到真菌DNA。68例患者中有10例（14.7%）烟曲霉菌特异性免疫球蛋白E呈阳性。该免疫球蛋白在患者中的平均浓度为11.32±4.12 IU/ml，在对照组中为0 IU/ml，差异有统计学意义。
作为检测真菌生长的方法，通过聚合酶链反应检测鼻腔抽吸物中的真菌DNA优于真菌培养。在变应性真菌性鼻-鼻窦炎中，真菌生长并不总是伴有变应性反应。
