真菌性鼻-鼻窦炎：微生物学和组织病理学视角
Fungal Rhinosinusitis: Microbiological and Histopathological Perspective.
作者信息
Singh Ajay Kumar, Gupta Prashant, Verma Nitya, Khare Vineeta, Ahamad Abrar, Verma Virendra, Agarwal S P
机构信息
Associate Professor, Department of Pathology, King George's Medical University, Lucknow, Uttar Pradesh, India.
Associate Professor, Department of Microbiology, King George's Medical University, Lucknow, Uttar Pradesh, India.
出版信息
J Clin Diagn Res. 2017 Jul;11(7):DC10-DC12. doi: 10.7860/JCDR/2017/25842.10167. Epub 2017 Jul 1.
INTRODUCTION
On the basis of histopathology Fungal Rhinosinusitis (FRS) is categorized into non-invasive (allergic fungal rhinosinusitis, fungal ball) and invasive (acute invasive, chronic invasive and granulomatous invasive fungal sinusitis). This differentiation helps to decide the treatment. Role of latest molecular methods such as PCR and conventional methods such as KOH microscopy and culture also needs to be evaluated. Therefore, in this study we planned to categorise fungal rhinosinusitis on the basis of histopathology and compare it with other methods such as PCR, culture and KOH microscopy.
AIM
To analyse fungal rhinosinusitis cases by both histopathologically and microbiologically.
MATERIALS AND METHODS
A total of 76 clinically suspected fungal rhinosinusitis cases were included in the study. The tissue of suspected cases were processed and examined by KOH microscopy, histopathologically, culture and PCR. Histopathological examination was done by PAS, GMS and H&E stain.
RESULTS
FRS was diagnosed in 37 (48.68%) cases out of 76 clinically suspected cases of FRS. In which 17 (22.3%) cases were positive by direct microscopy, 21 (27.6%) by culture, 27 (35.5%) by PCR and 14 (18.42%) by histopathology. Approximately 14 cases of FRS were classified according to histopathology; 10 (71.3%) as non-invasive FRS. Out of these 10, 9 (64.2%) were classified as AFRS and 1 (7.14%) as fungal ball. Only 4 cases (28.5%) were diagnosed with invasive FRS. Out of these 4 cases, 2 (14.2%) were of chronic invasive fungal rhinosinusitis, 1 (7.14%) was of granulomatous invasive fungal rhinosinusitis and 1 (7.14%) was of acute fulminant invasive fungal rhinosinusitis. Allergic Fungal Rhinosinusitis (AFRS) is the most common type of FRS. was found to be the most common fungi causing FRS.
CONCLUSION
Diagnosis should not be based on the single method. It should be done by both histopathological and microbiological methods, especially for those cases which are difficult to diagnose.
引言
根据组织病理学，真菌性鼻窦炎（FRS）可分为非侵袭性（变应性真菌性鼻窦炎、真菌球）和侵袭性（急性侵袭性、慢性侵袭性和肉芽肿性侵袭性真菌性鼻窦炎）。这种区分有助于确定治疗方案。还需要评估最新分子方法（如PCR）和传统方法（如氢氧化钾显微镜检查和培养）的作用。因此，在本研究中，我们计划根据组织病理学对真菌性鼻窦炎进行分类，并将其与PCR、培养和氢氧化钾显微镜检查等其他方法进行比较。
目的
通过组织病理学和微生物学方法分析真菌性鼻窦炎病例。
材料与方法
本研究共纳入76例临床疑似真菌性鼻窦炎病例。对疑似病例的组织进行处理，并通过氢氧化钾显微镜检查、组织病理学、培养和PCR进行检测。组织病理学检查采用过碘酸雪夫染色、吉姆萨染色和苏木精-伊红染色。
结果
在76例临床疑似真菌性鼻窦炎病例中，37例（48.68%）被诊断为真菌性鼻窦炎。其中，直接显微镜检查阳性17例（22.3%），培养阳性21例（27.6%），PCR阳性27例（35.5%），组织病理学阳性14例（18.42%）。根据组织病理学，约14例真菌性鼻窦炎病例得到分类；10例（71.3%）为非侵袭性真菌性鼻窦炎。在这10例中，9例（64.2%）被分类为变应性真菌性鼻窦炎，1例（7.14%）为真菌球。仅4例（28.5%）被诊断为侵袭性真菌性鼻窦炎。在这4例中，2例（14.2%）为慢性侵袭性真菌性鼻窦炎，1例（7.14%）为肉芽肿性侵袭性真菌性鼻窦炎，1例（7.14%）为急性暴发性侵袭性真菌性鼻窦炎。变应性真菌性鼻窦炎（AFRS）是真菌性鼻窦炎最常见的类型。发现是引起真菌性鼻窦炎最常见的真菌。
结论
诊断不应基于单一方法。应通过组织病理学和微生物学方法进行诊断，尤其是对于那些难以诊断的病例。
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