Title: Evaluation of Conventional and Molecular Techniques in the Diagnosis of Fungal Rhinosinusitis
Authors: Nitya Verma, Prashant Gupta, Veerendra Verma, Dakshina Bisht, S. P.Agarwal, Ajay Kumar Singh, Abrar Ahmad
DOI: http://dx.doi.org/10.18535/jmscr/v3i12.38
Introduction: Fungal infection of the nose and paranasal sinuses is increasing in both immunocompetent and immunocompromised patients. Limited studies on spectrum of fungi causing fungal rhinosinusitis (FRS) and the types of FRS are scarce from this region of India. We therefore analyzed the suspected cases of FRS by clinical, radiological, histopathological, mycological and molecular methods and categorized them in to non-invasive and invasive forms. Objective: To evaluate laboratory methods in the diagnosis of fungal rhinosinusitis and to find out the spectrum of fungi causing various forms of FRS Methods:44 patients of chronic rhinosinusitis were enrolled on the basis of history, clinical examination, and radiological findings from the E.N.T. department after obtaining their consent. Functional endoscopic sinus surgery was performed and tissues were examined histopathologically, by fungal culture and PCR. Antimicrobial susceptibility testing of the fungal isolates were done by disk diffusion (M51-A) & broth micro dilution (M38-A2) methods of CLSI. Result:Out of 44 clinically and radiologically suspected patients of chronic rhinosinusits, 23 (52%) were positive for fungal rhinosinuistis. In 44 cases, 18 (40.9%) cases were PCR positive, 12 (27%) were culture positive, 8(18%) were positive by KOH microscopy and 4 (9%) were positive on histopathology. Aspergillus flavus was found to be the most common fungal isolate causing fungal rhinosinusitis Conclusion: We found laboratory methods are essential in confirming the diagnosis of FRS. Among all the laboratory methods, though culture is an important diagnostic tool, PCR were found to be more significant than other methods. 1. Patron Piromchai, Pornthep kasemsiri, Supawan Laohasiriwong, Sanguansak Thanaviratananich. Chronic rhinosinusitis and emerging treatment options. International journal of general medicine, 2013;6: 453-464. 2. Zachary M. Soler and Rodney J. Schlosser. The role of fungi in disease of the nose and sinuses. Am J Rhinol & Allergy, 2012; 26: 351-358. 3. Schubertz MS. Allergic fungal sinusitis pathophysiology, diagnosis and management. Med Mycol, 2009;47:S324–30. 4. Sandhu G, Kline BC, Atockman L. Molecular probes for diagnosis of fungal infections. J Clin Microbiol 1995;33:2913–19. 5. Lanza D, Kennedy DW. Adult rhinosinusitis defined. Otolaryngol Head Neck Surg 1997; 117(3 pt 2):S1-7 6. Badiee P, Gandomi B, Sabz G, Khodami B, Choopanizadeh M, Jafarian H. Evaluation of nested PCR in diagnosis of fungal rhinosinusitis. Iran J Micro , 2015;7(1):62-66. 7. Prateek S, Banerjee G, Gupta P, Singh M, Goel M, Verma V. Fungal rhinosinusitis: A prospective study in a university hospital of Uttar Pradesh. Ind Jour Med Micro , 2013;31(1): 266-269. 8. Das A , Bal A, Chakrabarti, Panda N, Joshi K. Spectrum of fungal rhinosinusitis; histopathologist’s perspective. Wiley on line jour, 2009;64(7):854-859. 9. Michael RC, Michael JS, Ashbee RH, Mathews MS. Mycological profile of fungal sinusitis: An audit of specimens over a 7 year period in a tertiary care hospital in Tamil nadu. Indian J Pathol Microbio, 2008;51: 493-496. 10. Mohammaed M, Naggar EI, El-morsy S, Abou Beith A, Khafagi Y. Allergic fungal sinusitis: Detection of Universal fungal, Aspergillus and Bipolaris DNA in sinus aspirate using polymerase chain reaction and evaluation of Aspergillus specific IgE. Egypt. Journ of Med.Abstract
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