原位杂交检测对曲霉菌属鼻窦炎诊断价值的探讨

目的探讨原位杂交技术在真菌性鼻窦炎病原学诊断方面的应用价值。方法应用针对曲霉菌属18SrRNA序列互补的18S-1寡核苷酸探针，经地高辛标记对37例真菌性鼻窦炎患者术后的石蜡包埋标本进行原位杂交检测。结果37例真菌性鼻窦炎标本中28例曲霉菌属原位杂交呈阳性反应，作为对照的白色念珠菌感染组织杂交结果为阴性。HE染色和六胺银染色可疑曲霉菌感染分别为21例和23例。结论真菌性鼻窦炎真菌培养阴性或无法进行真菌培养时，原位杂交是一种敏感、特异和快速检测组织内真菌病原菌的有效方法。     

45例外耳道真菌病诊治体会

目的了解外耳道真菌病的致病菌种,正确诊断和治疗外耳道真菌病。方法取耳道分泌物涂片,用10%KOH法制片检查,镜检阳性者接种沙氏培养基做真菌培养。结果分离出致病真菌40株,曲霉菌占85%(34/40),白色念珠菌占15%(6/40)。致病真菌培养阳性率为91.1%。结论外耳道真菌病主要致病真菌是曲霉菌和白色念珠菌,中老年患者应进行常规血糖及尿糖检查。     

多重PCR诊断真菌性鼻-鼻窦炎的实验研究

目的:构建一多重PCR反应体系,并探讨其对真菌性鼻-鼻窦炎(FRS)快速诊断和同时鉴定常见致病菌的临床应用.方法:选择3对引物(真菌通用引物、曲霉特异性引物、毛霉特异性引物)建立多重PCR反应体系,采用曲霉菌、毛霉菌、链格孢菌、白色念珠菌等标准菌株DNA验证体系的适用性和摸索反应条件,同时将多重PCR、真菌培养2种方法用于FRS的鼻窦内容物的真菌检测,比较二者敏感性.结果:3对引物具有较好的通用性和特异性,在适宜的反应条件下均能扩增出目的片段.该反应体系的检测灵敏度为10 μg/L.20例FRS标本,真菌培养检测阳性7例,阳性率35%;多重PCR体系检测阳性15例,阳性率75%,两者差异有统计学意义(P<0.05).结论:该多重PCR体系是一种快速、敏感和特异性诊断方法,可对FRS做出快速诊断并鉴定常见的致病菌属.     

100例真菌性鼻窦炎的病原菌分析

目的 :探讨引起真菌性鼻窦炎的致病真菌及与临床的关系 ,为临床医师提供诊断依据 ,指导治疗。方法 :对 10 0例真菌性鼻窦炎患者 ,通过行鼻内窥镜手术所取的窦腔内容物送病理诊断的同时 ,行标本直接涂片镜检 ,接种培养 ,菌种鉴定。结果 :直接镜检霉菌阳性 98例 ;接种培养霉菌阳性 37株 ,其中曲霉菌属 31株 ,包括烟曲霉 14株 ,黄曲霉 10株 ,构巢曲霉 3株 ,灰绿曲霉 1株 ,并发现 3株曲霉新种被分别命名为北京曲霉 ,齐祖同曲霉 ,王端礼曲霉。其它种霉菌有少根根霉 1株 ,尖端足分支菌 3株 ,波氏假性霉样真菌 1株 ,链格孢子菌 1株。结论 :真菌性鼻窦炎的致病真菌以曲霉菌属为主 ,其预后与致病菌种和感染类型有一定关系     

鼻-鼻窦侵袭型真菌病的临床和病理学观察

目的探讨真菌侵袭黏膜组织所引起的临床和病理学特点及组织损伤的致病机理。方法对1984年4月至2002年8月16例经病理学证实为侵袭型真菌性鼻-鼻窦炎患者的临床资料进行回顾性分析，并对其病理形态进行观察。用HE染色观察真菌侵袭组织的方式及组织损伤的特点，Warthin-Starry(W-S)、过碘酸-Schiff(periodic acid-Schiff，PAS)染色显示侵入组织内真菌的形态特征，对其中1例作透射电镜观察。结果发现有基础疾病患者13例(糖尿病4例、鼻腔T细胞淋巴瘤1例、急性巨细胞性白血病伴甲型肝炎1例、慢性粒细胞性白血病1例、鼻窦及眶内恶性肿瘤2例、乙型肝炎合并肝硬变1例、眶内肿瘤切除术后1例、慢性上颌窦炎行上颌窦根治术后2例)，无基础疾病者仅3例。真菌培养检出曲霉菌10例，毛霉菌4例，镰刀霉菌1例，1例未作培养。随访6个月～5年，死亡8例(50．0％)。病理学观察：形成化脓性肉芽肿14例，真菌对小血管浸润16例，小动脉闭塞5例，小动脉菌栓1例，组织凝固性坏死16例。同侧眶内真菌侵袭8例，侵袭视神经3例。结论糖尿病、恶性肿瘤等基础疾病引起免疫功能低下，是侵袭型真菌性上颌窦炎的重要的发病基础。真菌性血管炎是造成组织损伤的直接原因。侵袭组织内的真菌主要为曲霉菌和毛霉菌等。     

鼻咽部真菌感染的诊断和治疗

目的 回顾性总结鼻咽部真菌感染患者的临床资料.方法 19例鼻咽部真菌感染患者的分泌物送涂片并行细菌和真菌培养,组织活检行病理学检查,并作菌种鉴定和药物敏感试验.采用敏感抗真菌药物(酮康唑、两性霉素B、氟康唑)或结合手术治疗.结果 所有患者鼻咽部真菌感染诊断成立,其中10例患者为单独发生,其余9例分别合并外耳道、鼻腔鼻窦、扁桃体、口腔、喉部感染.经菌种鉴定病原菌主要为白色念珠菌(8例)、黑曲菌(4例),其余为隐球菌3例、放线菌1例、假热带念珠菌2例、酵母菌1例.采用敏感抗真菌药物,13例结合局部手术治疗后皆获得治愈.18例随访1～2年未见复发;1例患者出现复发,重新治疗3周后痊愈,又随访1年,无复发.结论 鼻咽部分泌物涂片或真菌培养以及组织病理学检查可及早确诊真菌感染,抗真菌药物治疗并结合局部处理,疗效可靠.     

鼻腔鼻窦真菌病的真菌学和临床诊疗研究(附51例报告)

目的 :研究鼻腔、鼻窦真菌病的菌种鉴定、药敏检测和临床诊疗。方法 :对 51例鼻腔、鼻窦真菌病作如下研究 :1进行菌种鉴定 ;2用 E test法以含酮康唑 (KE) ,伊曲康唑 (IT) ,氟康唑 (FC) ,氟胞嘧啶 (FL)及二性霉素 B(AP)的药敏试条进行药敏检测 ;3病人以手术及抗霉菌药治疗。结果 :1致病菌主要为曲霉菌 ,占 87.5% ,其次为桔青霉菌 ,卡氏支孢霉菌及链格孢子菌较少见 ;2曲霉菌对 IT、FC、KE敏感 ,对 FL、AP有耐药性 ;桔青霉菌对 AP、FC、KE、IT敏感 ,对 FL有耐药性 ;卡氏支孢霉菌对 IT、KE敏感 ,对 FC,FL耐药 ;3本组治愈率为 (4 9/51) 96 .1% ,2例侵袭型者因合并有肝炎、糖尿病未愈。结论 :1鼻腔、鼻窦真菌病的致病真菌主要为曲霉菌 ,其次为桔青霉菌 ;2大多数致病真菌对 IT及 KE敏感 ,E test法药敏测试具有操作简便 ,定值准确 ,重复性好的优点 ;3本病的诊断主要根据其临床特征、影像学、真菌学及病理学所见作出。绝大多数患者全身情况良好 ,极少数有基础疾病 ;4本病的主要治疗为手术及抗霉菌药综合治疗     

外耳道真菌病的病原菌分布及疗效分析

目的 通过分析外耳道真菌病的临床特征,研究其病原菌分布及临床用药情况,为有效诊治外耳道真菌病提供科学依据。方法 回顾性分析2018年1月—2020年12月收治的91例确诊为外耳道真菌病患者的临床资料,采集所有患者患病耳道分泌物并进行病原菌培养和涂片镜检,棉蓝染色进行真菌鉴定。结果 91例患者耳闷耳痒100%,听力下降者63%,鼓膜穿孔者19.78%;真菌培养检出黑曲霉菌43%、土曲霉菌21%、假丝酵母菌12%,菌株均对唑类药物敏感性较高;临床使用唑类真菌药物治愈51例(56.04%),好转36例(39.56%),无效4例(4.40%),总有效率为95.60%。结论 曲霉菌和念珠菌属是引起外耳道真菌病的最常见病原体,清除真菌团块后应用敏感性抗真菌药,临床疗效较好。     

100例真菌性鼻窦炎的病原菌分析

目的：探讨引起真菌性鼻窦炎的致病真菌及与临床的关系，为临床医师提供诊断依据，指导治疗。方法：对１００例真生鼻窦炎患者，通过行鼻内窥镜手术所取的鼻腔内容物送病理诊断的同时，行标本直接涂片镜检，接种培养，菌种鉴定。结果：直接镜检并力 阳性９８例，接种培养霉菌阳性３７株，其中曲霉菌属３１株，包括烟曲霉１４株，黄曲霉１０株，构巢曲霉菌阳性９８例，接种培养养霉菌阳性３７株，分别命名为北京曲霉，齐祖同曲霉，工     

真菌特异性引物内转录片段PCR检测和培养的比较研究

目的:比较真菌特异性引物内转录片段(ITS)PCR检测方法与培养的敏感性,探讨真菌ITS PCR检测方法的敏感性与特异性及其在真菌性鼻窦炎诊断中的意义.方法:取18例临床诊断为真菌性鼻窦炎患者的鼻窦内分泌物,分别做ITS PCR及培养,比较2种方法阳性率的差异及检出真菌的相符率;同时以20例临床诊断为非真菌性慢性鼻窦炎患者鼻窦内分泌物为对照,进一步探讨ITS PCR对真菌性鼻窦炎临床诊断的意义.结果:18例真菌性鼻窦炎的标本中,ITS PCR方法检测真菌阳性的例数为14例(78%);培养法的阳性例数为8例(44%).20例慢性鼻窦炎ITS PCR方法检测阳性例数为1例(5%).结论:ITS PCR方法对于真菌性鼻窦炎的快速诊断很有价值,并能通过测序明确感染菌种,是一种高敏感性和高特异性的方法.     

免疫组织化学法在鼻窦真菌球诊断中的价值

OBJECTIVE: To study the pathogens of fungus balls in paranasal sinuses and establish an immunohistochemical test by which the main opportunistic fungi could be identified. METHODS: Twenty-five patients with fungal balls were treated by surgical removal of the fungus ball in the infected sinuses. The pathogenic fungi on the specimens were identified by means of routine PAS and immunohistochemical staining methods, and the sensitivity of the two methods were compared. RESULTS: The most commonly infected sinus was the maxillary sinus, followed by sphenoid sinus. Pathogens of fungal balls were found to be aspergillus (92%, 23/25) and candida 2 cases (8%). Aspergillus and candida albicans in infected sinuses could be specifically identified by immunostainning. There was no statistically significant differences of sensitivity between immunostainning and PAS stain. CONCLUSIONS: The main pathogen of the fungus ball was aspergillus. Immunostainning was a rapid and reliable method to identify fungi in infected tissues of paranasal sinuses. It should be widely used in the diagnosis of fungal sinusitis.     

Endoscopic sinus surgery in the isolated paranasal sinus aspergilloma

Fungal infections of the paranasal sinuses are in four clinical forms. Beside the acute fulminating form, chronic invasive form, allergic fungal sinusitis and fungus ball. Fungus ball is mostly encountered in only one paranasal sinus of an otherwise healthy person. Ten fungus balls of the paranasal sinuses are presented with their management and results.     

Fungus balls of the paranasal sinuses

Fungus balls of the paranasal sinuses represent a noninvasive manifestation of fungal sinusitis. Patients are immunocompetent but no more allergic than the general population. There is little tissue reaction to the tangled mat of hyphae. If the patient becomes immunocompromised, then the fungus ball may become invasive, as illustrated by an included case report. One hundred sixty-three additional cases of patients with paranasal sinus fungus balls are reviewed from the literature.     

Paranasal sinus fungus ball and surgery: a review of 175 cases

OBJECTIVE: To analyze the surgical results after Functional Endoscopic Sinus Surgery (FESS) in patients with paranasal sinus fungus ball. MATERIAL AND METHODS: Retrospective analysis of the results of FESS performed in 175 patients suffering from paranasal sinus fungus balls. RESULTS: All maxillary (n = 150), sphenoidal (n = 20), and ethmoidal (n = 4) locations have been treated exclusively by FESS to obtain a wide opening of the affected sinuses, allowing a careful extraction of all fungal material without removal of the inflamed mucous membrane. No major complication occurred. Postoperative care was reduced to nasal lavage with topical steroids for 3 to 6 weeks. Only 1 case of local failure have been observed (maxillary sinus, n = 1), and 6 cases of persisting of fungus ball (maxillary sinus, n = 4; frontal sinus, n = 2) with a mean follow-up of 5 years. No medical treatment (antibiotic, antifungal) was required. CONCLUSION: Surgical treatment of a fungus ball consists in opening the infected sinus cavity at the level of its ostium and removing fungal concretions while sparing the normal mucosa. No antifungal therapy is required. Finally, through this 175 patients study, FESS appears a reliable and safe surgical treatment with a low morbidity.     

Fungus balls of the paranasal sinuses: a review

In the past 30 years, thanks in part to the advance of both endoscopic technology and imaging possibilities, the classification, diagnosis, and management of rhinosinusitis caused by fungi have been better defined. These are basically divided into invasive and non-invasive forms based on the presence or absence of microscopic evidence of fungal hyphae within the tissues. Among the non-invasive fungal sinus diseases, fungus ball has been increasingly reported and large published series have allowed better characterization of the disease and the treatment strategies. Fungus ball of the paranasal sinuses is defined as the non-invasive accumulation of dense fungal concrements in sinusal cavities, most often the maxillary sinus. To describe this entity, confusing or misleading terms such as mycetoma, aspergilloma or aspergillosis would be best avoided. Clinical presentation is non-specific and the diagnosis is usually suspected on imaging studies. Surgical treatment, usually through an endonasal endoscopic approach, is curative. In this paper, we review the clinical, radiological, and pathological presentation of the fungus ball of the paranasal sinuses as well as the surgical management with emphasis on the transnasal endoscopic approach.     

Two cases with unusual mycetoma localizations in upper respiratory system

Fungus balls or mycetomas are extramucosal and noninvasive accumulations of degenerating fungal hyphae. In head and neck they may localized most frequently in the paranasal sinuses, especially in the maxillary sinus. These indolent infections are mostly caused by Aspergillus spp. In this article, we present two rare fungus ball cases: one occurring in an automastoidectomy cavity of a temporal bone and the other in a concha bullosa. Typically, both patients admitted with vague symptoms consistent with chronic infection resistant to conventional antibacterial medication.     

真菌球型真菌性鼻-鼻窦炎55例临床分析

目的:探讨真菌球型真菌性鼻-鼻窦炎的发病原因、鼻内镜手术方法及临床疗效。方法:回顾性分析55例真菌球型真菌性鼻-鼻窦炎患者的临床资料。结果:全部患者经鼻内镜手术治疗均获临床治愈,无一例出现手术并发症。随访6个月～2年,复发2例。结论:鼻腔、鼻窦局部解剖异常和局部创伤史是真菌球型真菌性鼻-鼻窦炎患者患病的主要原因。鼻内镜手术是治疗真菌球型真菌性鼻-鼻窦炎的有效手段。术后复发与术后是否定期冲洗窦腔有关。     

Aspergillosis of the frontal sinus.

Aspergillus is the most common fungal infection of the paranasal sinuses and usually appears as a chronic disease in an otherwise healthy person. Previously reported cases have involved the maxillary sinus alone in the majority of cases. To my knowledge, isolated frontal sinus aspergillosis has not been previously reported. A frontal osteoplastic flap approach was used to expose a fungus ball in the right frontal sinus of a healthy 69-year-old man. Histologic preparations and fungal cultures showed Aspergillus fumigatus. Follow-up substantiated prior experience that surgical removal of the fungal mass with drainage of the involved sinus is the treatment of choice in healthy patients with Aspergillus involving the paranasal sinuses.     

Histopathologic assessment of fungal involvement of the paranasal sinuses in Turkey

OBJECTIVE: To assess paranasal sinus material histopathologically for the presence of fungus. MATERIAL AND METHODS: Paraffin-embedded archival biopsy samples of patients who underwent endonasal sinus surgery between 1992 and 2002 were retrospectively assessed for the presence of fungi. Hematoxylin-eosin-stained sections of the materials were re-evaluated, and Gomori's methanamine silver stain was also applied as required. RESULTS: Fungus (Aspergillus) was detected histopathologically in only 21476 patients, both of whom were immunocompetent. One patient was considered to have chronic indolent sinusitis and the other allergic fungal sinusitis. CONCLUSIONS: Although histopathologic assessment is one of the most important diagnostic tools, on its own it may lead to underestimation of fungal involvement of the paranasal sinuses. Alternatively, fungal involvement of the paranasal sinuses may be very infrequent in Turkey.