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A study on the fungal rhinosinusitis: Causative agents, symptoms, and predisposing factors
Ebrahim Taghian1, Sayed Hamidreza Abtahi2, Abdolrasoul Mohammadi1
1Department of Medical Parasitology and Mycology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.
Background:
In natural conditions, inhaled fungi are considered a part of the microflora of nasal cavities and sinuses. However, subsequent to the protracted use of corticosteroids and antibacterial agents, suppression of the immune system by chemotherapy, and poor ventilation, these fungi can become pathogens. Fungal colonization in the nose and paranasal sinuses is a prevalent medical issue in immunocompetent and immunosuppressed patients. In this study, we aimed to categorize fungal rhinosinusitis (FRS) among immunocompetent and immunosuppressed patients and identified the etiologic agents of disease by molecular methods.
Materials And Methods:
A total of 74 cases were evaluated for FRS. Functional endoscopic sinus surgery was performed for sampling. The clinical samples were examined by direct microscopy with potassium hydroxide 20% and subcultured on Sabouraud Dextrose Agar with chloramphenicol. Polymerase chain reaction sequencing was applied to identify causative agents.
Results:
Thirty-three patients (44.6%) had FRS. Principal predisposing factors were antibiotic consumption (n = 31, 93.9%), corticosteroid therapy (n = 22, 66.6%), and diabetes mellitus (n = 21, 63.6%). Eyesore (n = 22, 66.6%), proptosis (n = 16, 48.5%), and headache (n = 15, 45.4%) were the most common clinical manifestations among patients. Rhizopus oryzae (n = 15, 45.4%) and Aspergillus flavus (n = 10, 30.3%) were the most prevalent fungal species.
Conclusion:
Diagnosis and classification of FRS are crucial, and a lack of early precise diagnosis can lead to a delay in any surgical or medical management. Since there are a variety of treatments for FRS, accurate identification of etiologic agents should be performed based on phenotypic and molecular methods.
Insights
Fungal rhinosinusitis (FRS) affects both immunocompetent and immunosuppressed patients, often linked to corticosteroid use and diabetes. Early diagnosis and molecular identification of fungi like Rhizopus oryzae are key for effective treatment.
Area of Science:
- Otorhinolaryngology
- Mycology
- Infectious Diseases
Background:
- Inhaled fungi are normal nasal flora but can become pathogenic in immunocompromised individuals.
- Fungal colonization of the nose and sinuses is common in both healthy and immunocompromised patients.
- Factors like corticosteroid use, chemotherapy, and poor ventilation can predispose individuals to fungal infections.
Purpose of the Study:
- To categorize fungal rhinosinusitis (FRS) in immunocompetent and immunosuppressed patients.
- To identify the specific fungal agents causing FRS using molecular methods.
- To understand the predisposing factors and clinical manifestations of FRS.
Main Methods:
- Evaluated 74 cases for FRS.
- Collected samples via functional endoscopic sinus surgery.
- Utilized direct microscopy, fungal culture, and Polymerase Chain Reaction (PCR) sequencing for identification.
Main Results:
- 33 patients (44.6%) were diagnosed with FRS.
- Common predisposing factors included antibiotic use (93.9%), corticosteroid therapy (66.6%), and diabetes mellitus (63.6%).
- Rhizopus oryzae (45.4%) and Aspergillus flavus (30.3%) were the most frequently identified fungal species.
Conclusions:
- Accurate diagnosis and classification of FRS are critical for timely management.
- Molecular identification of causative fungal agents is essential for effective treatment strategies.
- Early and precise diagnosis can prevent delays in surgical or medical interventions for FRS.
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