真菌性鼻鼻窦炎发病相关因素及临床特征分析

目的:探究影响真菌性鼻鼻窦炎发病的有关因素,并分析其临床特征。方法:选取在我院就诊的150例真菌性鼻鼻窦炎患者及150例慢性鼻鼻窦炎患者,回顾性分析2组患者的临床资料,将两者进行对照研究,通过多因素Logistic回归分析和检验的方法,对患者的术前资料进行分析,进而探讨影响真菌性鼻鼻窦炎发病的因素及其临床特征。通过真菌特异性六胺银染色的方法,对150例真菌性鼻鼻窦炎患者进行分型。结果:以年龄(x_1)、病程(x_2)、涕血(x_3)、头痛(x_4)、单侧或双侧病变(x_5)和钙化斑(x_6)为变量,获得了真菌性鼻鼻窦炎发病的Logistic回归预测方程:y=-8.714+1.201 x_1+0.497 x_2+4.576 x_3+1.188 x_4+2.697x_5+4.118 x_6,P=exp(y)/[1+exp(y)]。与慢性鼻鼻窦炎的发病情况对比,发现真菌性鼻鼻窦炎的发生多位女性患者,年龄在40岁以上,病程在3年以内,主要症状为头痛和涕血,影像学检查有单侧病变,且有钙化斑出现(P0.05)。在150例真菌性鼻鼻窦炎患者中,慢性侵袭性46例,非侵袭性104例。结论:真菌性鼻鼻窦炎的发病可以通过其相关因素的Logistic回归预测方程进行预测,其临床表现有明显的特征性。     

尖端赛多孢子菌引起的真菌性鼻窦炎1例并文献复习

目的 探讨尖端赛多孢子菌的实验室检测方法,了解其对5种常用抗真菌药物的体外敏感性.通过对相关文献的复习,熟悉真菌性鼻窦炎的临床表现和诊治方法.方法 将1例尖端赛多孢子菌引起的真菌性鼻窦炎患者经鼻内腔镜手术切除的团块用10％ KOH压片镜检、涂片革兰染色镜检、沙堡弱培养基培养、分子生物学方法鉴定到种.分离株应用E-test进行体外药敏试验.结果 鉴定为尖端赛多孢子菌.5种药物对其MIC范围分别为:伏立康唑0.064 μg/mL,卡泊芬净1.500 μg/mL,氟康唑16.000 μg/mL,两性霉素B＞32.000 μg/mL,5-氟胞嘧啶＞32.000 μg/mL.结论 尖端赛多孢子菌引起的真菌性鼻窦炎国内少见报道,易与肿瘤相混淆;实验室检测对正确诊断起决定性作用;行鼻内腔镜下手术治疗效果较好.了解该菌的耐药性对指导抗真菌治疗尤为关键.     

Clinicopathological and Radiological Features of Chronic Rhinosinusitis with Eosinophilic Mucin in Chungcheong Province of Korea

Background

Chronic rhinosinusitis (CRS) with eosinophilic mucin is considered rare in Korea. The object of this study was to categorize CRS patients with eosinophilic mucin into several groups and compared the groups based on their clinicopathological and radiological features.

Methods

In total, 105 CRS patients with eosinophilic mucin from four tertiary medical centers which are located at Chungcheong province of Korea were included for this study. The patients were divided into four groups for analysis, based on the presence or absence of an allergy (A) to a fungus or fungal element (F) in the mucin. The following were the four groups: allergic fungal rhinosinusitis (AFRS, A+F+), AFRS-like sinusitis (A+F?), eosinophilic fungal rhinosinusitis (EFRS, A?F+), and eosinophilic mucin rhinosinusitis (EMRS, A?F?). Their clinical manifestation, the presence of associated disease, radiological finding, treatment, and treatment outcome were reviewed and compared.

Results

There were no patients in the AFRS-like sinusitis group, 47 patients were assigned to the AFRS group, 27 to the EFRS group, and 41 to the EMRS group. Patients of AFRS group showed a significantly higher association with allergic rhinitis than did the other groups. The mean total serum IgE level in the AFRS patients was significantly higher than in the EFRS and EMRS patients. In the AFRS group and EFRS group, 67.6% and 74.1% had unilateral disease, respectively, in contrast to the EMRS group (4.9%). The mean Hounsfield unit values of the area of high attenuation in the AFRS patients were significantly higher than those in the other groups.

Conclusions

Significant clinicopathological differences existed among the subgroups of CRS with eosinophilic mucin. AFRS tends to be an allergic response to colonizing fungi in atopic individuals. In EFRS, local allergies to fungi might play a role in the disease. EMRS is thought to be unconnected with fungal allergies, and it showed different form compared with the AFRS and EFRS groups.

     

Ochroconis humicola Coexisting with Esthesioneuroblastoma: An Incidental Coloniser or Allergen?

Ochroconis humicola, a fish pathogen, is rarely reported to cause disease in human. We report its first isolation from nasal tissue of a human immunodeficiency virus-positive young female patient. Histopathologically, the nasal mass was diagnosed as esthesioneuroblastoma. She presented with right-sided nasal obstruction and bleeding for two and half months. Computed tomography scan showed the nasal mass filling the whole right nasal cavity, maxillary, ethmoid and sphenoid sinuses. The direct microscopy of the nasal tissue and mucin demonstrated the presence of septate hyphae. On culture, O. humicola was isolated from the same tissue and the fungus was identified by morphologic, physiologic and molecular data including sequencing of ITS and 28S rDNA regions. No antifungal was prescribed, and the whole mass was resected out by endoscopic surgery. The patient was treated further by radical radiotherapy. After 1 year of follow-up, patient is stable with no recurrence of tumour. The role of this fungus was not clear, as it may be bystander or producing allergic fungal rhinosinusitis.     

A follow-up study of mucociliary clearance and trace element and mineral status in children with chronic rhinosinusitis before and three months after endoscopic sinus surgery

BackgroundThe existing data demonstrate the potential role of trace elements in nasal mucociliary clearance, although the association between trace element and mineral status and ciliary function in children with chronic rhinosinusitis is insufficiently studied. Therefore, the objective of the present study is evaluation of trace element and mineral status and mucociliary function in pediatric CRS patients before and after functional endoscopic sinus surgery.MethodsThe present study involved 30 children with chronic rhinosinusitis without nasal polyps. During this follow-up the patients were examined preoperatively (point 0), underwent functional endoscopic sinus surgery, and were repeatedly examined at three months postoperatively (point 1). At both points the patients were subjected to quality-of-life assessment using SNOT-20 questionnaire; endoscopic and computer tomography examination of the nasal sinuses; evaluation of ciliary function and mucosal cytology using high-speed videomicroscopy; assessment of blood count and inflammatory markers; as well as analysis of trace element and mineral levels in whole blood, serum, and hair using inductively-coupled plasma mass-spectrometry.ResultsThe obtained data demonstrate that endoscopic sinus surgery significantly improved sinonasal pathology in children with chronic rhinosinusitis, as evidenced by significantly reduced Lund-Mackay, Lund-Kennedy, and SNOT-20 scores. At the same time, no significant improvement of ciliary functions or mucosal cytology was observed postoperatively. Trace element status assessment demonstrated that postoperative serum Zn, whole blood Mg and Cu were significantly lower as compared to preoperative values. In contrast, serum Mn and Cr, as well as whole blood Cr and hair Se were characterized by a significant increase at three months postoperatively. Multiple linear regression analysis demonstrated that serum Zn is significantly associated with the number of ciliated cells and cell viability, whereas serum Mn and whole blood Cu concentrations are inversely associated with cell viability and ciliary length, respectively. Hair Se was found to be associated with the number of neutrophils in the mucosa biopsy.ConclusionRedistribution of trace elements and minerals may at least partially mediate prolonged recovery of mucosal ciliary function in children with chronic rhinosinusitis in three months after functional sinus surgery, although the particular mechanisms of these alterations in trace element levels are to be discovered.     

同期与分期鼻内镜手术治疗慢性泪囊炎合并慢性鼻-鼻窦炎的疗效对比研究

摘要 目的：探讨同期与分期鼻内镜手术治疗慢性泪囊炎合并慢性鼻-鼻窦炎的临床疗效。方法：回顾性分析本院2017年1月至2019年10月期间收治的76例慢性泪囊炎合并慢性鼻-鼻窦炎患者的临床资料,根据手术方式分为A组和B组,各38例。A组行分期手术（鼻腔鼻窦病变处理控制鼻腔鼻窦炎症后再行鼻内镜下泪囊鼻腔造孔术）。B组行同期手术（处理鼻腔鼻窦病变后立即行鼻内镜下泪囊鼻腔造孔术）,比较两组围术期指标、临床疗效、术后并发症发生情况,采用慢性泪囊炎生活质量量表（DQOLS）评价患者术前和术后6个月时的生活质量。结果：B组总有效率为94.74 %（36/38）,A组总有效率为92.11 %（35/38）,两组总有效率比较无明显差异（P>0.05）;B组术后并发症总发生率为13.16 %（5/38）,与A组的10.53 %（4/38）比较无明显差异（P>0.05）。两组患者术后6个月时的DQOLS各维度评分和总分均较术前升高（P<0.05）,但组间比较差异均无统计学意义（P>0.05）。B组患者住院总费用少于A组,住院时间、手术时间均短于A组（P<0.05）,两组术中出血量比较无明显差异（P>0.05）。结论：同期手术与分期手术治疗慢性泪囊炎合并慢性鼻-鼻窦炎患者具有相当的临床疗效和安全性,且对患者生活质量的改善程度亦无明显差异,但前者能够缩短手术时间、住院时间及减少住院费用。     

腹部大手术术后深部真菌感染的临床与真菌学分析

目的探讨腹部大手术术后深部真菌感染的危险因素及诊治措施。方法回顾性分析2006年1月～2009年6月期间我科腹部大手术术后合并深部真菌感染48例患者的临床和真菌学资料。结果 48例真菌感染患者共分离出56株菌株,其中白念珠菌占41.1%,是最主要的致病菌株。患者基础疾病和术后长期、多种广谱抗生素联合使用是深部真菌感染的重要因素。结论深部真菌感染是腹部大手术术后的重要并发症,白念珠菌仍然是主要病原菌。对术后患者深部真菌感染应采取积极预防、及时发现和有效治疗。     

趋化因子CCL-18 在慢性鼻- 鼻窦炎中的表达及意义

目的:分析趋化因子CCL-18在不同组织病理特征慢性鼻-鼻窦炎和正常鼻黏膜的表达差异,探讨CCL-18在慢性鼻-鼻窦炎中的表达及意义。方法:采用苏木精-伊红染色(HE),Masson染色及过碘酸-雪夫(PAS)染色对慢性鼻-鼻窦炎组织进行病理分析。采用Western blot检测CCL-18蛋白水平在不同组织病理特征慢性鼻-鼻窦炎和正常鼻黏膜组织中的表达差异。结果:CCL-18蛋白水平在伴鼻息肉和不伴有鼻息肉慢性鼻窦炎均较正常鼻黏膜组织中显著上调(P<0.05)。CCL-18蛋白水平在嗜酸性粒细胞慢性鼻窦炎的表达水平明显高于非嗜酸性粒细胞慢性鼻窦炎(P<0.05)。腺体型,纤维炎症型及水肿型慢性鼻-鼻窦炎中CCL-18表达水平均高于正常鼻黏膜,以水肿型表达最为显著(P<0.05)。结论:CCL-18在嗜酸性粒细胞和水肿型慢性鼻窦炎中高度表达,提示CCL-18可能参与慢性鼻-鼻窦炎中嗜酸性粒细胞的浸润这一基本病理过程。     

Bacterial biofilms in patients with chronic rhinosinusitis

The possible presence of biofilms was examined in mucosal specimens of 15 patients, undergoing functional endoscopic sinus surgery or a modified Caldwell-Luc approach for chronic rhinosinusitis (CRS). Biofilms were found in 7 of the 15 patients, positive cultures being obtained in most samples, which supports the role of biofilms as an important factor in the pathogenesis of CRS.     

Update on allergic fungal rhinosinusitis

The combination of nasal polyposis, crust formation, and sinus cultures yielding Aspergillus was first noted in 1976 by Safirstein, who observed the clinical similarity that this constellation of findings shared with allergic bronchopulmonary Aspergillosis. Eventually this disease came to be known as allergic fungal rhinosinusitis (AFRS). As clinical evidence on AFRS continues to accumulate, controversy regarding its etiology, pathogenesis, natural history, and appropriate treatment naturally has emerged. Despite past and current efforts, many of these controversies remain incompletely resolved, but continuing clinical study has illuminated some aspects of the disease and has led to an improved understanding of AFRS and its treatment. This article is intended to review current data and theories regarding the pathophysiology and clinical presentation of AFRS, as well as the role of various surgical and nonsurgical forms of therapy.     

Genome sequence of Peptoniphilus rhinitidis 1-13T, an anaerobic coccus strain isolated from clinical specimens

A new Peptoniphilus species has been isolated from samples from a patient who was scheduled for endoscopic sinus surgery for chronic rhinosinusitis. The isolate, Peptoniphilus rhinitidis 1-13(T) (KCTC 5985(T)), can use peptone as a sole carbon source and produce butyrate as a metabolic end product. This is the first report of the draft genome sequence of a novel species in the genus Peptoniphilus within the group of Gram-positive anaerobic cocci.     

The effect of nasal polyposis related nasal obstruction on cognitive functions

Chronic rhinosinusitis with nasal polyposis is a chronic inflammatory disease of the respiratory mucosa of the nasal cavity and paranasal sinuses. The aim of this study was investigate the effect of nasal obstruction related to chronic rhinosinusitis with nasal polyposis on cognitive functions. Patients with chronic rhinosinusitis with nasal polyposis causing bilateral total or near total nasal obstruction were enrolled in the study. Symptoms of nasal congestion, loss of smell, postnasal drip, headaches, snoring, concentration difficulties and blunted affect were evaluated by Visual Analog Scale. Brief symptom inventory test, Stroop test, visual aural digit span, serial digit learning test and P300 test were used to evaluate cognitive functions. Three months after treatment, the tests done before surgery were repeated and the results were compared. A total of 30 patients were included in the study. On the Visual Analog Scale, all symptoms showed significant postoperative improvement in all patients (p?<?0.001 for all symptoms). Preoperative nasal congestion accompanied with impaired concentration were detected in 27 patients (90%), and these symptoms recovered in all these patients after treatment (p?=?0.035) (correlation coefficient 0.4). Only 22 patients completed the neuropsychological tests. The mean preoperative Stroop test (23.16?±?5.30), visual aural digit span test (24.68?±?3.52), and serial digit learning test (16.18?±?5.35) scores were showed significant improvement compared with mean postoperative Stroop test (21.12?±?5.69), visual aural digit span test (26.45?±?2.98), and serial digit learning test (19.31?±?4.47) scores (p?=?0.047, p?=?0.022, p?=?0.005 respectively). The postoperative P300 latency values improved in 19 (63%) patients. The preoperative and postoperative latency values for P300 showed a significant difference (p?=?0.029), whereas the preoperative and postoperative amplitude values for P300 did not differ (p?=?0.096). In conclusion, the results of this study indicate that chronic rhinosinusitis with nasal polyposis (CRSwNP) has negative effects on cognitive functions, such as the ability to focus and maintain concentration. These cognitive functions improve after the patients undergo endoscopic sinus surgery to treat their CRSwNP.     

Identification and incidence of fungal strains in chronic rhinosinusitis patients

The fungal revolution taking place in otorhinology inspired us to study the frequency of occurrence of fungi in the nasal mucus of chronic rhinosinusitis (CRS) patients (with or without polyposis) in order to evaluate the incidence of eosinophilic fungal sinusitis in CRS patients. Ninety-six samples were examined from patients with CRS. In 74 cases mucus was collected non-invasively, and in 22 cases during operation. The Gram-stained direct smears of all samples were also evaluated. Bacteria and fungi colonizing in the mucus were detected by culturing method. The control group consisted of 50 healthy volunteers. Typical aerobic pathogenic bacteria could be isolated from 34 patients. Fifty-seven aerobic bacteria were isolated, i.e. 1.6 bacteria/positive patient with a maximum of 3 different bacteria/sample. The most frequently isolated bacteria were Staphylococcus aureus, Escherichia coli, Klebsiella pneumoniae, Streptococcus pneumoniae, and Haemophilus influenzae. Yeasts and moulds could be detected from 79 patients (83%): Candida albicans, Candida spp., Aspergillus spp., Cladosporium spp, and Penicillium spp. were isolated most frequently. Altogether 237 yeasts and moulds were isolated, i.e. 3.0 different fungi/positive patient, with a maximum of 5 different fungi/sample. In the control group aerobic pathogens were not isolated, only apathogenic species. Fungi were isolated from 22 healthy patients (44%). These data indicate that fungi are frequently involved in the aetiology of CRS. IgE-medicated hypersensitivity to fungal allergens could not be proven in our patients.     

Microbiocenosis of nasal mucous membrane during allergic rhinosinusitis

Overall quantity of microorganisms and their relative prevalence on nasal mucous membrane in patients with allergic rhinosinusitis are determined. Microbial flora in studied group was characterized qualitatively and quantitatively. Obtained results showed that there were changes of microbiocenosis of nasal mucous membrane during allergic rhinosinusitis and in characteristics of species in Staphylococcus genus.     

Association of the -14C/G MET and the -765G/C COX-2 gene polymorphisms with the risk of chronic rhinosinusitis with nasal polyps in a Polish population

Chronic rhinosinusitis with nasal polyps is strongly associated with other diseases, including asthma and allergy. The following study tested the association of the -765 G/C polymorphism of cyclooxygenase-2 (COX-2) encoding gene and the -14C/G polymorphism of protooncogen MET (MET) encoding gene with a risk of chronic rhinosinusitis with nasal polyps in a Polish population. One hundred ninety-five patients of chronic rhinosinusitis with nasal polyps as well as 200 sex-, age-, and ethnicity-matched control subjects without chronic sinusitis and nasal polyps were enrolled in this study. Among the group of patients, 63 subjects were diagnosed with allergy and 65 subjects with asthma, respectively. DNA was isolated from peripheral blood lymphocytes of patients as well as controls, and gene polymorphisms were analyzed by restriction fragment length polymorphism-polymerase chain reaction (RFLP-PCR). Ten percent of the samples have been confirmed by a second method single-strand conformation polymorphism (SSCP)-PCR. We reported that the -765 G/C COX-2 (odds ratio [OR] 7.79; 95% confidence interval [CI] 4.88-12.4, p<0.001) and the -14C/G MET (OR 2.83; 95% CI 1.74-4.61, p<0.001) were associated with an increased risk of chronic rhinosinusitis with nasal polyps among analyzed group of patients. Moreover, the group of patients without allergy or asthma indicated the association of the -765 C/G (OR 7.25; 95% CI 4.38-12.1, p<0.001 and OR 7.61; 95% CI 4.47-12.6, p<0.001) genotype of the COX-2 as wells as the -14C/G (OR 2.47; 95% CI 1.46-4.17, p<0.001 and OR 2.59; 95% CI 1.54-4.37, p<0.001) genotype of MET with an increased risk of chronic rhinosinusitis with nasal polyps. Finally, it was also found that the selected group of patients with allergy or asthma indicated a very strong association of the -765 G/C (OR 5.64; 95% CI 2.91-10.9 and OR 4.74; 95% CI 2.49-9.03, p<0.001, respectively) genotype of the COX-2 with an increased risk of chronic rhinosinusitis with nasal polyps. Thus, our results suggest that COX-2 and MET gene polymorphisms may have deep impact on the risk of rhinosinusitis nasal polyp formation, which may also depend on asthma or allergy. Our results showed that the -765 G/C polymorphism of COX-2 gene and the -14C/G polymorphism of the MET gene may be associated with the risk of chronic rhinosinusitis with nasal polyps in a Polish population.     

Genetic Aspects of Chronic Rhinosinusitis

Chronic rhinosinusitis (CRS) is a syndrome associated with persistent inflammation of the mucous membranes of the nose and paranasal sinuses. There are two forms of CRS: chronic rhinosinusitis with nasal polyposis (CRSwNP) and chronic rhinosinusitis without nasal polyposis (NP) (CRSsNP). Available data indicate that innate immunity, adaptive immunity, tissue remodeling, and influence of microorganisms can play a modified role in the development of CRSwNP. The genetic predisposition to the development of CRS is also possible. Today there are several groups of genes which influence the development of chronic rhinosinusitis. They include the genes associated with CFTR locus, HLA genes, genes of innate immunity, genes involved in the development of TH2-inflammatory reactions, genes responsible for tissue remodeling of paranasal sinuses, genes involved in the metabolism of arachidonic acid, genes of xenobiotic transformation, and other pro-inflammatory genes. Identification of genetic susceptibility to CRS would make it possible to develop personalized approaches for prevention, tactics, and effective treatment of chronic rhinosinusitis.     

A Rare Fungal Species,Quambalaria cyanescens,Isolated from a Patient after Augmentation Mammoplasty – Environmental Contaminant or Pathogen?

Some emerging but less common human fungal pathogens are known environmental species and could be of low virulence. Meanwhile, some species have natural antifungal drug resistance, which may pose significant clinical diagnosis and treatment challenges. Implant breast augmentation is one of the most frequently performed surgical procedures in China, and fungal infection of breast implants is considered rare. Here we report the isolation of a rare human fungal species, Quambalaria cyanescens, from a female patient in China. The patient had undergone bilateral augmentation mammoplasty 11 years ago and was admitted to Peking Union Medical College Hospital on 15 September 2011 with primary diagnosis of breast infection. She underwent surgery to remove the implant and fully recovered thereafter. During surgery, implants and surrounding tissues were removed and sent for histopathology and microbiology examination. Our careful review showed that there was no solid histopathologic evidence of infection apart from inflammation. However, a fungal strain, which was initially misidentified as “Candida tropicalis” because of the similar appearance on CHROMagar Candida, was recovered. The organism was later on re-identified as Q. cyanescens, based on sequencing of the rDNA internal transcribed spacer region rather than the D1/D2 domain of 26S rDNA. It exhibited high MICs to 5-flucytosine and all echinocandins, but appeared more susceptible to amphotericin B and azoles tested. The possible pathogenic role of Q. cyanescens in breast implants is discussed in this case, and the increased potential for misidentification of the isolate is a cause for concern as it may lead to inappropriate antifungal treatment.     

血液系统肿瘤患者侵袭性肺部真菌感染的外科手术治疗

目的探讨怀疑肺部有侵袭性真菌感染(invasivefungalinfection,IFI)的血液恶性肿瘤患者行手术切除肺部病灶的安全性及有效性。方法分析2005年4月～2009年7月之间因血液系统肿瘤合并疑似侵袭性肺部真菌感染而接受肺切除术的10名患者,总结术后并发症及死亡率来探讨手术的有效性和安全性。结果手术均在全身麻醉下进行,5例为胸廓切开术,5例为胸腔镜下手术。3例为病灶楔形切除术,7例为肺叶切除术。术后组织病理:确诊真菌感染6例(60%),慢性细菌感染1例,3例未见明确病原菌。术后4例出现并发症:3例为轻度并发症(30%),其中2例气胸后自行吸收,1例局限性肺不张;1例严重并发症为血胸(10%)。术后30d死亡率为10%。术后真菌复发率为16%。随访至2009年8月31日,中位随访时间为3.8个月(0.7～31.1个月),4例(40%)死亡,但手术相关死亡率为0%。结论手术切除不仅有助于明确诊断而且还可以清除病灶、防止IFI复发和允许进一步的免疫抑制治疗,手术本身是安全的。     

伏立康唑联合手术治愈小腿镰刀菌感染1例

目的探讨串珠镰刀菌致小腿溃疡患者临床及实验室特征。方法多次取患者溃疡分泌物作直接镜检和真菌培养,观察真菌形态学特征。取皮损组织病理活检。结果在马铃薯培养基中25℃培养均长出白色棉絮状菌落,显微镜及扫描电镜下见大分生孢子呈镰刀状,小分生孢子链生和假头状着生并存,在沙堡琼脂25℃和37℃均生长良好,经鉴定为串珠镰刀菌。组织病理学显示为慢性炎性肉芽肿改变,PAS及六胺银染色均未见真菌成分。伏立康唑联合特比萘芬治疗有效,整形外科清创植皮后治愈。结论确诊1例串珠镰刀菌引起的小腿溃疡,伏立康唑联合手术治疗皮肤镰刀菌感染疗效好。