Clinical Mycological Analysis Of Fungal Rhinosinusitis

Objective: To study the types of main pathogenic bacteria of fungal rhino-sinusitis and the significance of mycological examination in guiding clinical treatment and diagnosis.Methods: The paranasal sinus contents of patients with fungal rhino-sinusitis diagnosed in our hospital from May 2018 to September 2019 were collected by functional endoscopic surgery for smear microscopic examination,fungal culture,molecular identification and histopathological examination.At the same time,general data such as age and sex of the patients were collected.Sex and age distribution,smear microscopic examination,fungal culture,molecular identification and histopathological examination of patients with fungal rhino-sinusitis were analyzed.Results: In this study,there were a total of 30 patients,including 11 male patients and 19 female patients,with a male to female ratio of about 1:1.73.The patients ranged in age from 22 to 72 years,with an average age of 49.7 years.There were 2 patients aged 21-30 years old(6.7%).There were 3 patients aged 31-40 years old(10.0%).There were 10 patients aged 41-50 years old(33,3%),5 patients aged 51-60 years,accounting for 16.7%;patients over 60 years old were 10 patients,accounting for 33.3%.Most of the patients(83.3%)were aged 40 years or older.Hyphae or spores were observed by KOH smear microscopy in 15 patients with a positive rate of 50.0%.Hyphae or spores were observed by fluorescence staining microscopy in 27 patients with a positive rate of 90.0%.Fungal colony formation was observed in the fungal culture of 9 patients,and the positive rate was about 30%,including 5 cases of aspergillus(55.6%)and 4 cases of scedosporium apiospermum(44.4%),respectively,and 1 case of aspergillus fumigosa and 1 case of aspergillus flavus could be clearly identified in aspergillus.The molecular identification of23 patients identified pathogenic bacteria,with a positive rate of 76.7%,including 17 cases(73.9%)of aspergillus,4 cases(17.4%)of scedosporium apiospermum,2 cases(8.7%)of exophiala dermatitidis,and only 1 case of aspergillus could be clearly identified as aspergillus fumigosa.Microscopic examination and molecular identification were positive in 9 patients with positive fungal culture.The results of all three tests were negative in 2patients.Only one patient was positive for the molecular test.Among the 23 patients withpositive molecular identification,11 patients were positive by KOH smear microscopy and12 patients were negative.Fluorescence staining microscopy was positive in 22 cases and negative in 1 case.The sensitivity and specificity of KOH smear were 73.3% and 20%respectively.The sensitivity and specificity were 81.5% and 66.7% respectively.Histopathological examination of 28 patients supported the diagnosis of fungal rhino-sinusitis.Conclusion: Aspergillus is the main pathogen of fungal rhino-sinusitis.Mycological examination can play an auxiliary role in diagnosis and help to improve etiology.Correct identification of pathogenic fungi is the key to proper treatment.