Time to speed up the diagnostic evaluation in clinically suspected rhinosinusitis patients: A debate on the conventional versus molecular workup to establish fungal infective etiology for prompt management
Background and Purpose: Rhinosinusitis (RS) is a clinical and radiological diagnosis that rarely reaches a proper infective etiological diagnosis. The most dreaded fact about invasive fungal rhinosinusitis is its poor prognosis in immunocompromised patients with a 60-80% mortality rate. The present...
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| Format: | Article |
| Language: | English |
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Mazandaran University of Medical Sciences
2022-03-01
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| Series: | Current Medical Mycology |
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| Online Access: | http://cmm.mazums.ac.ir/article_143818_c602d813179ee1f77238749a0b6c1efd.pdf |
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| author | Uneza Husain Ragini Tilak Sushil Aggarwal Ketan Priyadarshi Neeraj Dhameja |
| author_facet | Uneza Husain Ragini Tilak Sushil Aggarwal Ketan Priyadarshi Neeraj Dhameja |
| author_sort | Uneza Husain |
| collection | DOAJ |
| description | Background and Purpose: Rhinosinusitis (RS) is a clinical and radiological diagnosis that rarely reaches a proper infective etiological diagnosis. The most dreaded fact about invasive fungal rhinosinusitis is its poor prognosis in immunocompromised patients with a 60-80% mortality rate. The present study highlights and compares the various diagnostic techniques to establish a fungal etiological diagnosis in clinically suspected cases of RS from nasal biopsy specimens, with the emphasis on the molecular diagnostic approach.Materials and Methods: This prospective study included a total of 34 clinically suspected cases of RS who had recently undergone functional endoscopic sinus surgery (FESS)/biopsy from nasal polyps. Various laboratory methods (microbiological and histopathological) were utilized, including direct microscopic examination of clinical samples and fungal culture isolation. The molecular detection method of polymerase chain reaction (PCR) from clinical samples was also explored simultaneously. Serum immunoglobulin-E (IgE) testing of patients was also performed.Results: Out of 34 clinically suspected RS cases, fungal etiology was established in a total of 18 cases, 17 of whom were culture-proven. A total of 15 and 14 culture-proven cases were also detected on direct microscopic examination by potassium hydroxide (KOH) mount and histopathological staining, respectively. One case was additionally identified by molecular method. Aspergillus flavus complex was the most common pathogen isolated in culture. Allergic fungal RS was the most common type, followed by acute and chronic invasive types among all fungal RS cases.Conclusion: Accurate and prompt etiological diagnosis of fungal RS is still lagging with fewer options for quick results. Although microscopy and culture isolation can’t be replaced, PCR is a sensitive and specific method that should be incorporated as a supplementary tool for the early diagnosis and management, considering the delayed growth of fungi. |
| first_indexed | 2024-04-11T04:10:44Z |
| format | Article |
| id | doaj.art-622e267a9af54c169ed251a366ef936a |
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| issn | 2423-3439 2423-3420 |
| language | English |
| last_indexed | 2024-04-11T04:10:44Z |
| publishDate | 2022-03-01 |
| publisher | Mazandaran University of Medical Sciences |
| record_format | Article |
| series | Current Medical Mycology |
| spelling | doaj.art-622e267a9af54c169ed251a366ef936a2023-01-01T06:41:51ZengMazandaran University of Medical SciencesCurrent Medical Mycology2423-34392423-34202022-03-01811610.18502/cmm.8.1.9207143818Time to speed up the diagnostic evaluation in clinically suspected rhinosinusitis patients: A debate on the conventional versus molecular workup to establish fungal infective etiology for prompt managementUneza Husain0Ragini Tilak1Sushil Aggarwal2Ketan Priyadarshi3Neeraj Dhameja4Department of Microbiology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, IndiaDepartment of Microbiology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, IndiaDepartment of Otorhinolaryngology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, IndiaDepartment of Microbiology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, IndiaDepartment of Pathology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, IndiaBackground and Purpose: Rhinosinusitis (RS) is a clinical and radiological diagnosis that rarely reaches a proper infective etiological diagnosis. The most dreaded fact about invasive fungal rhinosinusitis is its poor prognosis in immunocompromised patients with a 60-80% mortality rate. The present study highlights and compares the various diagnostic techniques to establish a fungal etiological diagnosis in clinically suspected cases of RS from nasal biopsy specimens, with the emphasis on the molecular diagnostic approach.Materials and Methods: This prospective study included a total of 34 clinically suspected cases of RS who had recently undergone functional endoscopic sinus surgery (FESS)/biopsy from nasal polyps. Various laboratory methods (microbiological and histopathological) were utilized, including direct microscopic examination of clinical samples and fungal culture isolation. The molecular detection method of polymerase chain reaction (PCR) from clinical samples was also explored simultaneously. Serum immunoglobulin-E (IgE) testing of patients was also performed.Results: Out of 34 clinically suspected RS cases, fungal etiology was established in a total of 18 cases, 17 of whom were culture-proven. A total of 15 and 14 culture-proven cases were also detected on direct microscopic examination by potassium hydroxide (KOH) mount and histopathological staining, respectively. One case was additionally identified by molecular method. Aspergillus flavus complex was the most common pathogen isolated in culture. Allergic fungal RS was the most common type, followed by acute and chronic invasive types among all fungal RS cases.Conclusion: Accurate and prompt etiological diagnosis of fungal RS is still lagging with fewer options for quick results. Although microscopy and culture isolation can’t be replaced, PCR is a sensitive and specific method that should be incorporated as a supplementary tool for the early diagnosis and management, considering the delayed growth of fungi.http://cmm.mazums.ac.ir/article_143818_c602d813179ee1f77238749a0b6c1efd.pdfclinically suspected rhinosinusitisfungal rhinosinusitislaboratory diagnosismolecular detectionnasal tissue |
| spellingShingle | Uneza Husain Ragini Tilak Sushil Aggarwal Ketan Priyadarshi Neeraj Dhameja Time to speed up the diagnostic evaluation in clinically suspected rhinosinusitis patients: A debate on the conventional versus molecular workup to establish fungal infective etiology for prompt management Current Medical Mycology clinically suspected rhinosinusitis fungal rhinosinusitis laboratory diagnosis molecular detection nasal tissue |
| title | Time to speed up the diagnostic evaluation in clinically suspected rhinosinusitis patients: A debate on the conventional versus molecular workup to establish fungal infective etiology for prompt management |
| title_full | Time to speed up the diagnostic evaluation in clinically suspected rhinosinusitis patients: A debate on the conventional versus molecular workup to establish fungal infective etiology for prompt management |
| title_fullStr | Time to speed up the diagnostic evaluation in clinically suspected rhinosinusitis patients: A debate on the conventional versus molecular workup to establish fungal infective etiology for prompt management |
| title_full_unstemmed | Time to speed up the diagnostic evaluation in clinically suspected rhinosinusitis patients: A debate on the conventional versus molecular workup to establish fungal infective etiology for prompt management |
| title_short | Time to speed up the diagnostic evaluation in clinically suspected rhinosinusitis patients: A debate on the conventional versus molecular workup to establish fungal infective etiology for prompt management |
| title_sort | time to speed up the diagnostic evaluation in clinically suspected rhinosinusitis patients a debate on the conventional versus molecular workup to establish fungal infective etiology for prompt management |
| topic | clinically suspected rhinosinusitis fungal rhinosinusitis laboratory diagnosis molecular detection nasal tissue |
| url | http://cmm.mazums.ac.ir/article_143818_c602d813179ee1f77238749a0b6c1efd.pdf |
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