Fungal rhinosinusitis of the immunocompetent host: correlation study between computed tomography scan, mycological and histopathology

Background: Fungal rhinosinusitis is a characteristic disease that requires a great deal of interest. Knowing the fungal flora, its prevalence and symptomatic presentation in patients with chronic fungal rhinosinusitis will allow a better understanding of this disease, correct diagnosis, and treatment and developing its prognosis. Clinical presentation can provide to the subcategories of fungal rhinosinusitis however, histopathological and microbiological examinations provide accurate diagnosis and classification

Patients and Methods: This study was conducted on fifty patients of chronic fungal rhinosinusitis who had been referred to otorhinolaryngology surgeon for endoscopic sinus surgery in the last 2 years in Dr. Soliman Fakeeh Hospitals in Jeddah, Kingdom of Saudi Arabia, We selected some immunocompetent chronic rhinosinusitis patients with signs and symptoms of inflammation of nasal and paranasal sinuses. These patients had positive computed tomography and /or histopathological examinations. We evaluated clinical history, otolaryngologic examination with nasal endoscopy, computed tomography scan, mycological and bacterial cultures and histopathological examinations

Results: Fungal rhinosinusitis was the cause of chronic rhinosinusitis in 16.2% of patients with chronic rhinosinusitis submitted to paranasal sinuses endoscopic surgery. Fungal cultures were positive in 60% of specimens with predominance of 63.3% Aspergillus fumigatus, 20% Aspergillus flavus, 3.33% Aspergillus niger and 13.33% Candida albicans. While 40% of patients with rhinosinusitis showed no fungal growth. Bacteriological cultures indicated there is an association of bacterial infection in 16 patients out of 50 as; Staphylococcus aureus [43.75%], Staphylococcus haemolyticus [25%], Pseudomonas aeruginosa [18.75%] and klebsiella pneumonia [12.5%]. In 28% specimens there was no bacterial growth, and in 40% specimens the bacterial examination were not performed. Mixed bacterial and fungal infections were found in 30% as the following: Staphylococcus aureus and Aspergillus fumigatus, Staphylococcus aureus and Aspergillus flavis, Pseudomonas aeruginosa and Aspergillus fumigatus, Klebsiella pneumoniae and Candida albicans, and Staphylococcus haemolyticus and Candida albicans in 33.33%, 22.22%, 22.22%, 11.22% and 11.22% respectively. According to the histopathological findings the detected types were fungal rhinosinusitis, allergic rhinosinusitis, non specific inflammation and mixed reaction in 54%, 22%, 6%, and 18% respectively. All patients presented some type of findings in paranasal sinuses by computed tomography [CT] scan were classified as 60% allergic fungal sinusitis, 34% chronic invasive fungal sinusitis, 4% fungal ball and 2% acute invasive fungal sinusitis. As regards correlation of histopathology, CT and fungal cultures results of the studied 50 patients and according to CT classification of fungal sinusitis, positive histopathological findings were found in 53.33% of cases that were classified as allergic fungal sinusitis, while positive fungal culture were seen in 40%. In chronic invasive fungal sinusitis, histopathological findings were positive in all cases [100%] while positive fungal cultures were seen in 88.23%. In acute invasive fungal sinusitis and fungal ball CT classification, both histopathology and fungal cultures were positive in all cases [100%]

Aim of work: The aim of this study is to analyze and compare the results of clinical endoscopic findings, radiological, mycological, and histological criteria for optimizing the diagnosis of true fungal sinusitis

Conclusion: Early and specific diagnosis of fungal rhinosinusitis is necessary. The traditional methods used in routine practice for the diagnosis of fungal rhinosinusitis may be insensitive and nonspecific. Moreover, the allergic fungal rhinosinusitis represents an immunologic rather than infectious disease. The optimal duration of treatment and the role of patient preferences in clinical decision making also needed to be addressed. The maximum diagnosis will be available by combining traditional culture, histopathology and radiology. In this circumstance, molecular techniques are perhaps best placed to enable rapid and accurate identification

Prevalence of extended spectrum beta-lactamases production among resistant gram negative bacteria in samples of intensive care unit patients

The rapid emergence and dissemination of antimicrobial resistant microorganisms in hospitals worldwide is a problem of crisis dimensions. Although infections caused by drug resistant bacteria can strike anyone, they are especially grave for immune-compromised patients whose such as the hospitalized in Intensive Care Units [ICUs]. Extended Spectrum beta Lactamases [ESBLs] is a neglected health care crisis that is intended to provoke a debate. This study aimed to determine the prevalence of extended spectrum beta-lactamases multidrug resistant isolates of Enterobacteriacea in all samples [urine, respiratory, surgical and body fluid, blood] collected in ICU patients at El Damardash Hospital. Also, to study the antibiogram profiles of the ESBLs organisms isolated. A total of 1065 different samples collected from patients admitted to the surgical long term care nad ICUs were cultured. The antibiogram carried out for the possible ESBLs gram negative isolatles by screening preliminary method, thereafter confirmed for Klebsiella pneumonia [K.pneumoniae], Escherichia coli [E. coli] and Proteus mirabilis [P.mirabilis]. Out of the 1065 samples the total positive urine, respiratory, surgical and blood cultures were 434, 202, 352, and 77, respectively, where 670 gram negative organisms were isolated from the urine, respiratory, surgical and body fluid and the blood specimens were 299, 164, 187 and 20, respectively. The isolated Gram negative bacteria were 273 E. coli, 114 K. pneumoniae and 20 Proteus mirabilis isolates. The Gram negative organisms isolated from the urine culture was 68.9% [299/434], 64% [190/299] of the gram negative organisms were E. coli, 13.2% [25/190] were ESBL producers, 14% [41/299] the gram negative organism isolated from urine were K. penumoniae, 9.8% [4/41] were ESBL producers. About 4% [11/299] of the gram negative organisms were P. mirabilis and they were all non ESBLs producers. As regards, the gram negative organisms isolated from the respiratory specimens were 81.2% [164/202], 12% [20/164] of the gram negative organisms were E.coli, 15% [3/20] were ESBL producers, 19.5% [32/164] of gram negative organisms were K. penumoniae, 3% [1/32] of them were ESBL producers and 1.8% [3/164] of gram negative respiratory cultures were Proteus mirabilis, 33% [1/3] were ESBL producers. ESBLs is a neglected healthcare crisis in Egypt that needs strategies to treat, prevent and control the rising rate. In addition, clinical laboratories need to have adequate funding, equipment and expertise to provide a rapid and clinically relevant antibiotic testing service. Besides, the controlled use of 3[rd] generation cephalosporin along with implementation of infection control measures are the most effective means of controlling and decreasing the spread of ESBL isolates

rapid and accurate method for prevention and control of methicillin-resistant staphylococcus aureus in the ICU

Methicillin-resistant S. aureus [MRSA] oxacillin - resistant S. aureus [ORSA] is frequently encountered in health-care settings. Early screening for MRSA nasal colonization can identify patients requiring isolation and can be part of an effective infection control program. This study aimed to provide same-day results to facilitate rapid diagnosis and therapy MRSA to avoid hospital-acquired infections. A total of 80 patients from the medical intensive care units [ICUs] of El-Demerdash Hospital, Cairo Egypt, were screened for MRSA colonization. Two nasal swabs were collected from each patient, the first vortexed in the Liquid Stuart medium and two aliquots of 200 micro l were collected from the medium and tested. For direct culture, the 200 micro l aliquot was inoculated directly onto MRSA screening medium agar plate and incubated at 35[degree sign]C for 24-48h. The other 200 micro l aliquot was first cultured in a pre-enrichment broth medium for 24 hours at 35[degree sign]C, thereafter cultured onto MRSA screening medium agar for another 24-48 hr at 35[degree sign]C. The second swab was used to screen MRSA by a qualitative real-time PCR. Sixty six swabs [82.5%] were negative by culture and real time PCR for MRSA. Fourteen swab samples [17.5%] were positive by both methods. None was positive by culture only [0%], while the PCR assay detected additional four MRSA positive specimens [i.e 5%]. The sensitivity, specificity, positive-predictive value and negative-predictive value for PCR were 100%, 93.9%, 77.8% and 100%, respectively. Real-time PCR testing of nasal specimens can be used as a rapid and reliable technique for MRSA surveillance programs in the ICUs

Bacterial recovery in hemodialysis fluids

To examine the culture method that could provide the highest bacterial recovery, 150 reverse osmosis water samples used in hemodialysis were collected for comparison of the media [Tryptic Soy Agar, TSA vs Reasoner's 2A Agar, R2A], the temperature [20oC vs 37oC], the duration of incubation [48-hour vs 7-day], and the culture technique [membrane filtration vs spread plate methods]. The European Best Practice Guideline method, R2A at 20oC for 7-day incubation provided higher bacterial recovery than the Association for the Advancement of Medical Instrumentation [AAMI] method, TSA at 37oC for 48-hour incubation. The membrane filtration method gave better yield than the spread plate method. As such, the European Best Practice Guideline method in combination with the membrane filtration technique would be the culture method of choice for hemodialysis fluids

Reverse transcriptase -polymerase chain reaction and DNA enzyme immunoassay for diagnosis of dengue fever and for dengue virus typing

In this study the use of commercially prepared reagents for detection and typing of dengue viruses from clinical samples using reverse transcriptase- polymerase chain reaction [RT- PCR] was evaluated on local dengue strains isolated in Jeddah Saudi Arabia over the period from February 1994 to July 1999. Total of 80 dengue culture confirmed cases, and 30 culture negative and IgM negative non dengue cases, and additionaly dengue virus infected, 20, and non infected, 20, tissue culture supernatants from C6/36 cell line, were used. All dengue culture positive cases were detected by RT- PCR followed by gel electrophoresis and or DNA enzyme immunoassay [DEIA], except 1 sample, which was negative by RT-PCR but was positive in culture in 1994 epidemic, with a sensitivity of 98.7% and specificity of 100%. All positive cases were correctly typed using gel electrophoresis following nested PCR and also by DEIA from first amplification product, without the need of nested PCR. This study showed that the commercially availabe reagents for extraction, RT- PCR, and detection are effective methods for the rapid and sensitive as well as specific diagnosis of dengue virus infection and are also effective in rapid typing of the infecting serotype, and that the use of DEIA in detection and typing from first amplification products is as effective as nested PCR using specific primers followed by gel electrophoresis or culture followed by antigen detection using polyclonal and monoclonal antibodies in an indirect immunofluorescent assay