ABSTRACT
Objective::To assess the efficacy of Wenyang Huashi prescription on rehabilitation of patients after allergic fungal rhinosinusitis (AFRS) operation, and its effect on inflammatory factors and immune function. Method::One hundred and forty-four patients were randomly divided into control group and observation group by random number table, with 72 cases in each group. Patients in control group was treated with Messerklinger to remove lesions completely, and got anti-infective therapy for three days, prednisone acetate tablets, 10 mg/time, 2 times/days, fluticasone propionate inhaled aerosol for a continued 4 weeks, 2 sprays/time, 1 time/day, itraconazole capsules at the first, fifth and ninth week after treatment (one course of treatment was 7 days), 0.2 g/time, 1 time/day. In addition to the therapy of meloxicam tablets, patients in observation group were also given local rinsing and oral administration of Wenyang Huashi prescription. The courses of treatment of both groups were 12 weeks. Before the operation and at the fourth and 12th week after the operation, subjective conditions were assessed. And before the operation and at the 12th, 24th and 48th week after the operation, Lund-Kennedy detected by endoscopic sinus surgery and nasal and paranasal sinus outcomes test-20 (SNOT-20) were scored. And the relapse was recorded during 48 weeks after the operation. And levels of tumor necrosis factor-alpha (TNF-alpha), interleukin-1bet (IL-1bet), nuclear factor kappa B (NF-kappa B), intercellular adhesion molecule in peripheral blood-1 (ICAM-1), T lymphocyte subsets (CD3+, CD4+, CD8+ and CD4+ /CD8+) were detected. Result::By rank sum test, the clinical efficacy in observation group was better than that in control group (Z=2.016, P<0.05). At the fourth and 12th week after the operation, scores of nasal obstruction, dizziness, runny nose and dysosmia in observation group were lower than those in control group (P<0.01). And scores of lund-kennedy and SNOT-20 were lower than those in control group (P<0.01). And levels of TNF-α, IL-1β, NF-κB and ICAM-1 were lower than those in control group (P<0.01). After treatment, levels of CD3+, CD4+ /CD8+ and CD4+ were higher than those in control group, and level of CD8+ was lower than that in control group (P<0.05). During the one-year follow-up, the relapse rate in observation group was 7.81%(5/64), which was lower than 22.58%(14/62) in control group (χ2=5.363, P<0.05). Conclusion::Wenyang Huashi prescription can improve short-term and long-term symptoms, improve the comprehensive curative effect, the quality of life and the immune function of the body, alleviate inflammatory injury, reduce the recurrence rate and improve the prognosis, and so is worth further study and use.
ABSTRACT
Purpose: Chronic rhinosinusitis (CRS) is a widely prevalent condition globally as well as in India. The spectrum of fungal involvement in CRS runs from benign colonisation to potentially life-threatening invasive disease. Successful treatment of such mycotic infections largely depends on the accurate identification of the pathogen, early and appropriate intervention by surgical clearance, supported with antifungal medication as per standard regimen. Thus, this study was undertaken to determine the prevalence of fungal rhinosinusitis (FRS), and to analyse its clinicomycological profile. Materials and Methods: Fifty-two patients with clinical suspicion of CRS attending a tertiary care hospital during a one-year period were included in this retrospective analysis. The sinonasal specimens were subjected to microscopy by KOH mount and fungal culture as per standard mycological technique. Tissue specimens were also subjected to histopathological examination. Results: Male to female ratio was 1.25:1; age varied from 14 years to 62 years with majority of patients (37%) belonging to age group 21-40 years. The prevalence of FRS was 44%, and 74% of it was caused by Aspergillus sp. Aspergillus flavus (A. flavus) (52%) was the most prevalent fungus isolated. Allergic fungal rhinosinusitis (AFRS) was the most common presentation (79%). Conclusion: FRS is a continuous spectrum of disease varying in presentation, treatment and long-term sequelae. Correct identification of the fungus remains essential for appropriate treatment.
ABSTRACT
Curvularia inaequalis (Shear) Boedijn is a fungus dematiaceo, saprophyte and plant pathogen found mainly in tropical and subtropical areas, associated with various organic substrates. Rarely been identified in systemic infections, skin and there is only one report of allergic rhinosinusitis described above. A case of allergic fungal rhinosinusitis by Curvularia inaequalis (Shear) Boedijn in which diagnosis was considered the signs and symptoms, sinus CT and cultivation of mucin.The patient was treated with endoscopic surgical toilet, plus use of inhaled steroids and itraconazole systemic. With good clinical response, is asymptomatic at one year.
Curvularia inaequalis (Shear) Boedijn es un hongo dematiáceo, saprófito y fitopatógeno, presente principalmente en áreas tropicales y subtropicales, asociado a distintos sustratos orgánicos. Se ha identificado escasamente en infecciones sistémicas, cutáneas y sólo existe una comunicación de un caso de rinosinusitis alérgica descrito anteriormente. Presentamos el caso clínico de un paciente con una rinosinusitis alérgica fúngica por Curvularia inaequalis (Shear) Boedijn en cuyo diagnóstico se consideró los síntomas y signos clínicos, la TAC de senos paranasales y el cultivo de la mucina. El paciente fue tratado con un aseo quirúrgico por vía endoscópica, además del uso de corticoesteroides inhalatorios e itra-conazol sistémico. Presentó una buena respuesta clínica, encontrándose asintomático a un año del tratamiento.