Prof. Kassem Mohamed Kassem :: Publications:

Objectives: The present study aimed to evaluate the incidence of fungal elements in nasal lavage fluid obtained from immunocompetent patients with chronic rhinosinusitis (CRS) and to determine the diagnostic yield of fungal culture and polymerase reaction (PCR) detection of fungal DNA diagnostic techniques. Patients & Methods: The study included 31 patients; 23 males and 8 females with mean age of 41.5±6.8; range: 30-61 years and 9 healthy adult volunteers as control group. All patients underwent clinical examination including endoscopic evaluation of the extent of the disease and CT scan. After mucosal decongestion, patients underwent nasal lavage (NL) and collected fluid was used for detection of fungal growth on standard fungal culture media and for PCR identification of fungal DNA using panfungal PCR broad-range primers. Results: Endoscopic assessment detected bilateral disease in 10 patients; 8 patients had bilateral polypi, with a mean total endoscopic score of 6.5±1.4; range: 4-9 and mean CT score was 15.2±2.5; range: 10-20. Seventeen patients NL samples were fungal positive with a total detection rate of 54.8%. Fungal culture showed fungal growth in 8 patients NL samples with a positive detection rate of 25.8%. However, PCR fungal detection rate was 45.2% that was significantly higher compared to that reported for culture. Only 3 NL samples were culture positive/PCR negative, 5 NL samples were culture positive/PCR positive and 9 NL samples were culture negative/PCR positive. There was a positive significant correlation between PCR detection of fungal DNA and the presence of nasal polyposis and severity of disease as judged by Lund-Kennedy score of endoscopic assessment. Conclusion: Nasal lavage fluid PCR is more rapid and sensitive than standard culture in detecting the fungi in patients with fungal CRS and could be considered as an efficient method in diagnosis of fungal sinusitis. Tanta medical journal 2008