A Study on the Mycological Profile, Categorization and Antifungal susceptibility pattern of Chronic Fungal Rhinosinusitis in a Tertiary Care Hospital.

Kavitha, K (2012) A Study on the Mycological Profile, Categorization and Antifungal susceptibility pattern of Chronic Fungal Rhinosinusitis in a Tertiary Care Hospital. Masters thesis, Madras Medical College, Chennai.

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Abstract

INTRODUCTION : Rhinosinusitis is defined as the inflammation of nasal and paranasal Sinus mucosa and is associated with mucosal alterations ranging from Inflammatory thickening to gross nasal polyp formation. Rhinosinusitis is a Common disorder affecting approximately 20% of the population at some time of their lives. It has been estimated to affect approximately 23 million patients (4% of adult population)in the United States each year6. A recent survey reported that 11% of adults recalled a health professional’s diagnosis of Sinusitis. The International Classification of Diseases divides Rhinosinusitis into Acute and chronic forms according to the duration of symptoms. Acute Rhinosinusitis (ARS) lasts upto 12 weeks with complete resolution of symptoms, whereas Chronic Rhinosinusitis (CRS) persists beyond 12 weeks. Resistance to antifungals is not that commonly encountered problem .It is an emerging concern as resistance of Aspergillus spp to standard antifungals have been noted and reported. Hence, anti fungal susceptibility testing is advised for isolates causing FRS, particularly for invasive forms, chronic granulomatous forms and those occurring in mmunocompromised. Anti fungal susceptibility testing is not as simple as that of bacteria. It is tedious and costly and not routinely attempted in all laboratories .So, an attempt has been made in This study to try and compare different methods of susceptibility testing for Filamentous fungi. AIM OF THE STUDY : To isolate the fungi causing chronic fungal rhinosinusitis. To identify and speciate the fungi. To categorise the types of fungal sinusitis. To assess the risk factors favouring fungal involvement of paranasal sinuses. To study the susceptibility pattern of the fungal isolates to standard anti fungal drugs. To compare different methods of susceptibility testing for the fungal isolates. MATERIALS AND METHODS : All patients undergoing functional endoscopic sinus surgery (FESS) and/or diagnostic nasal endoscopy (DNE) were both taken under the study. Approval was obtained from the Institutional Ethical Committee before the commencement of the study. Informed consent was obtained from the study population. All patients satisfying the inclusion criteria were documented. Patients were interviewed by structured questionnaire. Exclusion criteria: Patients with symptoms of sinusitis < 12 weeks duration and age<18 years were excluded from the study. Data collection included name, age, sex, address, date of admission, diagnosis at admission, physical examination findings and Demographic profile which include H/O asthma, aspirin allergy, peripheral blood eosinophilia, Diabetes mellitus, Chronic eczema/dermatitis, COPD, Uremia/chronic kidney disease, neoplasm, immunosuppressive therapy, recurrence and injury /trauma to the sinuses. Statistical analysis were carried out using Statistical Package for Social Sciences (SPSS) and Epi-Info softwares by a statistician. The proportional data of this cross sectional study were tested using Pearson’s Chi Square analysis test and Fisher exact probability test. RESULTS : This study was conducted among a total of 380 cases of Chronic Rhinosinusitis who underwent Functional endoscopic sinus surgery and Diagnostic nasal endoscopy at the Upgraded Institute of Otorhinolaryngology during the study period. 80 cases which fulfilled the inclusion criteria were included in the study. Of the 80 cases, 43 cases were recognized as chronic fungal Rhinosinusitis. Overall incidence of FRS was 11.3% in this study. CONCLUSION : Chronic Fungal Rhinosinusitis largely impairs the active functioning of the patients in their day to day life and causes a significant morbidity and even mortality. This study was undertaken to assess the prevalence of CFRS, to isolate and identify the fungi &their sensitivity pattern to standard antifungal agents and to study the risk factors favouring CFRS in patients undergoing functional endoscopic sinus surgery and diagnostic nasal endoscopy in Rajiv Gandhi Government general hospital,Chennai. CFRS was noted in 11% of the cases in the present study. Anti fungal sensitivity testing should be done as a routine for all cases when feasible as resistant strains are emerging.In this study, all isolates were sensitive to Amphotericin B and Itraconazole by broth microdilution method & agar dilution. Though conventionally, microbroth /agar dilution is done for filamentous fungi, in this study E test and disk diffusion, (Amphotericin B 10 μg disk for Zygomycetes and Itraconazole 10 μg disk for all filamentous fungi) were found to be equally good and can be followed for routine testing. But, in life threatening invasive fungal infections, it is prudent to do microbroth/agar dilution for antifungal susceptibility testing.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Categorization ; Antifungal susceptibility pattern ; Chronic Fungal Rhinosinusitis ; Tertiary Care Hospital ; Mycological Profile.
Subjects: MEDICAL > Microbiology
Depositing User: Subramani R
Date Deposited: 02 Aug 2017 02:58
Last Modified: 02 Aug 2017 02:58
URI: http://repository-tnmgrmu.ac.in/id/eprint/1746

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