5例真菌性鼻窦炎临床及实验研究

摘要

目的：报道5例丝状真菌所致真菌性鼻窦炎病例。方法分析5例鼻窦炎患者临床资料,对患者鼻分泌物或鼻黏膜进行真菌直接镜检和培养,对培养获得菌株进行形态学和分子生物学鉴定。结果结合真菌直接镜检、培养和分子生物学方法,确定致病真菌为茄病镰刀菌、烟曲霉、黄曲霉、波氏假阿利什霉和萝卜镰刀菌。4例患者采用鼻内窥镜手术治疗,1例患者采用伏立康唑、两性霉素 B 控制病情,效果均良好。结论真菌性鼻窦炎致病真菌多样,分子生物学可做准确鉴定,鼻内镜手术治疗效果良好。%Objective To report five cases of nasal sinus mycoses caused by filamentous fungi and related laboratory inves-tigation.Methods Analyze five clinical cases of nasal sinusitis.Direct smear examination,fungal culture,PCR and sequence a-nalysis were performed for diagnosis.Results Morphological study could not identify fungi to species level but sequences a-nalysis can identify the 5 isolates as Fusarium solani ,Aspergillus fumigatus ,Aspergillus flavus ,Pseudallescheria boydii , Fusariam napiforme .Endoscopic surgeries were applied to 4 patients;1 patient received voriconazole and amphotericin B therapy;treatments were effective to all patients.Conclusions Nasal sinus mycoses could be cause by various fungi.Molecular Biology can identify pathogens to species level,and endoscopic surgery is a reliable treatment for nasal sinus mycoses.