Improving the Detection of Fungi in Eosinophilic Mucin: Seeing What We Could Not See Before
Improving the Detection of Fungi in Eosinophilic Mucin: Seeing What We Could Not See Before
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DOI：
10.1177/0194599812451010
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发表时间：
2012-11-01
影响因子：
3.4
通讯作者：
Ponikau, Jens U.
中科院分区：
文献类型：
--
作者：
Guo, Canting;Ghadersohi, Saied;Ponikau, Jens U.
客观的。探讨胰蛋白酶预消化慢性鼻窦炎 (CRS) 患者粘液中 Gomori 六胺银 (GMS) 染色对真菌组织学检测的改善。研究设计。前瞻性、单组、描述性分析。设置。多机构、主题和方法。对 12 名 CRS 手术患者的 34 份鼻窦标本进行了苏木精和伊红染色、GMS 染色、胰蛋白酶消化 GMS、几丁质酶免疫荧光染色和抗链格孢染色。所有患者均接受了 23 种真菌特异性 IgE 抗体的皮肤测试、总 IgE 血清学检测和放射变应原吸附测试 (RAST)。结果。传统的 GMS 染色仅在 34 个样本中检测到了 9 个样本 (27%)。用胰蛋白酶预消化标本显着改善了真菌的可视化（31/34，91%）。几丁质酶免疫荧光使 34 个样本中的 32 个 (94%) 中的真菌可视化，抗链格孢菌使 34 个样本中的 33 个 (97%) 可视化。 12 名患者中只有 8 名 (75%) 有可检测到的过敏。结论。该报告描述了对传统 GMS 染色剂的简单修改，可以显着改善真菌在组织学上的可视化，并解释了先前研究中检测不足的原因。这些新颖、更灵敏的组织学方法揭示了过敏性和非过敏性 CRS 患者的嗜酸性粘蛋白中存在真菌，进一步质疑 IgE 介导的病理生理学的关键作用。
Objective. To investigate the improvement in histologic detection of fungi with Gomori methenamine silver (GMS) stain by trypsin predigestion in the mucus of patients with chronic rhinosinusitis (CRS).Study Design. Prospective, single group, descriptive analysis.Setting. Multi-institutional.Subjects and Methods. Thirty-four sinus specimens from 12 surgical patients with CRS were stained with hematoxylin and eosin, GMS stain, GMS with trypsin digestion, immunofluorescence stains for chitinase, and anti-Alternaria. All patients received skin testing, total IgE serology, and radioallergosorbent tests (RAST) for 23 fungal-specific IgE antibodies.Results. The conventional GMS stain detected fungi in only 9 of 34 (27%) specimens. Predigesting the specimen with trypsin dramatically improved the visualization of fungi (31/34, 91%). The chitinase immunofluorescence visualized fungi in 32 of 34 (94%), and anti-Alternaria visualized 33 of 34 specimens (97%). Only 8 of 12 (75%) patients had detectable allergies.Conclusions. This report describes a simple modification of the conventional GMS stain that can significantly improve the visualization of fungi on histology and explains the lack of detection in previous studies. These novel, more sensitive histologic methods reveal the presence of fungi within the eosinophilic mucin in allergic and also nonallergic CRS patients, further questioning a crucial role of an IgE-mediated pathophysiology.