Prevalence of Non-invasive Fungal Rhinosinusitis in Elderly in Rural Community Hospitals

非侵襲性黴菌鼻竇炎在鄉村地區醫院高齡族群之盛行率

林鼎勝(Ding-Sheng Lin) ； 鍾育延(Yu-Yen Chung) ； 溫永頌(Yong-Rong Wun) ； 蕭信昌(Hsin-Chang Hsiao) ； 陳穆寬(Mu-Kuan Chen)

《台灣耳鼻喉頭頸外科雜誌》 50卷4期 (2015/12) Pp. 211-218

https://doi.org/10.6286/2015.50.4.211

摘要

背景：隨著內視鏡手術的發展與組織學的進步，有愈來越多的鼻部黴菌感染被診斷出來。根據我們的臨床經驗，在西螺的彰基雲林分院接受功能性鼻竇內視鏡手術的病人，有較高的黴菌感染比率。西螺鎮是台灣最主要的蔬菜生產地。這裡的農夫通常會使用雞糞當作有機肥料來增加收穫，因此我們認為這些有機肥料是黴菌感染的來源。方法：我們收集從2010年1月至2014年6月在彰基二林分院(二林鎮 彰化縣)和彰基雲林分院(西螺鎮 雲林縣)因為初次診斷為鼻竇炎而接受功能性鼻內視鏡的患者，來調查黴菌感染的情形，且利用logistic regression analysis, the Student t-test與the chi-square test等方法來統計分析，有顯著差異為 p ＜0.05。結果：總共收集了303名患者，其中共有38名藉由組織學證實有非侵襲性黴菌感染(12.5%)。我們發現住在西螺鎮的患者較二林地區有較高的黴菌感染率22.5% ( p = 0.041)。但是adjusted multiplelogistic regression analysis卻無統計上的顯著差異( p = 0.072)，而唯一有統計上顯著差異的是診斷的年齡(＞50 years) ( p = 0.025)。結論：根據這些結果，我們發現在西螺地區與二林地區兩者黴菌感染率雖有差別但是並無達到統計意義。兩者醫院無論在分開及合併唯一有顯著差異的為年齡(＞50 years) ( p = 0.025)。推論在鄉村地區若是初次診斷為鼻竇炎的年紀越大，越容易得到非侵襲性的黴菌感染。更廣大的區域研究需要被用來證實我們發現是否可以應在其他鄉村地區甚至是都市地區。

關鍵字

慢性鼻-鼻竇炎 ； 功能性鼻竇內視鏡手術 ； 非侵襲性黴菌感染 ； 鄉村地區

並列摘要

BACKGROUND: With the development of endoscopic sinus surgery and improvements in histologic detection, fungal rhinosinusitis is increasingly diagnosed. In our clinical experience, we have observed a higher percentage of non-invasive fungal rhinosinusitis in patients with chronic rhinosinusitis (CRS) undergoing functional endoscopic sinus surgery (FESS) in Yunlin Christian Hospital, Siluo Township, Yunlin County, Taiwan. Siluo is the major location for vegetable production in Taiwan, and the cultivation of vegetables is localized to specialized production areas. Farmers usually use ings as an organic fertilizer in order to gain more harvest. We hypothesized that organic fertilizer is the source of fungal infection. METHODS: A retrospective case-control study of 303 patients were identified to have undergone FESS in Yunlin Christian Hospital(Siluo Township, Yunlin County, Taiwan) and Erhlin Christian Hospital (Erhlin Township, Changhua County, Taiwan).The data collected included age at presentation to the hospital, sex, township of residence, and coronal CT scans. Statistical analyses were performed by using logistic regression analysis, the Student t-test, and the chi-square test. The level of statistical significance was set at p ＜ 0.05. RESULTS: In our study, the non-invasive fungal rhinosinusitis rate was 12.5% in patients with CRS undergoing FESS. Patients with CRS residing in Siluo Township (22.5%) were found to have a significantly higher incidence of non-invasive fungal rhinosinusitis compared to patients residing Erlin Township(11.0%) ( p = 0.041). However, in the adjusted multiple logistic regression analysis, the geographic region of patient residence was not found to be a contributing significant independent risk factor of non-invasive fungal rhinosinusitis ( p = 0.072). The only contributing factor we found was the age (＞50 years) at presentation ( p = 0.025). CONCLUSION: In this study, although patients with CRS residing in Siluo Township have a higher incidence of non-invasive fungal rhinosinusitis compared to patients residing Erlin Township, but there was no significant difference between these two area in the adjusted multiple logistic regression analysis. The only contributing factor we found was the age (＞50 years) at presentation ( p = 0.025). When older patients in rural area are diagnosed with CRS, they tended to have a higher rate of non-invasive fungal infection. Microbiological analysis of the organic fertilizer as the proposed source of fungal infection must be carried out. Further studies in a broader geographic region areas required to confirm if this finding can be applied to other rural or urban areas.

並列關鍵字

chronic rhinosinusitis ； functional endoscopic sinus surgery ； non-invasive fungal infection ； rural areas