Improving the detection of fungi in eosinophilic mucin

Seeing what we could not see before

Canting Guo, Saied Ghadersohi, Gail M. Kephart, Roger A. Laine, David A. Sherris, Hirohito Kita, Jens U. Ponikau

Research output: Contribution to journalArticle

17 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)943-949
Number of pages7
JournalOtolaryngology - Head and Neck Surgery (United States)
Volume147
Issue number5
DOIs
StatePublished - Nov 2012

Fingerprint

Methenamine
Mucins
Fungi
Coloring Agents
Trypsin
Immunoglobulin E
Alternaria
Chitinases
Fluorescent Antibody Technique
Radioallergosorbent Test
Serology
Mucus
Hematoxylin
Eosine Yellowish-(YS)
Digestion
Histology
Hypersensitivity
Skin
Antibodies

Keywords

  • CRS
  • Eosinophil
  • Fungi
  • GMS
  • Gomori methenamine silver
  • Rhinosinusitis
  • Sinusitis

ASJC Scopus subject areas

  • Otorhinolaryngology
  • Surgery
  • Medicine(all)

Cite this

Improving the detection of fungi in eosinophilic mucin : Seeing what we could not see before. / Guo, Canting; Ghadersohi, Saied; Kephart, Gail M.; Laine, Roger A.; Sherris, David A.; Kita, Hirohito; Ponikau, Jens U.

In: Otolaryngology - Head and Neck Surgery (United States), Vol. 147, No. 5, 11.2012, p. 943-949.

Research output: Contribution to journalArticle

Guo, Canting ; Ghadersohi, Saied ; Kephart, Gail M. ; Laine, Roger A. ; Sherris, David A. ; Kita, Hirohito ; Ponikau, Jens U. / Improving the detection of fungi in eosinophilic mucin : Seeing what we could not see before. In: Otolaryngology - Head and Neck Surgery (United States). 2012 ; Vol. 147, No. 5. pp. 943-949.
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abstract = "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.",
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