Physical examination should be complemented by full nasal endoscopy. Necrotic areas or sites of mucosal ulceration should be biopsied for immediate frozen section analysis (22). The presence of characteristic fungal hyphae invading the tissue confirms the diagnosis. The hyphae of zygomycetous fungi are broad and irregularly branched and have rare septations. This is in contrast to the hyphae of Aspergillus, which are narrow and have regular branching and septations. Special stains and fungal cultures can identify the species; however, these studies take too long to be of use in the initial management. Furthermore, these pathogens are notoriously difficult to culture.
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The term vaginitis is one that is applied to any inflammation or infection of the vagina, and there are many different conditions that are categorized together under this ‘broad’ heading, including bacterial vaginosis, trichomoniasis and non-infectious vaginitis.