1
|
Peng D, Li A, Kong M, Mao C, Sun Y, Shen M. Pathogenic Aspergillus Strains Identification and Antifungal Susceptibility Analysis of 452 Cases with Otomycosis in Jingzhou, China. Mycopathologia 2024; 189:30. [PMID: 38578519 DOI: 10.1007/s11046-024-00836-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 02/14/2024] [Indexed: 04/06/2024]
Abstract
OBJECTIVE To study the distribution of pathogenic Aspergillus strains of otomycosis in central China and the identification of their antifungal sensitivity. METHODS We collected external ear canal secretions clinically diagnosed as otomycosis from April 2020 to January 2023 from the Department of Otolaryngology-Head and Neck Surgery in central China. The pathogenic Aspergillus strains were identified through morphological examination and sequencing. The antifungal sensitivity was performed using the broth microdilution method described in the Clinical Laboratory Standard Institute document M38-A3. RESULTS In the 452 clinical strains isolated from the external ear canal, 284 were identified as Aspergillus terreus (62.83%), 92 as Aspergillus flavus (20.35%), 55 as Aspergillus niger (12.17%). In antifungal susceptibility tests the MIC of Aspergillus strains to bifonazole and clotrimazole was high,all the MIC90 is > 16 ug/mL. However, most Aspergillus isolates show moderate greatly against terbinafine, itraconazole and voriconazole. CONCLUSION A. terreus is the most common pathogenic Aspergillus strain in otomycosis in central China. The selected topical antifungal drugs were bifonazole and clotrimazole; the drug resistance rate was approximately 30%. If the infection is persistent and requires systemic treatment, terbinafine and itraconazole can be used. The resistance of Aspergillus in otomycosis to voriconazole should be screened to avoid the systemic spread of infection in immunocompromised people and poor compliance with treatment. However, the pan-azole-resistant strain of Aspergillus should be monitored, particularly in high-risk patients with otomycosis.
Collapse
Affiliation(s)
- Dan Peng
- Department of Otolaryngology Head and Neck Surgery, Jingzhou Hospital Affiliated to Yangtze University, Jingzhou, China
| | - Aimin Li
- Department of Pediatrics, Jingzhou Hospital Affiliated to Yangtze University, Jingzhou, China
| | - Mengdan Kong
- Department of Otolaryngology Head and Neck Surgery, Jingzhou Hospital Affiliated to Yangtze University, Jingzhou, China
| | - Chenggang Mao
- Department of Otolaryngology Head and Neck Surgery, Jingzhou Hospital Affiliated to Yangtze University, Jingzhou, China.
| | - Yi Sun
- Department of Dermatology, Jingzhou Hospital Affiliated to Yangtze University, Jingzhou, China
| | - Min Shen
- Department of Otolaryngology Head and Neck Surgery, Jingzhou Hospital Affiliated to Yangtze University, Jingzhou, China
| |
Collapse
|
2
|
Xu S, Zhang X, Yang Q, Li J, Yu Z. Identification of Microbial Community in Otomycosis by Metagenomic Next Generation Sequencing (mNGS): Potential Implication of Treatment with Terbinafine. Mycopathologia 2023; 188:995-1005. [PMID: 37723360 DOI: 10.1007/s11046-023-00791-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 08/28/2023] [Indexed: 09/20/2023]
Abstract
The present study was designed to identify the microbial community as well as to analyze its diversity by means of metagenomic Next Generation Sequencing (mNGS) in 17 patients with otomycosis treated with terbinafine in the Department of Otolaryngology of Shandong Provincial Hospital from June 2021 to June 2022, so as to evaluate the relationship between microbial community and terbinafine resistance. Those 17 patients were divided into two groups, i.e., Terbinafine Effective Group (TEG, n = 14 cases) and Terbinafine Resistance Group (TRG, n = 3 cases) according to the therapy effect, whose microbial community of secretion of external auditory canal was identified using mNGS. We found that the sequence of bacteria was significantly more than that of fungi and, whereas, the difference between the two groups of bacteria was not significant. There were significant differences in fungal community between the two groups. Aspergillus was the main pathogenic fungus of TEG patients while Malassezia was a dominant fungus in TRG patients. In conclusion, the results from this work indicate that Aspergillus terreusis is the main pathogenic fungus in this cohort of otomycosis patients and MNGS sequencing can offer comprehensive information about the microbial community of otomycosis. The fungus community dominated by Malassezia is more likely to be resistant to terbinafine, which provides certain guidance for clinical treatment of otomycosis with terbinafine.
Collapse
Affiliation(s)
- Shuai Xu
- Department of Otolaryngology, Shandong Provincial Hospital, Shandong University, Jinan, 250021, Shandong, China
| | - Xin Zhang
- Department of Otolaryngology, Shandong Provincial Hospital, Shandong University, Jinan, 250021, Shandong, China
| | - Qianqian Yang
- Department of Pathology, The First Affiliated Hospital of Soochow University, Suzhou, 215123, Jiangsu, China
| | - Jianfeng Li
- Department of Otolaryngology, Shandong Provincial Hospital, Shandong University, Jinan, 250021, Shandong, China.
| | - Zhaoyan Yu
- Department of Otolaryngology, Shandong Provincial Hospital, Shandong University, Jinan, 250021, Shandong, China.
- Dr. Michael Siu Academician Workstation, Shandong Public Health Clinical Center, Jinan, 250100, Shandong, China.
- Shandong Provincial Key Laboratory for Infectious Respiratory Diseases, Jinan, 250100, Shandong, China.
- Shandong Provincial Clinical Medical Research Center for Infectious Diseases, Shandong Public Health Clinical Center, Jinan, 250100, Shandong, China.
| |
Collapse
|
3
|
McCarty Walsh E, Hanson MB. Fungal Infections of the External Auditory Canal and Emerging Pathogens. Otolaryngol Clin North Am 2023; 56:909-918. [PMID: 37553272 DOI: 10.1016/j.otc.2023.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/10/2023]
Abstract
Fungal infections of the external auditory canal can range from common (otomycosis) to life threatening (necrotizing otitis externa). Proper identification of fungal pathogens is necessary to guide appropriate therapy, and a high index of suspicion for fungal causes of ear canal disease is critical. Fungal pathogens may be an especially important cause of ear canal disease in certain populations, including patients with diabetes, patients recently treated with antibiotics, and immunosuppressed patients. Opportunistic fungal infections of the ear canal are an emerging concern.
Collapse
Affiliation(s)
- Erika McCarty Walsh
- Department of Otolaryngology, Head and Neck Surgery, University of Alabama at Birmingham, Birmingham, AL, USA.
| | - Matthew B Hanson
- Department of Otolaryngology, SUNY Downstate Health Sciences University, Brooklyn, NY, USA
| |
Collapse
|
4
|
Singh gill GP, Panchal V, Bakshi R. Fungal otitis externa and tympanic membrane perforation. Indian J Otolaryngol Head Neck Surg 2023; 75:1-5. [PMID: 37206775 PMCID: PMC10188761 DOI: 10.1007/s12070-022-03132-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 07/13/2022] [Indexed: 11/30/2022] Open
Abstract
Introduction Otomycosis is a fungus-causing superficial infection of the external auditory canal that is common in otolaryngology practice. Though it is a worldwide infection, but is more prevalent in warm and humid regions. There has been rise in the occurrence of otomycosis in the last few years because of the extensive usage of antibiotic eardrops. Other influencing reasons for the occurrence of otomycosis is swimming, an immunocompromised host (e.g.: DM, AIDs) pregnancy, post-canal wall down mastoidectomy, tympanic membrane perforation, hearing aids and self-inflicted injuries. Methods Approval from the institutional ethics committee and penned informed agreement from all patients involved in the examination were obtained. 40 patients were included in the study, starting from 1stAugust to 30th September 2021, which emphasized on otomycosis infection with central tympanic membrane perforation. Physical findings such as whitish ear discharge and the presence of hyphae in the EAC, the ear drum, the middle ear mucosa were used to diagnose otomycosis. Result 20 patients of patched group and 20 patients of non-patched group did not visit for follow up. Data here is for patients who followed-up for 3 weeks. Any significant observation regarding statistical variation in the age, size of perforation, mycological analysis and pure tone audiometry among the two groups were not seen. Conclusion To conclude, we state that treatment with clotrimazole solution in patched group is safe in managing otomycosis with tympanic membrane perforation. Otomycosis is a fungus causing surface infection of the external auditory canal that otolaryngologists routinely diagnose by medical examination. In acute otomycosis, overgrowth of the fungus in the external auditory canal is due to increased humidity.
Collapse
|
5
|
Menu E, Filori Q, Dufour JC, Ranque S, L’Ollivier C. A Repertoire of Clinical Non-Dermatophytes Moulds. J Fungi (Basel) 2023; 9:jof9040433. [PMID: 37108888 PMCID: PMC10146755 DOI: 10.3390/jof9040433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 03/24/2023] [Accepted: 03/27/2023] [Indexed: 04/05/2023] Open
Abstract
Humans are constantly exposed to micromycetes, especially filamentous fungi that are ubiquitous in the environment. In the presence of risk factors, mostly related to an alteration of immunity, the non-dermatophyte fungi can then become opportunistic pathogens, causing superficial, deep or disseminated infections. With new molecular tools applied to medical mycology and revisions in taxonomy, the number of fungi described in humans is rising. Some rare species are emerging, and others more frequent are increasing. The aim of this review is to (i) inventory the filamentous fungi found in humans and (ii) provide details on the anatomical sites where they have been identified and the semiology of infections. Among the 239,890 fungi taxa and corresponding synonyms, if any, retrieved from the Mycobank and NCBI Taxonomy databases, we were able to identify 565 moulds in humans. These filamentous fungi were identified in one or more anatomical sites. From a clinical point of view, this review allows us to realize that some uncommon fungi isolated in non-sterile sites may be involved in invasive infections. It may present a first step in the understanding of the pathogenicity of filamentous fungi and the interpretation of the results obtained with the new molecular diagnostic tools.
Collapse
Affiliation(s)
- Estelle Menu
- Laboratoire de Parasitologie-Mycologie, IHU Méditerranée Infection, 13385 Marseille, France
- Institut de Recherche pour le Développement, Assistance Publique-Hôpitaux de Marseille, Service de Santé des Armées, VITROME: Vecteurs-Infections Tropicales et Méditerra-néennes, Aix Marseille Université, 13385 Marseille, France
| | - Quentin Filori
- INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l’Information Médicale, ISSPAM, Aix Marseille University, 13385 Marseille, France
| | - Jean-Charles Dufour
- INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l’Information Médicale, ISSPAM, Aix Marseille University, 13385 Marseille, France
- APHM, Hôpital de la Timone, Service Biostatistique et Technologies de l’Information et de la Communication, 13385 Marseille, France
| | - Stéphane Ranque
- Laboratoire de Parasitologie-Mycologie, IHU Méditerranée Infection, 13385 Marseille, France
- Institut de Recherche pour le Développement, Assistance Publique-Hôpitaux de Marseille, Service de Santé des Armées, VITROME: Vecteurs-Infections Tropicales et Méditerra-néennes, Aix Marseille Université, 13385 Marseille, France
| | - Coralie L’Ollivier
- Laboratoire de Parasitologie-Mycologie, IHU Méditerranée Infection, 13385 Marseille, France
- Institut de Recherche pour le Développement, Assistance Publique-Hôpitaux de Marseille, Service de Santé des Armées, VITROME: Vecteurs-Infections Tropicales et Méditerra-néennes, Aix Marseille Université, 13385 Marseille, France
| |
Collapse
|
6
|
Chavan RP, Ingole SM, Kanchewad Resident GS. Single Topical Application of 1% Clotrimazole Cream in Otomycosis. Indian J Otolaryngol Head Neck Surg 2022; 75:147-154. [PMCID: PMC9734867 DOI: 10.1007/s12070-022-03206-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 09/23/2022] [Indexed: 12/13/2022] Open
Abstract
Aim: To assess the clinical improvement after single dose topical application of 1% clotrimazole cream in otomycosis and follow up for recurrence at the end of first and the third month. Materials and Methods: A prospective observational study was carried out at Government Medical college hospital. Patients with KOH diagnosed fungal infection of external auditory canal were included in the study. After obtaining informed written consent from the participating patients, a detail clinical history was taken. Single topical application of 1% clotrimazole cream in otomycosis. The fungal debris was removed with the help of suction aspiration and dry mopping. A single topical application of 1% clotrimazole cream was applied under all aseptic precautions. On the 3rd day the applied cream was cleaned with help of suction under ear microscope. Patients were advised to follow up after one month and three months. During each follow up patients were assessed clinically and examined for residual fungal debris. Result: Otomycosis was seen predominantly in middle aged females, housewives and laborers by occupation. Earache was most common symptom seen in 65.2%. Unilateral involvement was seen in 89.3% cases. The most common organism isolated in otomycosis was Aspergillus niger. At the end of one month of treatment with a single dose of 1% clotrimazole cream, 102 (91.0%) patients were recovered and 10 (9.0%) patients were with persistence or recurrence of the symptoms. At the end of third month, the recovery rate was 84.8% and recurrence rate was 6.3%. Conclusion: Single topical application of 1% clotrimazole cream is effective in treating otomycosis.
Collapse
Affiliation(s)
- Reshma P. Chavan
- grid.466718.a0000 0004 1802 131XDepartment of ENT, GMC Miraj, Miraj, Maharashtra India
| | - Shivraj M. Ingole
- Department of Radiology, GGMC and Sir J.J group of Hospitals, Mumbai, Maharashtra India
| | | |
Collapse
|
7
|
Isolation, Characterization, and Antifungal Sensitivity Pattern of Fungal Species with Potential Resistance to Antifungal Drugs in Patients with Otomycosis. ARCHIVES OF CLINICAL INFECTIOUS DISEASES 2022. [DOI: 10.5812/archcid-129169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Background: Otomycosis is defined as a superficial fungal infection, accounting for about 10% of infectious otitis externa cases. Objectives: This study investigated patients with suspicious symptoms through the examination of their demographic information, isolate etiological agents, and in vitro antifungal susceptibility patterns. Methods: The samples of 170 patients with otitis externa symptoms were collected and confirmed for otomycosis by mycological examination (e.g., potassium hydroxide, methylene blue staining, and fungal culture) and molecular sequencing. In vitro antifungal susceptibility tests against miconazole, fluconazole, itraconazole, voriconazole, posaconazole, amphotericin B, and caspofungin were performed according to the Clinical and Laboratory Standards Institute (M27-A3/S4 and M38-A2). Results: Out of 170 patients, 145 subjects (85.29%) showed positive mycological findings. In this study, 55.8% of the patients were male, and the most common age group affected was 50 - 59 years (26.2%). Hearing loss and pruritus were the most common clinical manifestations. The most common occupation was being a housewife (47.5%), and most cases occurred during the winter (40%). Aspergillus niger was the most common species, followed by Aspergillus fumigatus, Candida albicans, and Candida glabrata. Caspofungin showed the highest activity against Aspergillus and Candida isolates; nevertheless, itraconazole demonstrated the lowest activity against Aspergillus isolates. Fluconazole showed the weakest power against Candida species. Conclusions: Due to climatic conditions, humidity, and dust, otomycosis has a high occurrence in Iran. Although otomycosis needs long-term antifungal therapy and recurrence is high in some cases, it is rarely life-threatening, and eardrop antifungals are usually enough to eradicate the infection. Local information about the antifungal pattern is useful for the control, prevention, and treatment of otomycosis.
Collapse
|
8
|
Krajden S, Summerbell RC, Datt A, Hawke M, Scott J. Monkey finger mycology? First case of otomycosis externa caused by Trichophyton simii after encounter with a monkey. Med Mycol Case Rep 2022; 37:17-18. [PMID: 35734193 PMCID: PMC9207075 DOI: 10.1016/j.mmcr.2022.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 05/31/2022] [Accepted: 06/05/2022] [Indexed: 11/17/2022] Open
Abstract
Unilateral ear pain, ear canal blockage and reduced hearing in an 18-year-old Canadian male who had travelled to India revealed, on examination of a swab, secretions bearing unusual fungal filaments visually suggestive of dermatophyte elements. Culture yielded Trichophyton simii, an unusual skin infecting species with a worldwide distribution but most often seen from India. The patient recalled swimming in the Ganges River but also had had his ear manipulated by a street monkey.
Collapse
Affiliation(s)
- Sigmund Krajden
- St. Joseph's Health Centre, 30 The Queensway, Toronto, ON, M6R 1B5, Canada
| | - Richard C. Summerbell
- Sporometrics, 219 Dufferin St #20c, Toronto, ON, M6K 3J1, Canada
- Dalla Lana School of Public Health, 155 College St Room 500, Toronto, ON, M5T 3M7, Canada
- Corresponding author. Sporometrics, 219 Dufferin St #20c, Toronto, ON, M6K 3J1, Canada.
| | - Aswani Datt
- St. Joseph's Health Centre, 30 The Queensway, Toronto, ON, M6R 1B5, Canada
| | - Mike Hawke
- Faculty of Medicine, University of Toronto, M5S 1A8, Canada
| | - James Scott
- Sporometrics, 219 Dufferin St #20c, Toronto, ON, M6K 3J1, Canada
- Dalla Lana School of Public Health, 155 College St Room 500, Toronto, ON, M5T 3M7, Canada
| |
Collapse
|
9
|
Isolation and identification of Aspergillus fumigatus from Immunocompromised patients in AL- Najaf Province. Int J Health Sci (Qassim) 2022. [DOI: 10.53730/ijhs.v6ns1.6240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
The present study was conducted to isolation and identification of Aspergillus fumigatus. Isolated from immunocompromised patients with (Diabetes, Cancer) by different identification methods including direct examination, laboratory culture and electron microscopy. During the period from (July to September 2016), a total of 50 swab were collected from immunocompromised patients with attending to the in AL- Sadder Medical City (the Center for Diabetes and Endocrinology) and (Euphrates middle Center for cancer diseases). In AL-Najaf Governorate, the samples were collected as following: 30 swab from the eyes of cancer patients who were suffering from prostate, leukemia, stomach and intestines cancer, also 20 swabs from the ears of diabetic patients. The percentage of female to male was as following, 29 females (58%) males and 21 (42%). In this study, the results show that the incidence of aspergillosis in women was higher than the male. The results of the present study reveal that the prevalence of aspergillosis from patient with cancer was more than diabetes patients which was 18 (66.66%) and 9 (33.33%), respectively.
Collapse
|
10
|
Gu X, Cheng X, Zhang J, She W. Identification of the Fungal Community in Otomycosis by Internal Transcribed Spacer Sequencing. Front Microbiol 2022; 13:820423. [PMID: 35369424 PMCID: PMC8965282 DOI: 10.3389/fmicb.2022.820423] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 01/26/2022] [Indexed: 11/25/2022] Open
Abstract
We used internal transcribed spacer (ITS) sequencing to identify the fungal community in otomycosis patients and to evaluate the treatment effects of bifonazole. Ten patients who visited the Department of Otolaryngology of Jiangsu Provincial Hospital on Integration of Chinese and Western Medicine from May 2020 to April 2021 were recruited. Otomycosis patients were treated with bifonazole solution once a day for 14 days. Samples collected from the external auditory canal before and after treatment (Pre-treatment, n = 14 ears; Post-treatment, n = 14 ears) were used for microscopic examination, fungal culture, and ITS sequencing. Samples collected from 10 volunteers (Control, n = 20 ears) were used as controls. The symptoms, including ear itching, aural fullness, otalgia, hearing loss, and physical signs were recorded before treatment as well as on the 7th and 14th days after treatment. Aspergillus was identified as a main pathogenic fungus by microscopic examination, fungal culture, and ITS sequencing. At the genus level, Aspergillus was more abundant in the pre-treatment group than the control and post-treatment groups, and Malassezia was more abundant in the control and post-treatment groups than the pre-treatment group. The fungal species richness and diversity reduced significantly in the pre-treatment group compared with the control and post-treatment groups. The effective rate of bifonazole was 64.29% and 100% on the 7th and 14th days after treatment, respectively. In conclusion, the results obtained from morphologic studies and ITS sequencing indicate that Aspergillus is the main pathogenic fungus of otomycosis patients in Nanjing, Jiangsu Province, China. Malassezia is the dominant resident fungi in healthy individuals. ITS sequencing provides comprehensive information about fungal community in otomycosis and is helpful in evaluating the efficacy of antifungal agents.
Collapse
Affiliation(s)
- Xiaona Gu
- Nanjing Drum Tower Hospital Clinical College of Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, China.,Department of Otolaryngology, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, China
| | - Xiangrong Cheng
- Department of Otolaryngology, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, China
| | - Jinhua Zhang
- Department of Laboratory Medicine, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, China
| | - Wandong She
- Nanjing Drum Tower Hospital Clinical College of Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, China.,Department of Otolaryngology-Head and Neck Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| |
Collapse
|
11
|
Javidnia J, Ghotbi Z, Ghojoghi A, Solhjoo K, Alshahni MM, Jeddi SA, Ahmadi B, Nouripour-Sisakht S, Ansari S, Shokoohi G. Otomycosis in the South of Iran with a High Prevalence of Tympanic Membrane Perforation: A Hospital-Based Study. Mycopathologia 2022; 187:225-233. [PMID: 35347533 DOI: 10.1007/s11046-022-00626-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 03/07/2022] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Otomycosis is a superficial infection of the external ear caused by fungal pathogens. The genera Aspergillus and Candida are considered the main fungal causative agents, with the predominance of Aspergillus section Nigri. The present study aimed to evaluate the clinical symptoms of patients with otomycosis and predisposing factors and to identify fungal etiological agents using molecular approaches. We also present an overview of published papers on tympanic membrane perforation (TMP) secondary to otomycosis. MATERIALS AND METHODS An otorhinolaryngologist collected specimens from external ear canals of patients with suspected otomycosis based on the patient's history and clinical examinations. The specimens were collected using sterile swabs. Fungal isolates were confirmed in clinical specimens by direct microscopy and culture methods. Fungal isolates were identified based on molecular approaches. RESULTS In total, specimens from 211 patients with suspected otomycosis were examined. The presence of fungi was confirmed in about 51% of patients based on fungal elements in direct microscopy and culture-positive fungi. Aspergillus tubingensis was the most commonly isolated species (52.77%), followed by Aspergillus niger (25.92%). Otomycosis due to infection with Candida species was observed in 16% of cases. Of note, in 36.11% of cases, otomycosis was associated with TMP. CONCLUSION A mycological examination is indispensable for a correct diagnosis in patients with otitis extern. TMP should be considered in patients with otomycosis, as it appears to be relatively common in this population.
Collapse
Affiliation(s)
- Javad Javidnia
- Student Research Committee Center, Mazandaran University of Medical Sciences, Sari, Iran.,Department of Medical Mycology, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Zahra Ghotbi
- Zoonosis Research Center, Jahrom University of Medical Sciences, Jahrom, Iran.,Department of Medical Parasitology and Mycology, School of Medicine, Jahrom University of Medical Sciences, Jahrom, Iran
| | - Aynaz Ghojoghi
- Department of Medical Mycology, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Kavous Solhjoo
- Zoonosis Research Center, Jahrom University of Medical Sciences, Jahrom, Iran.,Department of Medical Parasitology and Mycology, School of Medicine, Jahrom University of Medical Sciences, Jahrom, Iran
| | | | - Seyed Ali Jeddi
- Department of Laboratory Sciences, School of Allied Medical Sciences, Abadan University of Medical Sciences, Abadan, Iran
| | - Bahram Ahmadi
- Department of Medical Laboratory Sciences, Faculty of Paramedical, Bushehr University of Medical Sciences, Bushehr, Iran
| | | | - Saham Ansari
- Department of Parasitology and Mycology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Gholamreza Shokoohi
- Zoonosis Research Center, Jahrom University of Medical Sciences, Jahrom, Iran. .,Department of Medical Parasitology and Mycology, School of Medicine, Jahrom University of Medical Sciences, Jahrom, Iran.
| |
Collapse
|
12
|
Wu S, Cheng Y, Lin S, Liu H. A Comparison of Antifungal Drugs and Traditional Antiseptic Medication for Otomycosis Treatment: A Systematic Review and Meta-Analysis. Front Surg 2022; 8:739360. [PMID: 35004834 PMCID: PMC8728675 DOI: 10.3389/fsurg.2021.739360] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Accepted: 11/29/2021] [Indexed: 11/17/2022] Open
Abstract
Objectives/Hypothesis: To perform a systematic review and meta-analysis to compare the efficacy of and complications associated with antifungal drugs and traditional antiseptic medication for the treatment of otomycosis. Data Sources: The PubMed, EMBASE, GeenMedical, Cochrane Library, CBM, CNKI, VIP and other databases were searched from January 1991 to January 2021. Methods: The systematic literature review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Randomized controlled trials (RCTs) and non-randomized studies (case-control, cohort, and case series) were included to assess the topical use of antifungal drugs and traditional antiseptic medication in patients with otomycosis. The research subjects were patients who were clinically diagnosed with otomycosis and whose external auditory canal secretions were positive for fungi. Funnel plots were used to detect bias, and the Q test was used to assess heterogeneity. The random-effects model was used for meta-analysis. The t-test was used to assess significance. Results: Of the 324 non-duplicate studies screened, 16 studies met the criteria for full-text review, and 7 were included in the meta-analysis. Four studies reported recovery conditions (P = 0.01). Six common complications after medication use were compared, and there were no significant differences. The authors further conducted subgroup analysis according to complications. The differences in the rates of ear distension (P = 0.007), earache (P = 0.03) and tinnitus (P = 0.003) were statistically significant. Conclusion: The results of this meta-analysis and literature review showed that antifungal drugs and traditional antiseptic medication were effective in relieving symptoms in patients with otomycosis, and the two treatments were associated with different complications. Otolaryngologists have the option to use one medication or a combination of two drugs on the basis of the condition. Future research in this area should include RCTs with long-term follow-up to guide the development of otomycosis guidelines to overcome some of the weaknesses found in the literature. Systematic Review Registration:https://www.crd.york.ac.uk/PROSPERO/#myprospero.
Collapse
Affiliation(s)
- Shunyu Wu
- Department of Otolaryngological, Shanghai Changzheng Hospital, Shanghai, China
| | - Yin Cheng
- Department of Otolaryngological, Shanghai Changzheng Hospital, Shanghai, China
| | - Shunzhang Lin
- Department of Otolaryngological, Shanghai Changzheng Hospital, Shanghai, China
| | - Huanhai Liu
- Department of Otolaryngological, Shanghai Changzheng Hospital, Shanghai, China
| |
Collapse
|
13
|
Clinico-Mycological Profile of Otomycosis in Chronic Suppurative Otitis Media Patients Attending a Tertiary Care Teaching Hospital. JOURNAL OF PURE AND APPLIED MICROBIOLOGY 2021. [DOI: 10.22207/jpam.15.2.35] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Chronic Suppurative Otitis Media (CSOM) is commonly encountered chronic inflammation of middle ear as well as the mastoid cavity due to dysfunction of Eustachian tube followed by microbial infection. Fungal infection in CSOM is now a major otolarynological problem in India not only in children but in adults too. Excessive use of steroids, antibiotics, cytotoxic chemotherapies and immunosuppressive diseases has increased the incidence of otomycosis in recent years. To define the aetiology of clinically diagnosed otomycosis. To isolate and identify fungal agents and their association with different factors(age, sex, predisposing factors). A total of 100 clinically diagnosed patients of CSOM with suspicion of otomycosis were included in the study. Patients where passing swab is difficult as with canal stenosis were excluded. Samples were taken using sterile swabs and studied for microbial profile. Male to female ratio in study was 1.6:1. The most common fungi isolated in CSOM cases was Aspergillus fumigatus followed by Aspergillus niger. Other fungus isolated were Aspergillus flavus, Penicillium species, Mucor species and Candida species. 04 samples showed mixed growth of Aspergillus species and Candida species. In our study we concluded that Aspergillus complex was most commonly isolated fungi in CSOM cases.
Collapse
|
14
|
Jing R, Yang WH, Xiao M, Li Y, Zou GL, Wang CY, Li XW, Xu YC, Hsueh PR. Species identification and antifungal susceptibility testing of Aspergillus strains isolated from patients with otomycosis in northern China. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2021; 55:282-290. [PMID: 33839057 DOI: 10.1016/j.jmii.2021.03.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 03/15/2021] [Accepted: 03/21/2021] [Indexed: 01/22/2023]
Abstract
BACKGROUND/PURPOSE There are limited studies on species distribution and susceptibility profiles of Aspergillus strains isolated from patients with otomycosis in China. METHODS A total of 69 confirmed Aspergillus species isolates were obtained from ear swabs of patients diagnosed with otomycosis from 2017 to 2018 in northern China. Identification of these Aspergillus isolates at the species level was performed using conventional morphological methods and MALDI-TOF MS in combination with molecular sequencing, and in vitro susceptibility to nine antifungal agents was evaluated using the Sensititre YeastOne system. RESULTS The Aspergillus section Nigri had the greatest distribution of Aspergillus isolates. A. welwitschiae (n = 25) was the most predominant isolate in section Nigri, followed by A. tubingensis (n = 12) and A. niger (n = 11). Other Aspergillus species were also isolated, including A. terreus (n = 11), A. flavus/A. oryzae (n = 8), and A. fumigatus (n = 2). Amphotericin B, posaconazole, and echinocandins were highly in vitro active against all the isolates tested. 2.9% (2/69) of the isolates were resistant to azoles in our study, including one A. niger isolate with a high MIC value for itraconazole (ITR) (16 mg/L) and one A. tubingensis isolate cross-resistant to both voriconazole (VOR) (MIC >8 mg/L) and ITR (MIC >16 mg/L). One A. welwitschiae and one A. niger isolate both had increased MIC values of 4 mg/L against VOR. CONCLUSIONS A. welwitschiae was the most prevalent Aspergillus species isolated from patients with otomycosis. Our findings also indicated that the azole-resistant Aspergillus section Nigri should be utilized to guide clinical medication for Otomycosis.
Collapse
Affiliation(s)
- Ran Jing
- Department of Laboratory Medicine, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China; Graduate School, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China; Beijing Key Laboratory for Mechanisms Research and Precision Diagnosis of Invasive Fungal Diseases (BZ0447), Beijing, China
| | - Wen-Hang Yang
- Department of Laboratory Medicine, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China; Graduate School, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China; Beijing Key Laboratory for Mechanisms Research and Precision Diagnosis of Invasive Fungal Diseases (BZ0447), Beijing, China
| | - Meng Xiao
- Department of Laboratory Medicine, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China; Beijing Key Laboratory for Mechanisms Research and Precision Diagnosis of Invasive Fungal Diseases (BZ0447), Beijing, China
| | - Ying Li
- Department of Clinical Laboratory, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Gui-Ling Zou
- The Fourth Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
| | - Cheng-Ying Wang
- Daqing Oilfield General Hospital, Daqing, Heilongjiang, China
| | - Xiu-Wen Li
- Mudanjiang First People's Hospital, Heilongjiang, Mudanjiang, China
| | - Ying-Chun Xu
- Department of Laboratory Medicine, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China; Graduate School, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China; Beijing Key Laboratory for Mechanisms Research and Precision Diagnosis of Invasive Fungal Diseases (BZ0447), Beijing, China.
| | - Po-Ren Hsueh
- Department of Laboratory Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan; Department of Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan.
| |
Collapse
|
15
|
Kiakojuri K, Mahdavi Omran S, Roodgari S, Taghizadeh Armaki M, Hedayati MT, Shokohi T, Haghani I, Javidnia J, Kermani F, Badali H, Abastabar M. Molecular Identification and Antifungal Susceptibility of Yeasts and Molds Isolated from Patients with Otomycosis. Mycopathologia 2021; 186:245-257. [PMID: 33718990 DOI: 10.1007/s11046-021-00537-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Accepted: 02/17/2021] [Indexed: 11/29/2022]
Abstract
Fungal otitis externa, an infection of the external auditory canal caused by molds and yeasts, accounts for approximately 10-20% of ear canal infections accompanying high recurrence. The purpose of the current study was to assess the pattern of etiological agents of otomycosis and resistance profile as well as the rate of tympanic membrane perforation. A total of 1040 patients with symptoms of fungal otitis externa, in a period of two years, were investigated. The mycological tests revealed the presence of different fungi in 237 ears (22.8%). Fungal otitis was more related to filamentous fungi of the species Aspergillus flavus (54.43%), A. tubingensis (10.97%), and A. niger (8.86%), followed by yeasts, Candida orthopsilosis (7.59%), C. albicans (6.75%), and C. parapsilosis (5.06%). Tympanic membrane perforation rate was found to be 6.75% and was more common with otomycosis caused by A. flavus, A. tubingensis and C. albicans. In antifungal susceptibility tests, all tested drugs showed generally good activity against most isolates of molds and yeasts, while tolnaftate, clotrimazole, nystatin, and terbinafine had lowest effects. We found that among Aspergillus isolates, one A. niger isolate was resistant to voriconazole, and one A. flavus isolate was resistant to amphotericin B. Furthermore, among Candida species, three isolates of C. orthopsilosis showed high MIC values to fluconazole, two C. albicans isolates were considered fluconazole resistant and one isolate of C. parapsilosis was resistant to caspofungin and 3 isolates were resistant to fluconazole. Regarding the existence of the cases with perforated tympanic membrane and emerging species causing fungal otitis in the current report, the importance of the early physical examination, precise molecular identification, and the antifungal susceptibility evaluation is highlighted.
Collapse
Affiliation(s)
- Keyvan Kiakojuri
- Department of Ear, Nose, and Throat, Faculty of Medicine, Roohani Hospital, Babol University of Medical Sciences, Babol, Iran
| | - Saeid Mahdavi Omran
- Department of Medical Mycology, School of Medicine, Babol University of Medical Sciences, 47745-47176, Babol, Iran.
| | - Somayeh Roodgari
- Invasive Fungi Research Center, Communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran.,Department of Medical Mycology, School of Medicine, Mazandaran University of Medical Sciences, 48175-1665, Sari, Iran.,Student Research Committee, Mazandaran University of Medical Sciences, Sari, Iran
| | - Mojtaba Taghizadeh Armaki
- Department of Medical Mycology, School of Medicine, Babol University of Medical Sciences, 47745-47176, Babol, Iran
| | - Mohammad Taghi Hedayati
- Invasive Fungi Research Center, Communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran.,Department of Medical Mycology, School of Medicine, Mazandaran University of Medical Sciences, 48175-1665, Sari, Iran
| | - Tahereh Shokohi
- Invasive Fungi Research Center, Communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran.,Department of Medical Mycology, School of Medicine, Mazandaran University of Medical Sciences, 48175-1665, Sari, Iran
| | - Iman Haghani
- Invasive Fungi Research Center, Communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran.,Department of Medical Mycology, School of Medicine, Mazandaran University of Medical Sciences, 48175-1665, Sari, Iran
| | - Javad Javidnia
- Invasive Fungi Research Center, Communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran.,Department of Medical Mycology, School of Medicine, Mazandaran University of Medical Sciences, 48175-1665, Sari, Iran.,Student Research Committee, Mazandaran University of Medical Sciences, Sari, Iran
| | - Firoozeh Kermani
- Invasive Fungi Research Center, Communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran.,Department of Medical Mycology, School of Medicine, Mazandaran University of Medical Sciences, 48175-1665, Sari, Iran.,Student Research Committee, Mazandaran University of Medical Sciences, Sari, Iran
| | - Hamid Badali
- Invasive Fungi Research Center, Communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran.,Department of Medical Mycology, School of Medicine, Mazandaran University of Medical Sciences, 48175-1665, Sari, Iran
| | - Mahdi Abastabar
- Invasive Fungi Research Center, Communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran. .,Department of Medical Mycology, School of Medicine, Mazandaran University of Medical Sciences, 48175-1665, Sari, Iran.
| |
Collapse
|
16
|
Chen Q, Chu H, Tao Y, Peng L, Zhou L, Liu L, Wu X. A Comparison of Triamcinolone Acetonide Econazole Cream and Nystatin Suspension in Treatment of Otomycosis. Laryngoscope 2020; 131:E1640-E1646. [PMID: 33141477 DOI: 10.1002/lary.29190] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 09/05/2020] [Accepted: 10/05/2020] [Indexed: 11/09/2022]
Abstract
OBJECTIVES/HYPOTHESIS To compare the efficacy and adverse effects of triamcinolone acetonide econazole cream and nystatin suspension in the treatment of otomycosis, and to determine the clinical features, predisposing factors, and etiology of otomycosis. STUDY DESIGN A prospective study. METHODS A prospective clinical trial was conducted on 786 patients diagnosed with otomycosis. The study population was randomly divided into two treatment groups of triamcinolone acetonide econazole cream (TAEC) and nystatin suspension in a 1:1 ratio. After clearing all fungal deposits in the external auditory canal, the antimycotic drugs were locally applied for at least 2 weeks. The efficacy and adverse effects were compared between the two antifungal reagents by statistical analysis. Meanwhile, patient clinical data were collected to find out the clinical features, predisposing factors, and etiology. RESULTS Pruritis was the most common symptom and Aspergillus niger was the leading fungal pathogen. There was high association (44.5%) of otomycosis with a history of unclean ear picking. The cure rate was 97.6% in the TAEC group and 73.5% in the nystatin group (P < .01). Treatment with TAEC resulted in 2.4% of patients complaining of discomforts (irritant dermatitis, otalgia, or headache) versus 59.8% of patients complaining discomforts treated with nystatin (P < .01). The residue rate of antifungals was 1.9% in the TAEC group and 89.9% in the nystatin group (P < .01) at the end of treatment. CONCLUSIONS Thoroughly cleaning of the external auditory canal followed by local use of TAEC under endotoscope is an effective, convenient, and well-tolerated treatment for otomycosis. LEVEL OF EVIDENCE 1 Laryngoscope, 131:E1640-E1646, 2021.
Collapse
Affiliation(s)
- Qingguo Chen
- Department of Otolaryngology-Head and Neck Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Hanqi Chu
- Department of Otolaryngology-Head and Neck Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yanling Tao
- Department of Otolaryngology-Head and Neck Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Liyan Peng
- Department of Otolaryngology-Head and Neck Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Liangqiang Zhou
- Department of Otolaryngology-Head and Neck Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Lei Liu
- Department of Otolaryngology-Head and Neck Surgery, Tianyou Hospital Affiliated to Wuhan University of Science & Technology, Wuhan, China
| | - Xiaohui Wu
- Department of Laboratory Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| |
Collapse
|
17
|
Tasić-Otašević S, Golubović M, Đenić S, Ignjatović A, Stalević M, Momčilović S, Bojanović M, Arsić-Arsenijević V. Species distribution patterns and epidemiological characteristics of otomycosis in Southeastern Serbia. J Mycol Med 2020; 30:101011. [PMID: 32693980 DOI: 10.1016/j.mycmed.2020.101011] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2020] [Revised: 06/04/2020] [Accepted: 06/29/2020] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Otomycosis, a superficial fungal infection of the external auditory canal (EAC), is a disease with exceptionally high prevalence. AIM The aim of this study was to determine the prevalence of otomycosis, the distribution of causative species and to evaluate epidemiological characteristics of these infections. METHODOLOGY The patients' data were collected from record book and database of mycological examinations conducted at Public Health Institute Nis, Serbia. In the period from 2014 to 2018 samples of 1287 patients with symptoms and signs of EAC infection were investigated. Standard mycological methods were used for isolation and determination of fungi. RESULTS High prevalence of otomycosis was determined in examined patients (22.7%). However, the prevalence rates did not differ significantly in the studied period (p=0.931). The majority of patients were diagnosed with only unilateral EAC infection (82.9%). Considering all patients with otomycosis, mold infections caused by the genus Aspergillus (143/48.9%) were more frequent than Candida spp. ear infections (133/45.6%), with Aspergillus niger and Candida аlbicans being predominant causative agents. Mixed Aspergillus and Candida otomycosis was established in 16 (5.5%) patients. Otomycosis was more common in male subjects (26.8%, p=0.003) who also suffered from Aspergillus otomycosis more frequently (17.5%, p<0.001). The prevalence of these infections increases with age (p=0.005), while they do not show seasonal pattern (p>0.05). CONCLUSION Noted high prevalence of otomycosis, with both yeasts and non-dermatophyte molds acting as infectious agents which require different treatment, implies the necessity for further epidemiological monitoring of this form of superficial mycoses.
Collapse
Affiliation(s)
- S Tasić-Otašević
- Department of Microbiology and Immunology, Faculty of Medicine, University of Niš, Niš, Serbia; Public Health Institute Niš, Niš, Serbia.
| | - M Golubović
- Faculty of Medicine, University of Niš, Niš, Serbia; Clinic of Pediatrics, Clinical Center Niš, Niš, Serbia
| | - S Đenić
- Faculty of Medicine, University of Niš, Niš, Serbia; Center for Radiology, Clinical Center Nis, Nis, Serbia
| | - A Ignjatović
- Public Health Institute Niš, Niš, Serbia; Department of Medical Statistics, Faculty of Medicine, University of Niš, Niš, Serbia
| | - M Stalević
- Faculty of Medicine, University of Niš, Niš, Serbia
| | - S Momčilović
- Faculty of Medicine, University of Niš, Niš, Serbia; Plastic and Reconstructive Surgery Clinic, Clinical Center Niš, Niš, Serbia
| | - M Bojanović
- Faculty of Medicine, University of Niš, Niš, Serbia; Clinic of Otorhinolaryngology, Clinical Center Niš, Niš, Serbia
| | - V Arsić-Arsenijević
- Department of Microbiology and Immunology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| |
Collapse
|
18
|
Lou Z. The evaluation of endoscopic cartilage myringoplasty to repair perforations with otomycosis. Am J Otolaryngol 2020; 41:102493. [PMID: 32334921 DOI: 10.1016/j.amjoto.2020.102493] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 04/07/2020] [Accepted: 04/08/2020] [Indexed: 11/20/2022]
Abstract
OBJECTIVE We evaluated the graft success rates and hearing gains of tympanic membrane (TM) perforations with otomycosis undergoing endoscopic cartilage myringoplasty and local applications of antimycotic cream. STUDY DESIGN A prospective case series. MATERIALS AND METHODS In total, 74 persistent perforations with otomycosis who underwent cartilage myringoplasty were included. The pre-, intra-, and post-operative antimycotic cream were applied. The outcomes were the hearing gains and graft take rates at 6 months. RESULTS At 6 months, the graft take rate was 83.8% (62/74). 6.8% developed postoperative purulent otorrhea and re-perforations; 9.5% recurrent otomycosis with re-perforations; and 4.1% mild postoperative otorrhea that resolved without re-perforation. The mean preoperative air-bone gap (ABG) was 32.31 ± 5.47 dB and the mean postoperative ABG 17.24 ± 4.95 dB, thus significantly different (p < .05). Of the 74 patients, 11(14.9%) had ABG closures within 10 dB, 48 (64.9%) had closures within 20 dB, and 15 (20.3%) had closures within 30 dB. We encountered no instances of graft lateralization or significant blunting during follow-up. CONCLUSIONS Endoscopic cartilage myringoplasty effectively treats persistent perforations with otomycosis; however, pre-, intra-, and post-operative local applications of antimycotic cream are recommended.
Collapse
Affiliation(s)
- Zhengcai Lou
- Department of Otorhinolaryngology, Yiwu central Hospital, 699 jiangdong road, Yiwu city, 322000, Zhejiang province, China.
| |
Collapse
|
19
|
Koltsidopoulos P, Skoulakis C. Otomycosis With Tympanic Membrane Perforation: A Review of the Literature. EAR, NOSE & THROAT JOURNAL 2019; 99:518-521. [PMID: 31142158 DOI: 10.1177/0145561319851499] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE The purpose of the present study was to assess the rate of tympanic membrane perforation in patients with otomycosis and to discuss the literature regarding the difficulties in managing this condition. DATA SOURCES Literature review from 1999 to 2019, Web of Science, PubMed, and Medline. STUDY SELECTION We searched for eligible articles concerning the clinical entity of tympanic membrane perforation secondary to otomycosis. Case series and clinical trials were the types of articles included for this review. DATA EXTRACTION All the articles described in the study selection were used for this review. DATA SYNTHESIS Statistical techniques were not used. CONCLUSION Based on the available literature, it seems that tympanic membrane perforation secondary to otomycosis is not uncommon. The presence of this complication is associated with 2 problems: Antimycotic solutions are irritant to middle ear and may be ototoxic to the cochlea. Although most cases of fungus caused tympanic membrane (TM) perforation resolve with proper medical treatment, in a few patients a tympanoplasty may be required.
Collapse
|
20
|
Hagiwara S, Tamura T, Satoh K, Kamewada H, Nakano M, Shinden S, Yamaguchi H, Makimura K. The Molecular Identification and Antifungal Susceptibilities of Aspergillus Species Causing Otomycosis in Tochigi, Japan. Mycopathologia 2018; 184:13-21. [PMID: 30291485 DOI: 10.1007/s11046-018-0299-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Accepted: 09/24/2018] [Indexed: 02/01/2023]
Abstract
Aspergillus species are the most common pathogenic fungi involved in otomycosis, an infection of the outer ear canal. In this study, we examined the incidence of Aspergillus infections and the antifungal susceptibilities of 30 Aspergillus species isolates from patients with otomycosis who visited Saiseikai Utsunomiya Hospital between August 2013 and July 2016. Based on the morphological test results, the strains were identified as Aspergillus niger sensu lato (20 strains), A. terreus sensu lato (7 strains), and A. fumigatus sensu lato (3 strains). In contrast, the molecular identifications based on analyzing the isolates' partial β-tubulin gene sequences revealed them to be A. niger sensu stricto (12 strains), A. tubingensis (8 strains), A. terreus sensu stricto (7 strains), and A. fumigatus sensu stricto (3 strains). The antifungal susceptibility test results indicated that strains of A. tubingensis and A. niger sensu stricto displayed lower susceptibilities to ravuconazole, compared with the other isolates. The Aspergillus strains from this study showed low minimum inhibitory concentrations toward the azole-based drugs efinaconazole, lanoconazole, and luliconazole. Therefore, these topical therapeutic agents may be effective for the treatment of otomycosis.
Collapse
Affiliation(s)
- Shigehiro Hagiwara
- Graduate School of Medical Technology, Teikyo University, 2-11-1 Kaga, Itabashi-ku, Tokyo, 173-8605, Japan.,Department of Clinical Laboratory, Saiseikai Utsunomiya Hospital, 911-1 Takebayashi-machi, Utsunomiya, Tochigi, 391-0974, Japan
| | - Takashi Tamura
- General Medical Education and Research Center, Teikyo University, Tokyo, Japan.,Teikyo University Institute of Medical Mycology, Tokyo, Japan
| | - Kazuo Satoh
- General Medical Education and Research Center, Teikyo University, Tokyo, Japan.,Teikyo University Institute of Medical Mycology, Tokyo, Japan
| | - Hitoshi Kamewada
- Department of Clinical Laboratory, Saiseikai Utsunomiya Hospital, 911-1 Takebayashi-machi, Utsunomiya, Tochigi, 391-0974, Japan
| | - Masayasu Nakano
- Department of Laboratory Medicine, Saiseikai Utsunomiya Hospital, 911-1 Takebayashi-machi, Utsunomiya, Tochigi, 391-0974, Japan
| | - Seiichi Shinden
- Department of Otorhinolaryngology, Saiseikai Utsunomiya Hospital, 911-1 Takebayashi-machi, Utsunomiya, Tochigi, 391-0974, Japan
| | | | - Koichi Makimura
- Graduate School of Medical Technology, Teikyo University, 2-11-1 Kaga, Itabashi-ku, Tokyo, 173-8605, Japan. .,Medical Mycology Research Unit, Graduate School of Medicine, Teikyo University, Tokyo, Japan. .,General Medical Education and Research Center, Teikyo University, Tokyo, Japan. .,Teikyo University Institute of Medical Mycology, Tokyo, Japan.
| |
Collapse
|
21
|
Fungal Suppurative Otitis Media (Histopathology) Among Patients in North India. Head Neck Pathol 2018; 13:149-153. [PMID: 29671212 PMCID: PMC6513980 DOI: 10.1007/s12105-018-0918-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Accepted: 04/13/2018] [Indexed: 10/17/2022]
Abstract
Chronic suppurative otitis media (CSOM) has a substantial worldwide prevalence and is a major cause of hearing impairment. In cases of CSOM unresponsive to local antibiotics, superimposed fungal infection should be suspected. The aim of the present study was to study the spectrum of cases with fungal otitis media. The study was conducted over a period of 12 years (2006-2017). Fifteen cases of CSOM clinically not suspected to be of fungal etiology that underwent surgery with identification of fungal organisms on histopathology were included in the study. Age of the patients ranged from 12 to 75 years (mean age: 37.1 ± 22.7 years). Of 15 cases, 9 (60.0%) were males and 6 (40.0%) were females. It was a unilateral presentation in all. The complaints observed were ear discharge in all followed by itching (86.7%), pain (46.7%), decreased hearing (26.7%) and blocking sensation (13.3%). Histomorphologic typing of fungus was possible in 13/15 patients. Isolated aspergillus was identified in eight patients while mucor alone was seen in three patients. Mixed infection with Aspergillus + Candida and Aspergillus + Mucor was seen in one patient each. Categorization of fungus could not be done in rest of the two patients due to paucity of fungal profiles. Histopathological identification of fungal organisms in otomycosis provides a quick and fairly reliable diagnosis. Culture is considered the gold standard but it may not always be available or fruitful. Less turnaround time and accurate diagnosis facilitates prompt and optimal therapy in fungal otitis media thus preventing adverse outcomes.
Collapse
|
22
|
Ameye SA, Adeyemo A, Eziyi JA, Amusa YB. Clinical Profile of Otomycosis in a Sub-saharan African Tertiary Health Center. ACTA ACUST UNITED AC 2018. [DOI: 10.5005/jp-journals-10003-1290] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
|
23
|
Alarid-Coronel J, Celis-Aguilar E, Escobar-Aispuro L, Muñoz-Estrada V. Otomycosis in immunocompetent patients: Clinical and mycological features. Our experience with 40 cases. Clin Otolaryngol 2017; 43:373-377. [PMID: 28834405 DOI: 10.1111/coa.12966] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/13/2017] [Indexed: 11/27/2022]
Affiliation(s)
- J Alarid-Coronel
- Center of Research and Teaching of Health Sciences, Universidad Autónoma de Sinaloa, Culiacan, Mexico
| | - E Celis-Aguilar
- Department of Otolaryngology, Center of Research and Teaching of Health Sciences, Universidad Autónoma de Sinaloa, Culiacan, Mexico
| | - L Escobar-Aispuro
- Center of Research and Teaching of Health Sciences, Universidad Autónoma de Sinaloa, Culiacan, Mexico
| | - V Muñoz-Estrada
- Department of Dermatology, Center of Research and Teaching of Health Sciences, Universidad Autónoma de Sinaloa, Culiacan, Mexico
| |
Collapse
|
24
|
Agarwal P, Devi LS. Otomycosis in a Rural Community Attending a Tertiary Care Hospital: Assessment of Risk Factors and Identification of Fungal and Bacterial Agents. J Clin Diagn Res 2017; 11:DC14-DC18. [PMID: 28764159 DOI: 10.7860/jcdr/2017/25865.10068] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Accepted: 04/10/2017] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Otomycosis is one of the frequently encountered fungal infections of external auditory canal, commonly seen in tropical and subtropical regions of the world. Various host (local, systemic) and environmental factors can predispose a person to otomycosis. Although clinical presentations along with otoscopic findings of the patients are well suggestive of fungal infection, proper identification of causative agents is mandatory in order to prevent recurrences and complications. AIM To define the aetiology of clinically diagnosed otomycosis in rural population, to derive association of risk factors with otomycosis, to isolate and identify fungal and bacterial agents and to analyze the association between them. MATERIALS AND METHODS A prospective study was conducted in the Department of Microbiology and Department of Ear, Nose and Throat (ENT), SGT hospital over eight months period. A total of 350 consecutive patients of more than five years of age with clinical diagnosis of otomycosis were included in the study. Demographic profile, predisposing factors, presenting complaints and clinical findings of clinically diagnosed patients were evaluated and analyzed. Samples were collected, transported and evaluated by both direct examination and culture method for bacteriological and mycological examination. RESULTS Male to female ratio in study participants was 1.3:1. Mycological examination yielded 346 fungal isolates in 310 samples from a total of 350 clinically diagnosed cases of otomycosis. Self cleaning, instillation of mustard oil and use of ear drops appeared to be common predisposing factors in otomycosis. Significant association was observed between these practices and otomycosis. Aspergillus species was the predominant fungi followed by Candida spp., Penicillium, Mucor and Trichophyton mentagrophyte. 11% of the cases were found to have mixed fungal and bacterial infections. CONCLUSION The present study highlights the highest isolation of Aspergillus complex in cases of clinically diagnosed otomycosis in a rural community with higher practice of self cleaning and using home remedies and eardrops to get relief from sensation of blocked ear and itching.
Collapse
Affiliation(s)
- Priti Agarwal
- Associate Professor, Department of Microbiology, SGT University, Budhera, Gurgaon, Haryana, India
| | | |
Collapse
|
25
|
Shahin-Jafari A, Bayat M, Shahhosseiny MH, Tajik P, Roudbar-Mohammadi S. Effect of long-term exposure to mobile phone radiation on alpha-Int1 gene sequence of Candida albicans. Saudi J Biol Sci 2016; 23:426-33. [PMID: 27081370 PMCID: PMC4818327 DOI: 10.1016/j.sjbs.2015.05.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2015] [Revised: 04/11/2015] [Accepted: 05/02/2015] [Indexed: 11/28/2022] Open
Abstract
Over the last decade, communication industries have witnessed a tremendous expansion, while, the biological effects of electromagnetic waves have not been fully elucidated. Current study aimed at evaluating the mutagenic effect of long-term exposure to 900-MHz radiation on alpha-Int1 gene sequences of Candida albicans. A standard 900 MHz radiation generator was used for radiation. 10 ml volumes from a stock suspension of C. albicans were transferred into 10 polystyrene tubes. Five tubes were exposed at 4 °C to a fixed magnitude of radiation with different time periods of 10, 70, 210, 350 and 490 h. The other 5 tubes were kept far enough from radiation. The samples underwent genomic DNA extraction. PCR amplification of alpha-Int1 gene sequence was done using one set of primers. PCR products were resolved using agarose gel electrophoresis and the nucleotide sequences were determined. All samples showed a clear electrophoretic band around 441 bp and further sequencing revealed the amplified DNA segments are related to alpha-Int1 gene of the yeast. No mutations in the gene were seen in radiation exposed samples. Long-term exposure of the yeast to mobile phone radiation under the above mentioned conditions had no mutagenic effect on alpha-Int1 gene sequence.
Collapse
Affiliation(s)
- Ariyo Shahin-Jafari
- Department of Pathobiology, Faculty of Veterinary Specialized Sciences, Science and Research Branch, Islamic Azad University, Tehran, Iran
| | - Mansour Bayat
- Department of Pathobiology, Faculty of Veterinary Specialized Sciences, Science and Research Branch, Islamic Azad University, Tehran, Iran
| | | | - Parviz Tajik
- Department of Pathobiology, Faculty of Veterinary Specialized Sciences, Science and Research Branch, Islamic Azad University, Tehran, Iran
| | | |
Collapse
|
26
|
Goodale EC, Outerbridge CA, White SD. Aspergillusotitis in small animals - a retrospective study of 17 cases. Vet Dermatol 2015; 27:3-e2. [DOI: 10.1111/vde.12283] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/30/2015] [Indexed: 01/21/2023]
Affiliation(s)
- Elizabeth C. Goodale
- William R. Pritchard Veterinary Medical Teaching Hospital; School of Veterinary Medicine; University of California - Davis; 1 Garrod Drive Davis CA 95616 USA
| | - Catherine A. Outerbridge
- Department of Medicine and Epidemiology; School of Veterinary Medicine; University of California - Davis; 1 Garrod Drive Davis CA 95616 USA
| | - Stephen D. White
- Department of Medicine and Epidemiology; School of Veterinary Medicine; University of California - Davis; 1 Garrod Drive Davis CA 95616 USA
| |
Collapse
|
27
|
Huguenin A, Noel V, Rogez A, Chemla C, Villena I, Toubas D. Scedosporium apiospermum Otitis Complicated by a Temporomandibular Arthritis: A Case Report and Mini-Review. Mycopathologia 2015; 180:257-64. [PMID: 26105580 DOI: 10.1007/s11046-015-9911-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2014] [Accepted: 06/12/2015] [Indexed: 11/28/2022]
Affiliation(s)
- A Huguenin
- Parasitology-Mycology Laboratory, 45 rue Cognacq-Jay, CHU Maison Blanche, 51100, Reims, France,
| | | | | | | | | | | |
Collapse
|
28
|
Gharaghani M, Seifi Z, Zarei Mahmoudabadi A. Otomycosis in iran: a review. Mycopathologia 2015; 179:415-24. [PMID: 25633436 DOI: 10.1007/s11046-015-9864-7] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2014] [Accepted: 01/16/2015] [Indexed: 11/28/2022]
Abstract
Fungal infection of the external auditory canal (otitis externa and otomycosis) is a chronic, acute, or subacute superficial mycotic infection that rarely involves middle ear. Otomycosis (swimmer's ear) is usually unilateral infection and affects more females than males. The infection is usually symptomatic and main symptoms are pruritus, otalgia, aural fullness, hearing impairment, otorrhea, and tinnitus. Fungal species such as yeasts, molds, dermatophytes, and Malassezia species are agents for otitis externa. Among molds, Aspergillus niger was described as the most common agent in the literature. Candida albicans was more prevalent than other yeast species. Otomycosis has a worldwide distribution, but the prevalence of infection is related to the geographical location, areas with tropical and subtropical climate showing higher prevalence rates. Otomycosis is a secondary infection and is more prevalent among swimmers. As a result, a higher incidence is reported in summer season, when more people interested in swimming. Incidence of otomycosis in our review ranged from 5.7 to 81 %, with a mean value of 51.3 %. Our results showed that 78.59 % of otomycosis agents were Aspergillus, 16.76 % were Candida species, and the rest (4.65 %) were other saprophytic fungi. Among Iranian patients, incidence of infection was highest in summer, followed by autumn, winter, and spring. In Iran, otomycosis was most prevalent at the age of 20-40 years and the lowest prevalence was associated with being <10 years old. The sex ratio of otomycosis in our study was (M/F) 1:1.53.
Collapse
Affiliation(s)
- Maral Gharaghani
- Department of Medical Mycology, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | | | | |
Collapse
|
29
|
Primary otomycosis in the Indian subcontinent: predisposing factors, microbiology, and classification. Int J Microbiol 2014; 2014:636493. [PMID: 24949016 PMCID: PMC4052204 DOI: 10.1155/2014/636493] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2013] [Revised: 04/06/2014] [Accepted: 04/14/2014] [Indexed: 11/17/2022] Open
Abstract
Objective. To define otomycosis and determine the predisposing factors and microbiology in primary otomycosis. Study Design. Prospective study of two years and review of the literature. Setting. Academic Department of Otolaryngology in a coastal city in India. Patients. 150 immunocompetent individuals of whom 100 consecutive patients with a clinical diagnosis of otomycosis are considered as the study group and 50 consecutive patients with no otomycosis are considered as the control group. Results and Observations. Instillation of coconut oil (42%), use of topical antibiotic eardrops (20%), and compulsive cleaning of external ear with hard objects (32%) appeared to be the main predisposing factors in otomycosis. Aspergilli were the most common isolates (80%) followed by Penicillium (8%), Candida albicans (4%), Rhizopus (1%), and Chrysosporium (1%), the last being reported for the first time in otomycosis. Among aspergilli, A. niger complex (38%) was the most common followed by A. fumigatus complex (27%) and A. flavus complex (15%). Bacterial isolates associated with fungi in otomycosis were S. aureus, P. aeruginosa, and Proteus spp. In 42% of healthy external ears fungi were isolated. Conclusion. Aspergillus spp. were the most common fungi isolated, followed by Penicillium. Otomycotic ears are often associated with bacterial isolates when compared to normal ears. Fungi are also present in a significant number of healthy external auditory canals and their profiles match those in cases of otomycosis. The use of terms "primary" and "secondary" otomycosis is important to standardize reporting.
Collapse
|
30
|
|