Otomycosis in São Paulo

Aspergillus Genus and Its Various Human Superficial and Cutaneous Features

Superficial and cutaneous aspergillosis is a rare fungal disease that is restricted to the outer layers of the skin, nails, and the outer auditory canal, infrequently invading the deeper tissue and viscera, particularly in immunocompromised patients. These mycoses are acquired through two main routes: direct traumatic inoculation or inhalation of airborne fungal spores into paranasal sinuses and lungs. Lesions are classified into three categories: otomycosis, onychomycosis, and cutaneous aspergillosis. Superficial and cutaneous aspergillosis occurs less frequently and therefore remains poorly characterized; it usually involves sites of superficial trauma-namely, at or near intravenous entry catheter site, at the point of traumatic inoculation (orthopaedic inoculation, ear-self-cleaning, schizophrenic ear self-injuries), at surgery incision, and at the site of contact with occlusive dressings, especially in burn patients. Onychomycosis and otomycosis are more seen in immunocompetent patients, while cutaneous aspergillosis is widely described among the immunocompromised individuals. This paper is a review of related literature.

Single Dose Topical Application of Clotrimazole for the Treatment of Otomycosis: Is This Enough?

Background and Objectives

To determine the efficacy of filling the external auditory meatus with 1% clotrimazole at a single visit for the treatment of otomycosis.

Subjects and Methods

This prospective study included 40 patients who were referred to our clinic with complaints of ear itching, pain, and fullness, and were diagnosed with unilateral otomycosis. After cleaning the mycotic hyphae from the external auditory meatus, the ear canal was filled with 1% clotrimazole, using an intravenous catheter and syringe. The patients received follow-up examinations on post-treatment days 7, 15, and 45.

Results

The follow-up otomicroscopic examinations revealed that 95% of the ear canals were entirely clean and that all symptoms had resolved. The post-treatment scores of pain, aural fullness and itching were significantly lower than the pre-treatment scores (p<0.01).

Conclusions

Filling the external auditory meatus with 1% clotrimazole at a single visit is an easy, efficient, and cost-effective treatment for otomycosis. Additionally, high patient compliance makes this treatment superior to long-term topical therapy.

Etiologic Agents of Otomycosis in the North-Western Area of Iran

BACKGROUND

Otomycosis is a superficial fungal infection often involves the pinna and external auditory canal. It is a pathologic condition, with Candida and Aspergillus, the most common fungal species. It is common worldwide but more prevalent in tropical and subtropical countries.

OBJECTIVES

The aim of this study was to determine the etiologic agents and local epidemiologic pattern of otomycosis in northwest Iran.

PATIENTS AND METHODS

A series of 140 patients with clinically symptomatic otomycosis were studied in 21 cities, towns, and villages throughout northwest Iran between 2009 and 2011. Clinical samples were collected by swabs and then assessed by mycological investigation.

RESULTS

Otomycosis was diagnosed in 129 cases (92%, 76 male, 53 female) with the highest prevalence of cases occurring in males between 21 - 40 years of age. From an etiological point of view, 116 patients (90%, 21 - 40 years old) were infected by saprophytic mold and 9 patients (7%) were infected by yeast. Three cases (2%) involved dermatophytes, and in one case (1%) the subject was infected with Eurotium (the perfect stage of Aspergillus fumigatus). Aspergillus niger was the most common mold that was isolated, followed by A. flavus, A. fumigatus, Penicillium spp., Fusarium spp., and Rhizopus spp. A total of 2 yeasts belonging to genus Candida, C. albicans and C. tropicalis, were isolated.

CONCLUSIONS

Our study showed a high prevalence of otomycosis in the northwestern area of Iran. As such, proper diagnosis and treatment by aseptic techniques for this disease is urgently needed.

Otomycosis in the north of Iran: common pathogens and resistance to antifungal agents

Otomycosis as a kind of external otitis can be caused by various species of fungi. To use the appropriate treatment, it is necessary to identify the causal agent of otomycosis. The aim of this study was to determine the pathogens that caused otomycosis and also the efficacy of different antifungal agents. 100 patients with diagnosis of otomycosis/otitis extern were entered in this study. Bacterial culture was performed by eosin methylene blue agar, blood agar; and Sabouraud dextrose agar was used to culture the fungal agents. Minimum inhibitory concentration test also was performed to determine the efficacy of Clotrimazole, Fluconazole, Ketoconazole and Nystatin on the fungal pathogens. Otomycosis was confirmed in 43% of patients by positive culture. The most prevalent fungal pathogen was Aspergillus niger which was sensitive to Clotrimazole, Fluconazole, Ketoconazole. Candida albicans was sensitive to all drugs, in which, the most sensitivity was due to fluconazole. The most frequent fungal pathogen in our otomycosis cases is A. niger, and most of fungi that caused otomycosis are sensitive to clotrimazole.

Otomycosis in central iran: a clinical and mycological study

BACKGROUND

Otomycosis is a fungal infection of the external ear with bothersome symptoms. The aim of this study was to evaluate the prevalence of fungal agents, predisposing factors and characteristics of patients.

METHODS

Between May 2008 and April 2010, 171 patients with clinical suspicion of otomycosis were enrolled and the samples from their external ear were examined for any mycological infection.

RESULTS

Otomycosis was confirmed after mycological diagnosis in 69% of clinically suspected patients. The highest incidence of otomycosis was in autumn and in patients aged 21-40 years old. Working in dry dusty environment was a major predisposing factor. Pruritus was the most common symptom. Aspergillus flavus was the most common fungus in otomycosis followed by A. niger, Candida albicans, A. fumigatus, A. nidulans and C. parapsilosis.

CONCLUSION

Clinical suspicion of otomycosis is important to prevent unnecessary use of antibiotics. Etiology of fungal pathogens in dry dusty regions is not similar to hot humid areas and this needs to be considered in future susceptibility tests and treatment of patients with otomycosis.

Bacterial and fungal organisms in otitis externa patients without fungal infection risk factors in Erzurum, Turkey

AIM

To describe the bacterial and fungal organisms in otitis externa patients without other risk factors for fungal infections.

STUDY DESIGN

Cross sectional cohort descriptive study.

MATERIALS AND METHODS

Ear swabs were obtained from 362 patients aged 1 to 55 years old with clinically diagnosed otitis externa in Erzurum, Turkey, between January 2006 and April 2007, and cultured for aerobic and anaerobic bacteria and fungi, using EMB, 5% sheep's blood, chocolate agar, anaerobic blood agar plate, thioglycollate broth and sabaroud agar using standard microbiological technique to diagnose isolates.

RESULTS

219 cultures were positive and a total of 267 isolates were obtained. Of the isolates, 68.16% (n: 182) were aerobic or facultative bacteria, 1.12 % (3) were anaerobic bacteria, 30.71 % (82) were fungi and 17.5 % (38) were polymicrobial infections.

CONCLUSION

Fungal organisms especially Candida species may be isolated from ears of otitis externa patients without fungal infection risk factors such as ear self-cleaning, local antimicrobial, antifungal or corticosteroid drops or systemic antimicrobial or antifungal agents within the preceding week. Bacterial and fungal cultures may be recommended, and anti-fungal agents may be added, to treatment regimens in patients with otitis externa.

Flora fúngica no ambiente da Unidade de Terapia Intensiva Pediátrica e Neonatal em hospital terciário

OBJETIVO: As infecções nosocomiais são responsáveis por morbidade e mortalidade significativas no período neonatal. Considerando-se a preocupação com a qualidade do ar de áreas críticas como Unidades de Terapia Intensiva (UTI), foi realizado um levantamento da flora fúngica das UTI Pediátrica e Neonatal do Hospital das Clínicas Samuel Libânio, Pouso Alegre (MG), com a finalidade de identificar a presença de fungos potencialmente patogênicos e oportunistas. MÉTODOS: Foram realizadas 30 coletas, que incluíram leitos, incubadoras, janelas, aparelhos de ar condicionado, telefone, estetoscópios, portas e maçanetas. Placas de Agar Sabouraud Dextrose com o material das coletas foram incubadas em temperatura ambiente por 15 dias. A identificação foi baseada nas características macroscópicas no exame direto e em microcultivos. RESULTADOS: Fungos potencialmente patogênicos e toxigênicos foram isolados. A análise quantitativa das colônias revelou a presença de 11 gêneros. Verificou-se que mais de 40% das colônias correspondem ao gênero Penicillium spp, seguido por Cladosporium spp e Chrysosporium spp. CONCLUSÕES: Os fungos encontrados podem apresentar grande potencial de patogenicidade, principalmente em imunodeprimidos. É importante adotar medidas de controle ambiental, como assepsia dos equipamentos, controle da presença de visitantes, lavagem das mãos pelos funcionários e troca de filtros de ar condicionado.

Otomycosis: a retrospective study

Otomycosis is a fungal infection of the external ear canal with only a few studies about its real frequence in Brazil.

Aim

to evaluate otomycosis frequence and characteristics in patients with clinical suspicion of external otitis.

Study design

Retrospective study with transversal cohort (2000-2006).

Materials and methods

103 patients were assigned to mycological diagnosis (direct microscopic examination and culture).

Results

Otomycosis was diagnosed in 19.4% of the patients. Patient age varied from 2 to 66 years (an average of 23.5 years of age), and 60% of otomycosis cases were seen in women between 2 to 20 years of age. Chronic otitis, previous antibiotic therapy and the lack of cerumen were predisposing factors; itching, otalgia, otorrhea and hypoacusis were the symptoms reported by the patients. The most frequently isolated species were C. albicans (30%), C. parapsilosis (20%), A. niger (20%), A. flavus (10%), A. fumigatus (5%), C. tropicalis (5%), Trichosporon asahii (5%) and Scedosporium apiospermum (5%).

Conclusions

Otomycosis is endemic in JoÆo Pessoa-PB. Clinical exam and mycological studies are important for diagnostic purposes because otomycosis symptoms are not specific.

Microbiological study of external otitis in Rosario City, Argentina

Mycological and/or bacteriological studies were performed on 294 samples isolated from the external auditory control (EAC). It was observed that 185 (81.5%) of the mycological analysis were negative while 42 (18.5%) were positive with the following distribution: 22 Candida (9.7%), 15 Aspergillus (6.5%) and five associations of Aspergillus and Candida (2.2%). The bacteriological studies were negative in 52 cases (23.6%) and the frequency of the bacterial agents (75.5%) isolated were as follows: 41 Pseudomonas aeruginosa (18.6%), 24 Proteus mirabilis (10.9%), 24 Staphylococcus aureus (10.9%), and three associations of Ps. aeruginosa and Pr. mirabilis (1.4%). Pseudomonas aeruginosa, which was the most frequent bacterial species isolated, did not present associations with any fungus.

Otomycosis: prevalence, clinical symptoms, therapeutic procedure

Local lesions observed in otitis, create favourable conditions for the growth of fungi and development of mycoses both in the external and middle ear, as well as in post-operative cavities, especially in cases of open-type surgery. The objective of this study was: (1) to determine the prevalence of mycotic infections in inflammatory conditions of the ear; (2) to evaluate the relationship between the presence of fungi and clinical symptoms of inflammation; and (3) to construct a model of therapeutic procedure. The study concerned 345 individuals, including 295 patients (381 ears) who presented with symptoms of otitis. The mycological examinations revealed presence of fungi in 30.4% cases (116 ears). Positive culture results were obtained predominantly in patients with post-operative suppuration (52.8%). Otomycosis was more often associated with fungi of the genus Candida (3/5) than with fungi of the genus Aspergillus (2/5). The analysis of symptoms in otomycoses showed that in bacteria-induced otitis, pruritus, discharge, post-operative defective hearing and headaches are most common; the analysis of signs showed that reddened epidermis and lining of the tympanic cavity are statistically more frequent. The therapeutic protocol adopted in otomycoses yields good results: 89%--complete cure.