Aspergillus causing chronic suppurative otitis media (CSOM) is rare in immunocompetent people; however, it can occur as a significant opportunistic pathogen in immunocompromised patients. Here, in our study, a 53-year-old diabetic patient having a history of CSOM visited the Department of Otorhinolaryngology-Head and Neck Surgery (ENT-HNS), Tribhuvan University and Teaching Hospital (TUTH), Nepal, in March 2016. Although he was on medication with an antibacterial ear drop from the last 10 days, his right ear was presented with otorrhea, pruritus, otalgia, aural fullness, hearing impairment, and tinnitus from the last 3-4 months. Preliminarily, otoscopy of the right ear revealed the presence of fungal mass. For further diagnosis, ear discharge was aseptically collected and sent to the laboratory to confirm the etiological agents. Findings of laboratory analysis indicated that Gram staining of aural discharge displayed pus cells with fungal spores but did not exhibit bacteria. Furthermore, potassium hydroxide (KOH) mount revealed the presence of fungal spores and septate hyphae with the characteristic of dichotomous branching. Culture in four different bacterial media (chocolate agar, blood agar, MacConkey agar, and Robertson’s cooked meat medium) has unveiled no bacterial growth. However, fungal growth was observed in both bacterial and fungal media. Thereafter, the fungal colony was investigated via a lactophenol cotton blue (LPCB) tease mount which displayed the structure of Aspergillus. Aspergillus niger was microbially conformed by specifically characterizing the specific phenotypic biseriate structure of phialides and the black-coloured conidia. For medication, the patient was treated with Candid Ear Drop with clotrimazole (1% w/v) plus lidocaine (2% w/v) for 4 weeks which successfully improved his condition.

ObjectiveThis study was designed to find out the fungal aetiological agents in chronic suppurative otitis media (CSOM) patients attending tertiary care centre of Nepal. ResultTotal 123 samples of 117 patients, outdoor as well as indoor from Department of ENT and Head and Neck Surgery (HNS) TUTH, Maharajgunj, Kathmandu those specimens were processed and among them, 23(18.7%) was found potassium hydroxide (KOH) mount positive whereas positive growth was in 27 specimens. The prevalence rate of fungus was 21.95 percent in which the main pathogen was Aspergillus species (51.8%), followed by Candida species (14.8 %). Keywords: CSOM, KOH, Fungal culture, Aspergillus

Poster session 3, September 23, 2022, 12:30 PM - 1:30 PM Objectives The study was designed to find out the fungal etiological agents in chronic suppurative otitis media (CSOM) patients attending the tertiary care center of Nepal. Methods The laboratory-rooted study was performed at the Department of Clinical Microbiology. Specimen was collected in the ENT and Head and Neck Surgery Department of Tribhuvan University Teaching Hospital (TUTH), Nepal from February 2016 to July 2016. All clinical specimens were collected from hospitalized as well as outdoor patients having CSOM. Specimens were processed according to standard methodology. A total of 117 patients having CSOM were confirmed cases by the otolaryngologists and their 123 specimens were included in the study. Ear discharge was collected using sterile swab sticks which were labeled and sent to the laboratory for potassium hydroxide (KOH) mount and fungal culture studies. Results A total of 123 specimens were collected and processed. Distribution of patients according to the site among the total patients (n = 117), 69 (59.0%) were specimens from the left ear, 42 (35.9%) right ear, and 6 (5.1%) from both ears (bilateral) (Table 1). The 19-30 years age group was highest (34.1%) and followed by 31-50 years having 23.6%. Occupationally students were higher in number (29.9%) and it was followed by housewives (27.4%). A total of 47.8% of cases are from Kathmandu and remain from different regions of Nepal. Out of 123 specimens, 23 (18.7%) were found KOH mount positive (Table 2). The distribution of fungal isolates is as follows—among total isolates Aspergillus flavus 7, A. fumigatus 6, Acremonium 3, Candida albicans 2, Penicillium 2 A. niger 1, C. krusei 1, C. tropicalis 1, Curvularia 1, Fusarium 1, Mucor 1, and Syncephalastrum racemosum 1 (Table 3). Conclusion The prevalence of fungi in CSOM patients was quite high (21.9%). This observation was different from the study of India conducted by Kumar et al. (15%) and in contrast with another researcher in Singapore, Loy et al. (8.8%). Aslam et al. from Pakistan study revealed only 2.1% and Khwakhali et al. study from Nepal estimated about 1.94% of the Nepalese population suffer from a serious fungal infection annually (commonly in HIV/AIDS and immunocompromised hosts) which are diluted by our findings. The possible reason may be due to location, temperature, negligence on mycological complications, and their treatment in Nepal. Treatment of CSOM should be based on the result of fungal culture. CSOM cases are found in all age groups (2-80 years) with various health statuses, different occupations, and in dispersed regions of Nepal. Phenotyping identification is cumbersome and have risk of infections which increases the chance of applying genotyping technique will be beneficial. Antifungal susceptibility testing should be mandatory since it helps in improving clinical outcomes by optimization of antifungal practices. Many CSOM patients complained that they were not cured even long time of use of antibacterial drugs. It clears that fungal etiological agents can't be neglected. If I am not wrong, Nepal has no separate designated mycology laboratory. There is also a lack of funding for clinical fungal studies and their awareness regarding fungal pathogens.