Clinical Presentations, Cluster Analysis and Laboratory-Based Investigation of Aspergillus Otomycosis—A Single Center Experience

Abstract

Species of Aspergillus (A.) niger complex and A. flavus complex are predominant molds that are causative agents of otomycoses. The goal of this study was to investigate the clinical presentation, diagnostic procedure, and appearance of relapse in patients with Aspergillus-otomycosis, as well as to determine the biofilm production ability of species isolated in relapse. Thirty patients with laboratory evidenced Aspergillus-otomycosis followed by two check-ups (30 and 60 days after initiation of treatment with antimycotics for local application) were included in the study. For isolation and identification of Aspergillus spp. the standard mycological procedure was applied. Results showed very high sensitivity of microscopy, but 16.7% Aspergillus species required the optimal temperature of 27–28 °C for cultivation. Applied statistical cluster analysis showed a defined specific cluster/group of patients with A. niger complex-otomycosis. Sixty days after diagnosis and treatment initiation, six patients had a relapse, with the same species of Aspergillus genus being the cause. To establish the ability of biofilm production, the modified method described by Pierce and Kvasničková was performed, and all six species isolated in the relapse episode had the ability to produce biofilm. Official criteria and recommendations are needed due to the possibility of misdiagnosis, which leads to the prolongation and complication of the disease.

Relapsing Aspergillus otomycosis despite prolonged systemic antifungal therapy and resolution after topical voriconazole administration: A case report

“…otic usage of a voriconazole sterile solution previously validated for treatment of eye infections) potentially increased drug concentration at the infection site, allowing for successful eradication where systemic antifungal therapy failed. Biofilm formation has been implicated in cases of Aspergillus otomycosis as a potential contributory factor to relapse [ 8 ]; it remains to be seen if administration of topical antifungals may allow for better biofilm penetration and thereby contribute to eradication. Additionally, usage of topical voriconazole minimised toxicities and/or drug interactions associated with conventional (systemic) administration.…”

Poly-(lactic-co-glycolic) Acid Nanoparticles Entrapping Pterostilbene for Targeting Aspergillus Section Nigri

“…are recognized as the fungi that form biofilms [ 24 ]. The negative consequences of biofilms are widely reported [ 14 ]. Aspergillus diseases are often associated with biofilm formation that increases host inflammation, rapid disease progression, and mortality.…”

“…Aspergillus section Nigri includes species causing pulmonary aspergillosis and otomycosis in humans, as well as localized and disseminated diseases in domestic and wild animals. Otomycosis, the fungal infection caused by Aspergillus section Nigri, is localized in the external auditory canal, and less commonly in the middle ear [ 13 , 14 ]. Currently, the treatment options for otomycosis are still limited.…”

Molecular strategy for the direct detection and identification of the most common fungal community in cerumen specimens by multiplex PCR

“…CHROM-agar Candida medium (CHROMagar Candida , France, CA222) was used for the primary identification of Candida species. Moulds were primarily identified based on macroscopic colony morphological characteristics and slide culture examination with lactophenol cotton blue staining [1].…”

“…Otomycosis is a superficial fungal infection that is responsible for approximately 9-27 % of otitis externa [1]. The infection is characterized by otorrhea, itching, otalgia, ear fullness, scaling, and hearing loss [2].…”