Invasive External Otitis Caused by Aspergillus

Phillips, Peter; Bryce, Graham E.; Shepherd, John; Mintz, Don

doi:10.1093/clinids/12.2.277

Cited by 43 publications

(14 citation statements)

References 13 publications

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“…In one case, the infection was polymicrobial and included A. niger, A. flavus, and A. fumigatus (38). In three reports, the Aspergillus species was not identified (3,7,32). Treatment and tolerance.…”

Section: Resultsmentioning

confidence: 99%

“…Nineteen patients had an identified cause of acquired immunodeficiency, the most common underlying condition being AIDS (n ϭ 7) (7,27,33,34,45). Five patients suffered from acute leukemia (17,25,30,32,38), and five had diabetes mellitus as the sole underlying condition (2,13,16,19,23). One patient had myelodysplasia (3), one had neuroblastoma (12), one suffered from chronic otitis externa (10), and three patients had no identified underlying diseases (8,13,37).…”

Section: Resultsmentioning

confidence: 99%

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Antifungal Therapy of Aspergillus Invasive Otitis Externa: Efficacy of Voriconazole and Review

Parize

Chandesris

Lanternier

et al. 2009

Antimicrob Agents Chemother

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Invasive otitis externa (IOE) due to Aspergillus is a rare, potentially life-threatening, invasive fungal infection affecting immunocompromised patients. The invasive process may lead to skull base osteomyelitis with progressive cranial nerve palsies and can result in irreversible hearing and neurological impairment. We report two cases of Aspergillus IOE treated with voriconazole alone and a literature review of antifungal therapy of Aspergillus IOE. Twenty-five patients, including the two described in the present report, were analyzed. Eighteen patients were treated with amphotericin B, and nine of them received itraconazole as an additional agent. Three patients received initial therapy with itraconazole, and one patient was treated with both voriconazole and caspofungin therapy. The two patients in the present report received voriconazole therapy alone with good clinical and biological tolerance despite prolonged treatment. The last patient did not receive antifungal therapy, as the diagnosis was made postmortem. Eighteen patients underwent an initial extensive surgical debridement. The majority of the patients had a favorable outcome, 17 patients experienced a complete recovery, and 6 showed a partial improvement. Both of the patients reported on here had favorable outcomes, and no aggressive surgical debridement was required. Although voriconazole has been shown to be effective for the treatment of invasive aspergillosis, its precise role in the management of Aspergillus IOE had not been documented. These observations demonstrate that voriconazole could be an effective and well-tolerated therapeutic option for the management of Aspergillus IOE.Invasive otitis externa (IOE) is a particular entity among ear infections (6). Its main feature is its spreading from the external auditory canal to adjacent anatomical structures including soft tissues, cartilage, and bone. The invasive process can lead to skull base osteomyelitis, progressive cranial nerve palsies, and even death if IOE is not recognized and treated early. Invasive external otitis typically occurs in elderly diabetic patients, and Pseudomonas aeruginosa is the most common causative microbial pathogen (11,35).Fungal pathogens, mostly Aspergillus spp., are a rare cause of IOE (5). As for other localizations of invasive aspergillosis, Aspergillus IOE occurs in immunocompromised patients, usually with profound and long-lasting neutropenia or under longterm steroid therapy (21), as well as in patients with uncontrolled diabetes mellitus (14).The treatment of Aspergillus sp. IOE classically includes extensive surgical debridement and intensive long-term antifungal therapy including amphotericin B and/or itraconazole. Despite this management, this pathology is associated with substantial morbidity and mortality, mostly due to late diagnosis and patient comorbidities (2, 37). Treatment failure could also be a result of suboptimal therapeutic management as a consequence of antifungal agent toxicity. In particular, the side effects of amphotericin B, especia...

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Antifungal Therapy of Aspergillus Invasive Otitis Externa: Efficacy of Voriconazole and Review

Parize

Chandesris

Lanternier

et al. 2009

Antimicrob Agents Chemother

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“…Three of the four patients discussed in the present report had polymicrobial infections with various fungal pathogens also isolated. Aspergillus has been recognized as a causative agent, 12 but we believe the involvement of fungal organisms can be overlooked. The fungal pathogens identified in the patients presented in the current report were isolated on deep tissue biopsy specimens obtained at the time of surgery and therefore were not likely contaminates or secondary to prior antibiotic therapy.…”

Section: Discussionmentioning

confidence: 93%

Invasive Fungal and Bacterial Infections of the Temporal Bone

Marzo

Leonetti

2003

The Laryngoscope

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“…Invasive (malignant) otitis externa is mostly seen in patients with impaired cellular immunity [9] and can also be caused by fungi [10]. Since E. dermatitidis is capable of causing severe and even life-threatening cerebral phaeohyphomycosis [4], clinicians need to be aware of risks of infection with involvement of this fungus at an anatomic site close to the brain.…”

Section: Isolation Of Exophiala (Wangiella) Dermatitidis In a Case Ofmentioning

confidence: 99%