Otomycosis Caused by the Cryptic and Emerging Species Aspergillus sydowii : Two Case Reports

Abstract

Two cases of otomycosis have been reported in patients undergoing tympanomastoidectomy. The first one had chronic otitis media, hypertrophic concha and nasal septum deviation, tympanic perforation and otorrhea. The second had otalgia, pruritus, chronic otitis media and cholesteatoma. Direct examination showed mycelial septate filaments with a branch at an angle close to 45°, later identified as Aspergillus sydowii by sequencing the BenA and CaM genes. Susceptibility testing showed low MIC of amphotericin B, itraconazole, ketoconazole and ciclopirox olamine. In both cases, ketoconazole was instituted for 10 days. Otomycosis is a challenge as it is primarily recurrent in patients undergoing surgery. The clinical implication, the identification of the emerging pathogen and the determination of MIC were necessary for the knowledge of the epidemiological profile and establishment of the treatment.

Fungi involved in rhinosinusitis in arid regions: insights from molecular identification and antifungal susceptibility

“…Aspergillus caespitosus is a soil fungus ( 33 ) and has been reported previously from BAL specimen of a patient suffering from tuberculosis in Qatar ( 34 ). Aspergillus sydowii was reported in patients with otomycosis in Brazil ( 35 ).…”

Susceptibility Testing of Environmental and Clinical Aspergillus sydowii Demonstrates Potent Activity of Various Antifungals

“…The genus is formally divided in subgenera, sections, and series, with the cosmopolitan and environmental species A. sydowii classified in series Versicolores (subgenus Nidulantes , section Nidulantes ) [ 2 , 3 ]. A. sydowii is an opportunistic non-dermatophytic filamentous fungus with increasing reports of human disease, mainly associated with superficial skin infection and onychomycosis that are often empirically treated with oral terbinafine or itraconazole [ 4 – 7 ]. Cases of keratitis, black grain mycetoma and peritonitis during peritoneal dialysis have also been described [ 8 – 11 ].…”

Coinfection of Cedecea lapagei and Aspergillus sydowii detected in bronchoalveolar lavage fluid of a patient with pulmonary infection using metagenomic next−generation sequencing: A case report

“…Given its ubiquitous presence in the environment, humans are easily exposed to these microorganisms through direct contact such as skin contact, respiratory inhalation and dietary intake [ 17 ]. It has been reported in the literature that A. sydowii is an opportunistic pathogen capable of causing superficial skin infections, onychomycosis, otomycosis, and mycetoma, but there have been rare reports of cases where it caused respiratory infections in humans [ [19] , [20] , [21] , [22] ].…”