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Chen Z, Zhao Z. Study on the microbial diversity of ear canal secretions from patients with otomycosis. Front Surg 2024; 11:1277799. [PMID: 38450054 PMCID: PMC10916698 DOI: 10.3389/fsurg.2024.1277799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 01/30/2024] [Indexed: 03/08/2024] Open
Abstract
Otomycosis is caused by fungi, which usually cause discharge and additional discomfort. The highest incidence of otomycosis occurs in summer. To better treat this disease, it is necessary to study the microbial diversity of otomycosis secretions. In this regard, this study used high-throughput sequencing technology to determine the microbial diversity of the ear canal secretions of six typical patients with otomycosis in Wuhan via internal transcribed spacer (ITS) and 16S rRNA analyses and proposed a reasonable clinical treatment plan. Six patients with otomycosis in the Department of Otorhinolaryngology, Hubei Third People's Hospital Affiliated with Jianghan University, were selected from June 2022 to August 2022. The results showed that Staphylococcus spp. (average abundance 29.05%) was the dominant bacteria and Aspergillus spp. (average abundance 90.68%) was the dominant fungus involved in otomycosis secretion. Aspergillus spp. can cause inflammation of the external auditory canal combined with bacterial infections such as Staphylococcus spp., which can cause discharge in the ear canal. High-throughput sequencing provides comprehensive information on the microbial community involved in otomycosis discharge and will aid in evaluating the efficacy of clinical treatment and medication.
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Affiliation(s)
| | - Zhang Zhao
- Department of Otorhinolaryngology, Hubei NO.3 People's Hospital of Jianghan University, Wuhan, China
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MacDonald WW, Wakely PE, Kalmar JR, Argyris PP. Fungal Otitis Externa (Otomycosis) Associated with Aspergillus Flavus: A Case Image. Head Neck Pathol 2024; 18:5. [PMID: 38334859 PMCID: PMC10858010 DOI: 10.1007/s12105-023-01606-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 12/16/2023] [Indexed: 02/10/2024]
Abstract
A 48-year-old man presented with a chief complaint of intermittent right ear otorrhea of several-month duration, occasional otalgia and progressive unilateral hearing impairment. He also reported frequent episodes of headache and pressure in the sinuses and maxilla. Previous systemic treatment with antibiotics failed to alleviate the symptoms. A head/neck CT showed completely normal mastoid, middle ear and external auditory canal regions without any evidence of opacification or bone erosion. Otoscopic examination of the right ear disclosed aggregates of dried, brown, fibrillar material and debris occluding the external auditory canal and obstructing the otherwise intact tympanic membrane. Dilation of the external auditory canal or thickening of the tympanic membrane were not appreciated. The canal was debrided and the fibrillar material was placed in formalin. Histopathologic examination revealed numerous branching, septated fungal hyphae organized in densely-packed clusters. In other areas, the fungal hyphae abutted or were attached to lamellated collections of orthokeratin. As highlighted by GMS staining, the fungi were morphologically compatible with Aspergillus species. The clinicopathologic findings supported a diagnosis of fungal otitis externa, while the numerous anucleate squamous cells were compatible with colonization of an underlying, probably developing, cholesteatoma. Culture of material isolated from the external auditory canal confirmed the presence of Aspergillus flavus. In this illustrative case, we present the main clinical and microscopic characteristics of Aspergillus-related otomycosis developing in the setting of a tautochronous cholesteatoma.
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Affiliation(s)
- William W MacDonald
- Department of Pathology, The Ohio State University Wexner Medical Center, James Cancer Hospital and Solove Research Institute, Columbus, OH, USA
| | - Paul E Wakely
- Department of Pathology, The Ohio State University Wexner Medical Center, James Cancer Hospital and Solove Research Institute, Columbus, OH, USA
| | - John R Kalmar
- Division of Oral and Maxillofacial Pathology, The Ohio State University College of Dentistry, Postle Hall, Room 2191 305 W. 12th Ave, Columbus, OH, USA
| | - Prokopios P Argyris
- Division of Oral and Maxillofacial Pathology, The Ohio State University College of Dentistry, Postle Hall, Room 2191 305 W. 12th Ave, Columbus, OH, USA.
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Bojanović M, Stalević M, Arsić-Arsenijević V, Ignjatović A, Ranđelović M, Golubović M, Živković-Marinkov E, Koraćević G, Stamenković B, Otašević S. Etiology, Predisposing Factors, Clinical Features and Diagnostic Procedure of Otomycosis: A Literature Review. J Fungi (Basel) 2023; 9:662. [PMID: 37367598 DOI: 10.3390/jof9060662] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 06/01/2023] [Accepted: 06/06/2023] [Indexed: 06/28/2023] Open
Abstract
Otomycosis (OM) is a superficial fungal infection of the external auditory canal (EAC) with a worldwide prevalence ranging from 9% to 30%. Commonly, otomycoses are caused by Aspergillus (A.) niger complex and Candida spp. Other causative agents are yeasts of the genera Cryptococcus spp., Rhodotorula spp., Geotrichum candidum, dermatophytes (Trichophyton mentagrophytes), and non-dermatophytes molds (Fusarium spp., Penicillium spp., Mucorales fungi). The widest range of different species causing OM are found in the territories of Iran, India, China, Egypt, Mexico, and Brazil. Fungal infection of the EAC varies from mild to severe forms. It can be acute, subacute, or chronic, and is often unilateral, while the bilateral form is more common in immunocompromised patients. From an epidemiological point of view, tropical and subtropical climates are the most significant risk factor for the development of otomycosis. Other predisposing conditions include clothing habits, EAC hygiene practices, long-term antibiotic therapy, diabetes, and immunodeficiency. Since it is often difficult to distinguish otomycosis from an infection of a different origin, laboratory-based evidence, including standard procedures (microscopy and cultivation), is essential for diagnosis. For the treatment of this superficial fungal infection, there are no official therapeutic guidelines and protocols. However, many antifungals for local application, such as polyene, imidazoles, and allylamines, can be applied, as well as systemic antimycotics (triazoles) in severe forms of infection.
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Affiliation(s)
- Mila Bojanović
- Medical Faculty, University of Niš, 18000 Niš, Serbia
- University Clinical Center Niš, 18000 Niš, Serbia
| | - Marko Stalević
- Medical Faculty, University of Priština in Kosovska Mitrovica, 38220 Kosovska Mitrovica, Serbia
| | | | - Aleksandra Ignjatović
- Medical Faculty, University of Niš, 18000 Niš, Serbia
- Public Health Institute Niš, 18000 Niš, Serbia
| | - Marina Ranđelović
- Medical Faculty, University of Niš, 18000 Niš, Serbia
- Public Health Institute Niš, 18000 Niš, Serbia
| | | | - Emilija Živković-Marinkov
- Medical Faculty, University of Niš, 18000 Niš, Serbia
- University Clinical Center Niš, 18000 Niš, Serbia
| | - Goran Koraćević
- Medical Faculty, University of Niš, 18000 Niš, Serbia
- University Clinical Center Niš, 18000 Niš, Serbia
| | - Bojana Stamenković
- Medical Faculty, University of Niš, 18000 Niš, Serbia
- Institute For Treatment and Rehabilitation "Niška Banja", 18205 Niš, Serbia
| | - Suzana Otašević
- Medical Faculty, University of Niš, 18000 Niš, Serbia
- Public Health Institute Niš, 18000 Niš, Serbia
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Bojanović M, Ignjatović A, Stalević M, Arsić-Arsenijević V, Ranđelović M, Gerginić V, Stojanović-Radić Z, Stojković O, Živković-Marinkov E, Otašević S. Clinical Presentations, Cluster Analysis and Laboratory-Based Investigation of Aspergillus Otomycosis—A Single Center Experience. J Fungi (Basel) 2022; 8:jof8030315. [PMID: 35330316 PMCID: PMC8948793 DOI: 10.3390/jof8030315] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 03/09/2022] [Accepted: 03/10/2022] [Indexed: 02/05/2023] Open
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.
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Affiliation(s)
- Mila Bojanović
- Medical Faculty, University of Niš, 18000 Niš, Serbia; (M.B.); (A.I.); (M.S.); (M.R.); (E.Ž.-M.)
- Clinic of Otorhinolaryngology, University Clinical Center Niš, 18000 Niš, Serbia
| | - Aleksandra Ignjatović
- Medical Faculty, University of Niš, 18000 Niš, Serbia; (M.B.); (A.I.); (M.S.); (M.R.); (E.Ž.-M.)
- Public Health Institute Niš, 18000 Niš, Serbia
| | - Marko Stalević
- Medical Faculty, University of Niš, 18000 Niš, Serbia; (M.B.); (A.I.); (M.S.); (M.R.); (E.Ž.-M.)
| | | | - Marina Ranđelović
- Medical Faculty, University of Niš, 18000 Niš, Serbia; (M.B.); (A.I.); (M.S.); (M.R.); (E.Ž.-M.)
- Public Health Institute Niš, 18000 Niš, Serbia
| | - Vladimir Gerginić
- Medical Faculty, University of Belgrade, 11000 Belgrade, Serbia; (V.A.-A.); (V.G.)
| | - Zorica Stojanović-Radić
- Department of Biology, Faculty of Science and Mathematics, University of Niš, 18000 Niš, Serbia; (Z.S.-R.); (O.S.)
| | - Ognjen Stojković
- Department of Biology, Faculty of Science and Mathematics, University of Niš, 18000 Niš, Serbia; (Z.S.-R.); (O.S.)
| | - Emilija Živković-Marinkov
- Medical Faculty, University of Niš, 18000 Niš, Serbia; (M.B.); (A.I.); (M.S.); (M.R.); (E.Ž.-M.)
- Clinic of Otorhinolaryngology, University Clinical Center Niš, 18000 Niš, Serbia
| | - Suzana Otašević
- Medical Faculty, University of Niš, 18000 Niš, Serbia; (M.B.); (A.I.); (M.S.); (M.R.); (E.Ž.-M.)
- Public Health Institute Niš, 18000 Niš, Serbia
- Correspondence: ; Tel.: +381-184-226-384
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Tasić-Otašević S, Golubović M, Đenić S, Ignjatović A, Stalević M, Momčilović S, Bojanović M, Arsić-Arsenijević V. Species distribution patterns and epidemiological characteristics of otomycosis in Southeastern Serbia. J Mycol Med 2020; 30:101011. [PMID: 32693980 DOI: 10.1016/j.mycmed.2020.101011] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2020] [Revised: 06/04/2020] [Accepted: 06/29/2020] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Otomycosis, a superficial fungal infection of the external auditory canal (EAC), is a disease with exceptionally high prevalence. AIM The aim of this study was to determine the prevalence of otomycosis, the distribution of causative species and to evaluate epidemiological characteristics of these infections. METHODOLOGY The patients' data were collected from record book and database of mycological examinations conducted at Public Health Institute Nis, Serbia. In the period from 2014 to 2018 samples of 1287 patients with symptoms and signs of EAC infection were investigated. Standard mycological methods were used for isolation and determination of fungi. RESULTS High prevalence of otomycosis was determined in examined patients (22.7%). However, the prevalence rates did not differ significantly in the studied period (p=0.931). The majority of patients were diagnosed with only unilateral EAC infection (82.9%). Considering all patients with otomycosis, mold infections caused by the genus Aspergillus (143/48.9%) were more frequent than Candida spp. ear infections (133/45.6%), with Aspergillus niger and Candida аlbicans being predominant causative agents. Mixed Aspergillus and Candida otomycosis was established in 16 (5.5%) patients. Otomycosis was more common in male subjects (26.8%, p=0.003) who also suffered from Aspergillus otomycosis more frequently (17.5%, p<0.001). The prevalence of these infections increases with age (p=0.005), while they do not show seasonal pattern (p>0.05). CONCLUSION Noted high prevalence of otomycosis, with both yeasts and non-dermatophyte molds acting as infectious agents which require different treatment, implies the necessity for further epidemiological monitoring of this form of superficial mycoses.
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Affiliation(s)
- S Tasić-Otašević
- Department of Microbiology and Immunology, Faculty of Medicine, University of Niš, Niš, Serbia; Public Health Institute Niš, Niš, Serbia.
| | - M Golubović
- Faculty of Medicine, University of Niš, Niš, Serbia; Clinic of Pediatrics, Clinical Center Niš, Niš, Serbia
| | - S Đenić
- Faculty of Medicine, University of Niš, Niš, Serbia; Center for Radiology, Clinical Center Nis, Nis, Serbia
| | - A Ignjatović
- Public Health Institute Niš, Niš, Serbia; Department of Medical Statistics, Faculty of Medicine, University of Niš, Niš, Serbia
| | - M Stalević
- Faculty of Medicine, University of Niš, Niš, Serbia
| | - S Momčilović
- Faculty of Medicine, University of Niš, Niš, Serbia; Plastic and Reconstructive Surgery Clinic, Clinical Center Niš, Niš, Serbia
| | - M Bojanović
- Faculty of Medicine, University of Niš, Niš, Serbia; Clinic of Otorhinolaryngology, Clinical Center Niš, Niš, Serbia
| | - V Arsić-Arsenijević
- Department of Microbiology and Immunology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
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Aboutalebian S, Mahmoudi S, Mirhendi H, Okhovat A, Abtahi H, Chabavizadeh J. Molecular epidemiology of otomycosis in Isfahan revealed a large diversity in causative agents. J Med Microbiol 2019; 68:918-923. [PMID: 31063125 DOI: 10.1099/jmm.0.000985] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
PURPOSE To elucidate the clinical and microbial epidemiology of otomycosis in Isfahan, Iran. METHODOLOGY From January 2016 to January 2017 all patients clinically suspected of otomycosis at Al-Zahra Hospital, Isfahan, Iran were recruited. Specimens were taken using sterile swabs by an otorhinolaryngologist and subjected to culture and microscopy using potassium hydroxide and Giemsa stain. Isolated fungi were identified based on morphological and molecular characteristics. RESULTS Otomycosis was confirmed in 97/120 patients (80.8 %). Females (72.2 %) and patients aged 30-39 years (33 %) were more commonly affected than others. Manipulation of ear canal (62.9 %) was the most common predisposing factor. Pruritus was observed in 84.54 % of the patients followed by hearing impairment (81.4 %), and most episodes were detected over the summer (50.5 %). Culture was positive for 81 (83.5 %) of confirmed cases and molds were the most prevalent causative agents (n=51, 63 %) followed by yeasts (n=19, 23.4 %) and yeast/mold mixes (n=11, 13.6 %). For the 16 remaining patients, no growth was seen in culture despite a positive result on direct examination. In total, 92 isolates (63 molds and 29 yeasts) were recovered in culture. Application of molecular methods showed 18 fungal species and the vast majority of them belonged to Aspergillus (n=53, 57.6 %) and Candida genus. Among the species involved, Candida parapsilosis (n=22, 22.7 %) and Aspergillus tubingensis (n=15, 15.5 %) were the most encountered species. CONCLUSION Outcomes from this study showed a different picture of prevalence, where C. parapsilosis and A. tubingensis but not Aspergillus niger were the most species encountered from patients suffering from otomycosis.
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Affiliation(s)
- Shima Aboutalebian
- 1 Department of Medical Parasitology and Mycology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Shahram Mahmoudi
- 2 Department of Medical Parasitology and Mycology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
- 3 Students' Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Hossein Mirhendi
- 1 Department of Medical Parasitology and Mycology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Ahmadreza Okhovat
- 4 Department of Otolaryngology, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Hamidreza Abtahi
- 4 Department of Otolaryngology, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Javaher Chabavizadeh
- 1 Department of Medical Parasitology and Mycology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
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