Aspergillus spp. invasive external otitis: favourable outcome with a medical approach

Clin Microbiol Infect. 2016 May;22(5):434-7. doi: 10.1016/j.cmi.2015.12.027. Epub 2016 Jan 21.

Authors

E Marchionni¹, P Parize², A Lefevre³, P Vironneau⁴, M E Bougnoux⁵, S Poiree³, H Coignard-Biehler², S E DeWolf², K Amazzough², F Barchiesi⁶, V Jullien⁷, A Alanio⁸, D Garcia-Hermoso⁹, M Wassef¹⁰, R Kania⁴, O Lortholary¹¹, F Lanternier¹²

Affiliations

¹ Paris Descartes University, Infectious Diseases and Tropical Medicine Department, Necker Pasteur Infectious Diseases Centre, Necker-Enfants Malades Hospital, APHP, IHU Imagine, Paris, France; Infectious Diseases Department, Marche Polytechnic University, Ancona, Italy.
² Paris Descartes University, Infectious Diseases and Tropical Medicine Department, Necker Pasteur Infectious Diseases Centre, Necker-Enfants Malades Hospital, APHP, IHU Imagine, Paris, France.
³ Department of Radiology, Necker-Enfants Malades Hospital, Paris, France.
⁴ Department of Oto-Rhino-Laryngology, Lariboisière Hospital, Paris Diderot University, Paris, France.
⁵ Microbiology Laboratory, Necker-Enfants Malades Hospital, Paris Descartes University, Paris, France; Biology and Pathogenicity Unit, Institut Pasteur, Paris, France.
⁶ Infectious Diseases Department, Marche Polytechnic University, Ancona, Italy.
⁷ Department of Pharmacology, Paris Descartes University, Sorbonne Paris Cité, Inserm U1129, Hôpital Européen Georges-Pompidou, Paris, France.
⁸ Parasitology-Mycology Laboratory, Lariboisière-Saint Louis Hospital, Paris, France.
⁹ Institut Pasteur, Centre National de Référence Mycoses invasives et Antifongiques, Paris, France.
¹⁰ Department of Pathology, Faculty of Medicine, Lariboisière Hospital, Paris Diderot University, Paris, France.
¹¹ Paris Descartes University, Infectious Diseases and Tropical Medicine Department, Necker Pasteur Infectious Diseases Centre, Necker-Enfants Malades Hospital, APHP, IHU Imagine, Paris, France; Institut Pasteur, Centre National de Référence Mycoses invasives et Antifongiques, Paris, France; Institut Pasteur, Unite de Mycologie Moleculaire, CNRS URA3012, Paris, France.
¹² Paris Descartes University, Infectious Diseases and Tropical Medicine Department, Necker Pasteur Infectious Diseases Centre, Necker-Enfants Malades Hospital, APHP, IHU Imagine, Paris, France; Institut Pasteur, Centre National de Référence Mycoses invasives et Antifongiques, Paris, France; Institut Pasteur, Unite de Mycologie Moleculaire, CNRS URA3012, Paris, France. Electronic address: fanny.lanternier@nck.aphp.fr.

PMID: 26802213
DOI: 10.1016/j.cmi.2015.12.027

Abstract

Aspergillus spp. invasive external otitis (IEO) is a rare infection. We performed a seven-year, single-centre retrospective study from 2007 to 2014 including all patients with proven Aspergillus spp. IEO. Twelve patients were identified. All patients had a poorly controlled diabetes mellitus and one underwent solid organ transplant. The most frequently isolated species was Aspergillus flavus (n = 10) and voriconazole was the first-line therapy in all cases, with a median length of treatment of 338.5 days (158-804 days). None of the patients underwent extensive surgery. The clinical outcome was excellent. However, otological sequelae were reported, including hearing impairment (n = 7) and facial palsy (n = 3).

Keywords: Aspergillus spp.; diabetes mellitus; invasive; otitis; voriconazole.

MeSH terms

Adult
Aged
Antifungal Agents / therapeutic use
Aspergillosis / diagnosis*
Aspergillosis / drug therapy
Aspergillosis / microbiology
Aspergillosis / pathology*
Aspergillus / classification
Aspergillus / isolation & purification*
Diabetes Complications
Female
Humans
Male
Middle Aged
Necrosis / pathology*
Organ Transplantation / adverse effects
Otitis Externa / diagnosis*
Otitis Externa / drug therapy
Otitis Externa / microbiology
Otitis Externa / pathology*
Retrospective Studies
Treatment Outcome
Voriconazole / therapeutic use

Substances

Antifungal Agents
Voriconazole