Fungal Malignant Otitis Externa Due to <i>Scedosporium Apiospermum</i>

Yao, Mike; Messner, Anna H.

doi:10.1177/000348940111000415

Cited by 66 publications

(31 citation statements)

References 18 publications

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“…Prolonged oral therapy is often necessary for months. Itraconazole and miconazole show in vitro and in vivo efficacy and could be used as an alternative to voriconazole [20][21][22][23][24]. Topical azoles seem to be an alternative to systemic treatment in uncomplicated S. [6,20,[24][25][26] but are not sufficient to treat cases with bones and soft tissues involvement or cerebral dissemination.…”

Section: Discussionmentioning

confidence: 99%

Scedosporium apiospermum Otitis Complicated by a Temporomandibular Arthritis: A Case Report and Mini-Review

Huguenin¹,

Noël²,

Rogez³

et al. 2015

Mycopathologia

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Scedosporium apiospermum is an ubiquitous fungus responsible for various infections in immunocompromised and immunocompetent patients. Ear infections are infrequent. We report an exceptional case of S. apiospermum external otitis complicated by temporomandibular joint arthritis. After 6 months of antibiotherapy, diagnosis was established by mycological analysis of external auditory canal and infratemporal fossae needle sampling. A satisfactory outcome was obtained after 2 months of voriconazole alone. We have reviewed 15 cases of S. apiospermum otitis. Seven of these patients were immunocompromised. Most common clinical presentation included a chronic external otitis lasting months or years before complication stage. Most common clinical features included recurrent unilateral otalgia (11/15) and purulent otorrhea (13/15). Diagnosis was often made at later stage (12/15) with local extension to bones and/or soft tissues (9/15) or cerebral lethal dissemination (3/15).The extremely low incidence of S. apiospermum otomycosis and its non-specific presentation results in a frequent diagnosis delay. A mycological investigation should be performed in case of persistent external otitis and/or osteolysis despite prolonged antibiotic treatment to prevent further extension of the disease.

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Section: Discussionmentioning

confidence: 99%

Scedosporium apiospermum Otitis Complicated by a Temporomandibular Arthritis: A Case Report and Mini-Review

Huguenin¹,

Noël²,

Rogez³

et al. 2015

Mycopathologia

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“…apiospermum as a cause of otitis externa; however, the organism may have been a saprobe of the external auditory canal (37,486). Saprobic involvement of the auditory canal occurs when constant drainage keeps the canal moistened, as occurs in the setting of chronic otitis media with perforated tympanic membranes or when the canal is filled with desquamating debris from chronic seborreic or psoriatic dermatitis.…”

Section: Saprobic Involvement/colonization Of Airwaysmentioning

confidence: 99%

Infections Caused byScedosporiumspp

et al. 2008

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SUMMARY Scedosporium spp. are increasingly recognized as causes of resistant life-threatening infections in immunocompromised patients. Scedosporium spp. also cause a wide spectrum of conditions, including mycetoma, saprobic involvement and colonization of the airways, sinopulmonary infections, extrapulmonary localized infections, and disseminated infections. Invasive scedosporium infections are also associated with central nervous infection following near-drowning accidents. The most common sites of infection are the lungs, sinuses, bones, joints, eyes, and brain. Scedosporium apiospermum and Scedosporium prolificans are the two principal medically important species of this genus. Pseudallescheria boydii, the teleomorph of S. apiospermum, is recognized by the presence of cleistothecia. Recent advances in molecular taxonomy have advanced the understanding of the genus Scedosporium and have demonstrated a wider range of species than heretofore recognized. Studies of the pathogenesis of and immune response to Scedosporium spp. underscore the importance of innate host defenses in protection against these organisms. Microbiological diagnosis of Scedosporium spp. currently depends upon culture and morphological characterization. Molecular tools for clinical microbiological detection of Scedosporium spp. are currently investigational. Infections caused by S. apiospermum and P. boydii in patients and animals may respond to antifungal triazoles. By comparison, infections caused by S. prolificans seldom respond to medical therapy alone. Surgery and reversal of immunosuppression may be the only effective therapeutic options for infections caused by S. prolificans.

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“…Eckburg et al [18] report a 21-year male with HIV and hemophila, who developed sinusitis and mastoiditis with S. apiospermum, which progressed despite antifungal therapy. Yao and Messner [19] report a fatal case of malignant otitis externa in a 21-year-old patient with AIDS. A review of five cases from Northern Britain [20] included three healthy patients with otitis who had positive polymicrobial cultures including P. boydii.…”

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confidence: 99%