Malignant <i>Aspergillus flavus</i> Otitis Externa with Jugular Thrombosis

Moniot, Maxime; Montava, Marion; Ranque, Stéphane; Scemama, Ugo; Cassagne, Carole; Arthur, Varoquaux

doi:10.3201/eid2504.180710

Cited by 8 publications

(4 citation statements)

References 10 publications

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“…The 68 studies included a total of 74 individual cases of fungal TBO (Tables 3 and 4) (8,12,24–89). The mean age (SD) was 55.5 (23.3) years, and 74.3% (55/74) were male.…”

Section: Resultsmentioning

confidence: 99%

Trends and Outcomes of Fungal Temporal Bone Osteomyelitis: A Scoping Review

et al. 2022

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IntroductionTemporal bone osteomyelitis is an invasive infection most often caused by bacteria and associated with high mortality. Fungal etiologies are rare and little is known of the predictors of disease severity and outcomes in fungal temporal bone osteomyelitis.Materials and MethodsA scoping review was performed to determine what is known from the literature on how clinical, diagnostic, and treatment characteristics relate to patient outcomes in fungal temporal bone osteomyelitis. Using PRISMA guidelines, three databases were searched to identify all published cases of fungal temporal bone osteomyelitis. Data were extracted from each study, including clinical, diagnostic, and treatment characteristics, and outcomes.ResultsSixty-eight studies comprising 74 individual cases of fungal temporal bone osteomyelitis were included. All studies were case reports. There were high rates of diabetes, facial nerve palsy, infectious complications, and need for surgical intervention, as well as a significant delay in the evaluation and diagnosis of fungal temporal bone osteomyelitis. Disease recovery was greater in patients presenting with otorrhea, comorbid diabetes, and in those without facial nerve palsy.DiscussionMany of the defining characteristics of fungal temporal bone osteomyelitis remain unknown, and future reports should focus on determining factors that improve timely diagnosis and treatment of fungal TBO in addition to identifying prognostic indicators for outcomes and survival.

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“…The 68 studies included a total of 74 individual cases of fungal TBO (Tables 3 and 4) (8,12,24–89). The mean age (SD) was 55.5 (23.3) years, and 74.3% (55/74) were male.…”

Section: Resultsmentioning

confidence: 99%

Trends and Outcomes of Fungal Temporal Bone Osteomyelitis: A Scoping Review

et al. 2022

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“…IJVthr is often a complication of head and neck, local skin, and throat infections [ 23 , 24 , 46 , 47 , 48 ], surgery [ 49 , 50 , 51 ], trauma [ 17 ], local or distant malignancy [ 3 , 11 , 25 , 51 , 52 ], central venous catheter placement [ 43 , 44 , 45 ], polycythemia vera [ 37 , 53 , 54 , 55 ], intravenous drug abuse [ 56 , 57 ], neck massage [ 12 ], ovarian hyperstimulation syndrome [ 58 , 59 , 60 , 61 ], hypercoagulable state secondary to factor V Leiden, protein C, protein S, anti-phospholipid syndrome, anti-thrombin III deficiency [ 13 , 14 , 36 , 62 , 63 , 64 , 65 ], or it can be a primary process [ 1 , 3 , 4 , 5 ].…”

Section: Resultsmentioning

confidence: 99%

Internal Jugular Vein Thrombosis: Etiology, Symptomatology, Diagnosis and Current Treatment

et al. 2021

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(1) Background: internal jugular vein thrombosis (IJVthr) is a potentially life-threating disease but no comprehensive reviews on etiology, symptomatology, diagnosis and current treatment guidelines are yet available; (2) Methods: we prospectively developed a protocol that defined objectives, search strategy for study identification, criteria for study selection, data extraction, study outcomes, and statistical methodology, according to the PRISMA standard. We performed a computerized search of English-language publications listed in the various electronic databases. We also retrieved relevant reports from other sources, especially by the means of hand search in the Glauco Bassi Library of the University of Ferrara; (3) Results: using the predefined search strategy, we retrieved and screened 1490 titles. Data from randomized control trials were few and limited to the central vein catheterization and to the IJVthr anticoagulation treatment. Systematic reviews were found just for Lemierre syndrome, the risk of pulmonary embolism, and the IJVthr following catheterization. The majority of the information required in our pre-defined objectives comes from perspectives observational studies and case reports. The methodological quality of the included studies was from moderate to good. After title and abstract evaluation, 1251 papers were excluded, leaving 239 manuscripts available. Finally, just 123 studies were eligible for inclusion. We found out the description of 30 different signs, symptoms, and blood biomarkers related to this condition, as well as 24 different reported causes of IJVthr. (4) Conclusions: IJVthr is often an underestimated clinical problem despite being one of the major sources of pulmonary embolism as well as a potential cause of stroke in the case of the upward propagation of the thrombus. More common symptoms are neck pain and headache, whereas swelling, erythema and the palpable cord sign beneath the sternocleidomastoid muscle, frequently associated with fever, are the most reported clinical signs. An ultrasound of the neck, even limited to the simple and rapid assessment of the compression maneuver, is a quick, economic, cost-effective, noninvasive tool. High quality studies are currently lacking.

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“…Auricular and ocular localizations are frequently reported as keratitis and chronic otomycosis [5][6][7][8][9][10][11]. A. flavus is also the first agent of skull base aspergillosis, whose typical form is malignant external otitis [12][13][14][15][16][17], and the principal risk factor is diabetes [18]. A. flavus could also be implicated in many other clinical forms such as pulmonary invasive aspergillosis [19][20][21][22], chronic rhinosinusitis [23], brain abscesses [24], myositis [25,26], arthritis [27], spondylodiscitis [28,29], endocarditis [30,31], mediastinitis [32], eumycetoma [33], and allergic [34] or hypersensitivity syndromes like hot tub pneumonitis [35].…”

Section: Introductionmentioning

confidence: 99%

The Molecular Identification and Antifungal Susceptibility of Clinical Isolates of Aspergillus Section Flavi from Three French Hospitals

Djenontin,

Costa,

Mousavi

et al. 2023

Microorganisms

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(1) Background: Aspergillus flavus is a cosmopolitan mold with medical, veterinary, and agronomic concerns. Its morphological similarity to other cryptic species of the Flavi section requires molecular identification techniques that are not routinely performed. For clinical isolates of Aspergillus section Flavi, we present the molecular identification, susceptibility to six antifungal agents, and clinical context of source patients. (2) Methods: One hundred forty fungal clinical isolates were included in the study. These isolates, recovered over a 15-year period (2001–2015), were identified based on their morphological characteristics as belonging to section Flavi. After the subculture, sequencing of a part of the β-tubulin and calmodulin genes was performed, and resistance to azole antifungals was screened on agar plates containing itraconazole and voriconazole. Minimum inhibitory concentrations were determined for 120 isolates by the European Committee on Antimicrobial Susceptibility Testing (EUCAST) broth microdilution method. (3) Results: Partial β-tubulin and calmodulin sequences analysis showed that 138/140 isolates were A. flavus sensu stricto, 1 isolate was A. parasiticus/sojae, and 1 was A. nomiae. Many of the isolates came from samples collected in the context of respiratory tract colonization. Among probable or proven aspergillosis, respiratory infections were the most frequent, followed by ENT infections. Antifungal susceptibility testing was available for isolates (n = 120, all A. flavus ss) from one hospital. The MIC range (geometric mean MIC) in mg/L was 0.5–8 (0.77), 0.5–8 (1.03), 0.125–2 (0.25), 0.03–2 (0.22), 0.25–8 (1.91), and 0.03–0.125 (0.061) for voriconazole, isavuconazole, itraconazole, posaconazole, amphotericin B, and caspofungin, respectively. Two (1.67%) isolates showed resistance to isavuconazole according to current EUCAST breakpoints with MICs at 8 mg/L for isavuconazole and voriconazole. One of these two isolates was also resistant to itraconazole with MIC at 2 mg/L. (4) Conclusions: The present characterization of a large collection of Aspergillus belonging to the Flavi section confirmed that A. flavus ss is the predominant species. It is mainly implicated in respiratory and ENT infections. The emergence of resistance highlights the need to perform susceptibility tests on section Flavi isolates.

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Malignant Aspergillus flavus Otitis Externa with Jugular Thrombosis

Cited by 8 publications

References 10 publications

Trends and Outcomes of Fungal Temporal Bone Osteomyelitis: A Scoping Review

Trends and Outcomes of Fungal Temporal Bone Osteomyelitis: A Scoping Review

Internal Jugular Vein Thrombosis: Etiology, Symptomatology, Diagnosis and Current Treatment

The Molecular Identification and Antifungal Susceptibility of Clinical Isolates of Aspergillus Section Flavi from Three French Hospitals

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