Necrotizing External Otitis in Patients with AIDS

Ress, Bradford D.; Luntz, Michał; Telischi, Fred F.; Bałkany, Thomas J.; Whiteman, Michelle L. H.

doi:10.1097/00005537-199704000-00006

Cited by 52 publications

(28 citation statements)

References 19 publications

(64 reference statements)

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“…Eighteen patients were males, and five were females; most of the patients were adults (n ϭ 21), and the median age was 46 years (range, 7 to 85 years). Nineteen patients had an identified cause of acquired immunodeficiency, the most common underlying condition being AIDS (n ϭ 7) (7,27,33,34,45). Five patients suffered from acute leukemia (17,25,30,32,38), and five had diabetes mellitus as the sole underlying condition (2,13,16,19,23).…”

Section: Resultsmentioning

confidence: 99%

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Antifungal Therapy of Aspergillus Invasive Otitis Externa: Efficacy of Voriconazole and Review

Parize

Chandesris

Lanternier

et al. 2009

Antimicrob Agents Chemother

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Invasive otitis externa (IOE) due to Aspergillus is a rare, potentially life-threatening, invasive fungal infection affecting immunocompromised patients. The invasive process may lead to skull base osteomyelitis with progressive cranial nerve palsies and can result in irreversible hearing and neurological impairment. We report two cases of Aspergillus IOE treated with voriconazole alone and a literature review of antifungal therapy of Aspergillus IOE. Twenty-five patients, including the two described in the present report, were analyzed. Eighteen patients were treated with amphotericin B, and nine of them received itraconazole as an additional agent. Three patients received initial therapy with itraconazole, and one patient was treated with both voriconazole and caspofungin therapy. The two patients in the present report received voriconazole therapy alone with good clinical and biological tolerance despite prolonged treatment. The last patient did not receive antifungal therapy, as the diagnosis was made postmortem. Eighteen patients underwent an initial extensive surgical debridement. The majority of the patients had a favorable outcome, 17 patients experienced a complete recovery, and 6 showed a partial improvement. Both of the patients reported on here had favorable outcomes, and no aggressive surgical debridement was required. Although voriconazole has been shown to be effective for the treatment of invasive aspergillosis, its precise role in the management of Aspergillus IOE had not been documented. These observations demonstrate that voriconazole could be an effective and well-tolerated therapeutic option for the management of Aspergillus IOE.Invasive otitis externa (IOE) is a particular entity among ear infections (6). Its main feature is its spreading from the external auditory canal to adjacent anatomical structures including soft tissues, cartilage, and bone. The invasive process can lead to skull base osteomyelitis, progressive cranial nerve palsies, and even death if IOE is not recognized and treated early. Invasive external otitis typically occurs in elderly diabetic patients, and Pseudomonas aeruginosa is the most common causative microbial pathogen (11,35).Fungal pathogens, mostly Aspergillus spp., are a rare cause of IOE (5). As for other localizations of invasive aspergillosis, Aspergillus IOE occurs in immunocompromised patients, usually with profound and long-lasting neutropenia or under longterm steroid therapy (21), as well as in patients with uncontrolled diabetes mellitus (14).The treatment of Aspergillus sp. IOE classically includes extensive surgical debridement and intensive long-term antifungal therapy including amphotericin B and/or itraconazole. Despite this management, this pathology is associated with substantial morbidity and mortality, mostly due to late diagnosis and patient comorbidities (2, 37). Treatment failure could also be a result of suboptimal therapeutic management as a consequence of antifungal agent toxicity. In particular, the side effects of amphotericin B, especia...

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Section: Resultsmentioning

confidence: 99%

“…All patients but one received longterm antifungal therapy. One patient received no treatment since the diagnosis was made postmortem (34). Seventeen patients were initially treated with amphotericin B, and nine of them also received itraconazole as an additional agent.…”

Section: Resultsmentioning

confidence: 99%

Antifungal Therapy of Aspergillus Invasive Otitis Externa: Efficacy of Voriconazole and Review

Parize

Chandesris

Lanternier

et al. 2009

Antimicrob Agents Chemother

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“…All 6 of these patients were young (14,20,21,27,27, and 41 years of age in cases 22, 16,21,8,20, and 18, respectively) and were severely immunocompromised (4 with end-stage AIDS, 1 with severe neutropenia from chemotherapy for acute lymphoblastic leukemia, and 1 with graft-versus-host disease following bone marrow transplantation). An additional 7 patients died of other causes within a year of their fungal MOE.…”

Section: Review Of Literaturementioning

confidence: 99%

Fungal Malignant Otitis Externa Due to Scedosporium Apiospermum

Yao

Messner²

2001

Ann Otol Rhinol Laryngol

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Malignant otitis externa (MOE) is an infection of the external auditory canal that invades the skull base. Aspergillus species fungi were the pathological organism in 21 of 23 reported cases of fungal MOE. We report on a 21-year-old man with end-stage acquired immunodeficiency syndrome (AIDS) and fungal MOE caused by Scedosporium apiospermum. Fungal MOE is most common in patients with end-stage AIDS and hematologic malignancies. Granulation tissue is not a common finding in these patients, and the infectious process often starts in the mastoid air cells or middle ear space, as opposed to the external auditory canal. Surgical debridement and amphotericin B are the mainstays of therapy; resolution of the infection depends greatly on the severity of the underlying disease.

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“…MOE should be suspected in all patients who have HIV and otitis externa that does not improve with appropriate therapy. MOE in patients who have HIV may lack typical granulation tissue along the floor of the external auditory canal (EAC) [10]. Fungal MOE is found in patients who have HIV more commonly than in those who have diabetes, particularly patients who have severe AIDS [11].…”

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confidence: 99%