Novel Use of a Swimming Pool Biocide in the Treatment of a Rare Fungal Mastoiditis

Abstract

Successful treatment of a chronic Lecythophora hoffmannii fungal mastoiditis involved a combination of radical surgical removal of all apparent infected tissue along with local treatments with polyhexamethylene biguanide, a common swimming pool biocide agent under the brand name Baquacil (Avecia, Manchester, United Kingdom). Given the prolonged course of treatment, this report particularly stresses the importance of concurrent surgery combined with creative local antimicrobial therapy to eliminate an unusual fungal infection in an immunocompetent host.

Successful Use of Locally Applied Polyhexamethylene Biguanide as an Adjunct to the Treatment Of Fungal Osteomyelitis

“…There are four cases of fungal osteomyelitis reported in the literature in which PHMB had been used as a component of treatment (2,3,7,8). These four cases, together with our two cases, are summarized in Table 1.…”

“…F ungi are uncommon causes of osteomyelitis in immunocompetent patients (1). Fungal osteomyelitis can be difficult to treat (2); the optimal management is a combination of antifungal treatment and surgical debridement (2)(3)(4)(5), although this approach is not universally successful (2).…”

Successful Treatment ofScedosporium aurantiacumOsteomyelitis in an Immunocompetent Patient

“…Polyhexamethylene biguanide is a disinfectant with broad antimicrobial activity, including fungi [27]. For example, it has been helpful for the treatment of fungal infections of the ear and parasitic infections of the eye [28,29].…”