amphotericin-b and Otitis-Externa

Aspergillus and Candida spp are the most frequently isolated fungi in patients with otomycosis. The diagnosis of otitis externa relies on the patient's history, otoscopic examination under microscopic control, and imaging studies. Direct preparation of the specimens, particularly with optical brighteners, mycologic culture, and histologic examination, is very important and strongly recommended for the correct diagnosis. Patients with noninvasive fungal otitis externa should be treated with intense débridement and cleansing, and topical antifungals. Topical antifungals, such as clotrimazole, miconazole, bifonazole, ciclopiroxolamine, and tolnaftate, are potentially safe choices for the treatment of otomycosis, especially in patients with a perforated eardrum. The oral triazole drugs, itraconazole, voriconazole, and posaconazole are effective against Candida and Aspergillus, with good penetration of bone and the central nervous system. These drugs are essential in the treatment of patients with malignant fungal otitis externa complicated by mastoiditis and meningitis.

Topics: Administration, Topical; Amphotericin B; Anti-Infective Agents; Antifungal Agents; Clotrimazole; Drug Resistance, Fungal; Econazole; Humans; Itraconazole; Miconazole; Mycoses; Ointments; Otitis Externa

The case is reported of a 73-y-old diabetic man with malignant otitis externa due to Aspergillus niger. Cure was achieved with a 3 week course of intravenous amphotericin B, followed by oral itraconazole for 3 months. The characteristics and the outcome of 13 reported cases of malignant otitis externa caused by Aspergillus sp. are presented.

Topics: Administration, Oral; Aged; Amphotericin B; Antifungal Agents; Aspergillosis; Aspergillus niger; Follow-Up Studies; Humans; Infusions, Intravenous; Itraconazole; Male; Otitis Externa; Risk Assessment; Severity of Illness Index; Tomography, X-Ray Computed; Treatment Outcome

Herein, we report a case of otitis externa caused by Malassezia slooffiae complicated with mastoiditis. A 70-year-old male complained of fever and severe otorrhea from left external auditory canal 2 months after undergoing a craniotomy to remove a hematoma. He had right-sided paralysis and undertook bed rest. Brain computed tomography revealed continuous fluid accumulation in the left mastoid air cells and middle ear from left external auditory canal in addition to leukocytosis and increased C-reactive protein level. The tympanic membrane was severely swelling. These results indicated the presence of otitis media and mastoiditis. Otorrhea culture showed large amounts of M. slooffiae. The administration of liposomal amphotericin B (L-AMB), the irrigation of external auditory canal with normal saline, and the application of topical ketoconazole ointment were started. The administration of L-AMB for 8 weeks and voriconazole, which was switched from L-AMB, for 4 weeks ameliorated his infection and he was transferred to another hospital to receive rehabilitation. From these results and his clinical course, the diagnosis of otitis externa caused by Malassezia slooffiae complicated with mastoiditis was made. And the possibility of the contamination by M. slooffiae was very low. Clinicians should be aware that M.slooffiae can provoke otological infections since M. slooffiae is the most common Malassezia sp. in external auditory canal.

Topics: Aged; Dermatomycoses; Humans; Malassezia; Male; Mastoiditis; Otitis Externa

Cutaneous leishmaniasis typically presents as a painless papule progressing to an ulcer or plaque. In this case study of the ear, the disease manifested as a small painful bump progressing into redness and swelling about the ear with purulent drainage. After multiple oral/intravenous antipseudomonal, antistaphylococcal, and antifungal treatments, there was no improvement. The skin progressed to an erythematous plaque and hemorrhagic ulcer; punch biopsy and speciation revealed Leishmaniasis guyanensis. The patient was switched to a seven-dose course of intravenous L-amphotericin B (visceral leishmaniasis protocol). Within 21 days, pain and edema resolved and the ulcers healed. Three-month follow-up demonstrated no recurrence. Further studies are needed to evaluate the use of L-amphotericin B in Leishmaniasis guyanensis.

Topics: Adult; Amphotericin B; Antiprotozoal Agents; Ear; Guyana; Hearing Loss; Humans; Leishmania guyanensis; Leishmaniasis, Cutaneous; Male; Otitis Externa; Travel

Fungal necrotizing otitis externa is rare, although its frequency has increased over the last few years. We report four cases, which to our knowledge make up the largest series published and discuss the main diagnostic problems and the management of this infection.. Our study investigated two men and two women, all diabetics, aged between 69 and 74 years. All four patients were first treated for bacterial necrotizing otitis externa. Diagnosis was reviewed after a lack of response to antibiotic therapy. Aspergillus flavus and Candida parapsilosis were the fungal agents isolated in each of the two patients. Diagnosis was established based on the pathological specimen for one patient. The last patient was treated without identifying the causal fungus. Two patients developed facial paralysis during disease progression. Treatment was based on intravenous amphotericin B and oral itraconazole. Three patients are now free of disease after a three- to six-month course of antifungal therapy; one patient was not followed up.. Fungal necrotizing otitis externa should be suspected in cases where there is no response to antipseudomonal antibiotic therapy. Deep biopsies from the external auditory canal or the mastoid are usually needed to confirm the diagnosis.

Topics: Aged; Amphotericin B; Antifungal Agents; Candidiasis; Female; Fluconazole; Humans; Male; Necrosis; Otitis Externa; Tomography, X-Ray Computed

A 74-y-old male receiving haemodialysis presented with right-sided otalgia, otorrhoea and diffuse swelling on the right external auditory canal. Following an initial successful treatment with prolonged intravenous antibiotics, the patient relapsed with a secondary infection in the same site due to Candida glabrata. We report an unusual case of malignant otitis externa caused by the fungus C. glabrata.

Topics: Aged; Amphotericin B; Antifungal Agents; Candida glabrata; Candidiasis; Fluconazole; Gallium Radioisotopes; Humans; Male; Otitis Externa; Radiography; Recurrence; Renal Dialysis; Tomography, Emission-Computed, Single-Photon

Malignant otitis externa caused by fungal infections is rare. A review of the literature showed only 9 cases, and the causative fungus in all cases was Aspergillus. This article reports an unusual case caused by Malassezia sympodialis.. A 53-year-old man with non-insulin dependent diabetes presented with malignant otitis externa. He deteriorated despite treatment with intravenous antipseudomonal therapy and surgical debridement. Microbiologic tests revealed M. sympodialis. He responded rapidly to intravenous amphotericin.. Systemic human infections caused by M. sympodialis have not been reported. M. furfur systemic infection is rare and has been associated lipid hyperalimentation by means of a central catheter. Only 1 other case of M. fungemia without these associated risk factors has been reported.. The first case of malignant otitis externa caused by M. sympodialis is presented. It highlights the difficulty of initial biologic diagnosis and the need for lipid-enriched media to grow this fastidious organism.

Topics: Amphotericin B; Antifungal Agents; Dermatomycoses; Diabetes Mellitus, Type 2; Follow-Up Studies; Humans; Malassezia; Male; Middle Aged; Otitis Externa; Tomography, X-Ray Computed; Treatment Outcome

Topics: Administration, Topical; Adolescent; Agranulocytosis; Amphotericin B; Aspergillosis; Humans; Otitis Externa; Precursor Cell Lymphoblastic Leukemia-Lymphoma

It is important to test the antimicrobial sensitivity of the aetiological agents of otitis externa before starting treatment in order to prevent the development of antibiotic resistance in the microorganisms. In this study the sensitivity patterns in bacteria and yeasts isolated as aetiological agents from otitis externa were analysed. Antifungal and antibacterial activity tests were done using the automated system ATB Fungus and the classic diffusion test respectively. The azole compounds had the greatest antifungal properties, while beta-lactams had the strongest antibiotic activity. This study reflects the increasing importance of sensitivity tests in chronic otitis externa due to the increasing antimicrobial resistances in bacteria and yeasts. If it is necessary to initiate an empiric treatment before the results of the antimicrobial test, the application of miconazole or econazole for yeasts and oxacillin or amoxicillin-clavulanic acid against bacteria is recommended.

Topics: Amphotericin B; Animals; Antifungal Agents; Dog Diseases; Dogs; Econazole; Miconazole; Microbial Sensitivity Tests; Nystatin; Otitis Externa

We describe here a case of cryptococcal empyema thoracis and periauricular pyogenic abscess in a child with Bruton's agammaglobulinaemia. The cryptococcal empyema thoracis was treated with intravenous amphotericin B and intravenous fluconazole for six weeks followed by oral fluconazole. The pyogenic periauricular abscess was surgically drained and treated with intravenous ceftazidime and cloxacillin for two weeks. He also received monthly intravenous immunoglobulin.

Topics: Abscess; Agammaglobulinemia; Amphotericin B; Ceftazidime; Child, Preschool; Cloxacillin; Combined Modality Therapy; Cryptococcosis; Empyema, Pleural; Fluconazole; Humans; Immunization, Passive; Male; Opportunistic Infections; Otitis Externa

To report otic administration of parenteral amphotericin B 0.25% in sterile water.. A 44-year-old HIV+ man was diagnosed with otitis externa. The patient's past medical history was remarkable for positive Coccidioides immitis serology for more than five months, essential hypertension, and Barrett's esophagitis. Culture results from an ear swab revealed 4+ Aspergillus fumigatus and 3+ Staphylococcus, coagulase negative. Antiinfective therapy for the otitis externa included oral and topical antibacterial and antifungal medications. Amphotericin B 0.25% in sterile water was prepared by the pharmacy for topical otic administration. The otic amphotericin B was dispensed with instructions to refrigerate and assigned a one-week expiration date. The prescription called for instillation of 1-2 drops in each ear three times a day. The patient's signs and symptoms of otitis externa resolved during several weeks of antiinfective therapy. Topical administration of amphotericin B 0.25% in sterile water was not associated with any local adverse effects in this patient.. The rationale for use of the parenteral amphotericin B formulation to prepare an otic dosage form, and the rationale for the specific concentration and expiration date chosen are discussed.. This patient tolerated topical otic administration of amphotericin B 0.25% in sterile water when administered three times daily.

Topics: Administration, Topical; Adult; Amphotericin B; Aspergillosis; Aspergillus fumigatus; Drug Administration Routes; Drug Administration Schedule; Ear Canal; HIV Seropositivity; Humans; Male; Otitis Externa; Water

83 cases of mycotic otitis of external ear are reported during a period of 27 months from three departments of otorhinolaryngology in Libreville (Gabon, Central Africa) Prevalence is estimated at about 25% among all infectious otitis. The main functional signs are pruritus, otorrhea, pain and hypoacousia. The physical examination shows masse of white, grey, black or creamy caseous debris, invading the external auditory meatus (EAM) which is sometimes inflammatory. Fungal species responsible of otitis are Aspergillus (54%), yeasts (45%) mainly Candida, infrequently Fusarium (1%). A niger (26%), A. flavus (17%), Candida parapilosis (18%), Candida albicans (9%) are predominant species isolated (70%) among all the 21 species of identified fungi from otomycosis in Gabon. Therapy, done by thorough washing of the ear followed by insertion into the EAM of a wick soaked in Econazole or Amphotericin B, is quickly effective.

Topics: Administration, Topical; Adolescent; Adult; Amphotericin B; Child; Dermatomycoses; Econazole; Female; Gabon; Hearing Disorders; Humans; Male; Middle Aged; Otitis Externa

We report a rare case of invasive external otitis caused by aspergillosis in an elderly nondiabetic patient. Amphotericin B therapy was curative. Atypical features of the presentation delayed diagnosis. Early use of tissue biopsy and culture to guide prompt initiation of therapy is recommended. The clinical spectrum and microbiology of invasive aspergillosis are also reviewed.

Topics: Aged; Aged, 80 and over; Amphotericin B; Aspergillosis; Candidiasis; Diagnosis, Differential; Humans; Male; Otitis Externa

Topics: Amphotericin B; Animals; Arthritis; Cat Diseases; Cats; Dog Diseases; Dogs; Hip Dislocation; Mitosporic Fungi; Otitis Externa; Specimen Handling; Synovial Fluid; Technology, Radiologic