Etiologic role of Aspergillus species in otomycosis
Mahendra Pal
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Abstract
A study was undertaken to ascertain the etiologic role of Aspergillus species in otitis externa in 34 patients, which comprised of 20 males and 14 females of different age groups attending the outpatients department of ENT at Bharauch, Gujarat, India. The fungi were demonstrated in 26 patients, giving a prevalence of 76.4%. The diagnosis in each patient was established by direct microscopy of fungal elements in cytological smear, and by cultural isolation of fungi on Sabouraud medium and " APRM " medium. Among the various Aspergillus species , A. niger was most commonly identified (41.0%), followed by A. flavus, A. terreus, A. fumigates, A.candidua , and A.nidulans. The detailed morphology of fungal isolates was studied in " Narayan " stain. All cases of fungal otitis were unilateral. The most important predisposing factors associated with disease were mechanical injury, and use of topical antibacterial antibiotics. Topical application of 1% clotimazole, and 2% mercurochrome solution showed good clinical response in most of the patients. It is emphasized that cytological examination should be carried out in all the patients to elucidate the causative significance of opportunistic fungi in otitis externa. Moreover, " Narayan " stain should be widely employed in microbiology laboratory to study the morphology of fungi implicated in otomycosis. As mercurochrome is very cheap compound, its use in poor resource nations for the management of mycotic otitis is emphasised. The routine application of new medium " APRM " , which is very cheap, and easy to prepare, is recommended for primary isolation of opportunistic fungi from clinical and environmental materials.
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Otomycosis due to Aspergillus flavus and aspergillus niger in a floor mill worker
In this paper, we report an interesting case of dual mycotic infections of the ear in a young male, flour mill worker due to Aspergillus flavus and A.niger from Gujarat, India. The patient was having pain in his left ear for the last 45 days. Direct microscopical examination of the ear wax by potassium hydroxide technique showed hyaline, septate, thin branched hyphae morphologically simulating to Aspergillus. Fungal elements were also observed in the methylene blue stained smears. The culture of the ear swabs and ear wax on Sabouraud dextrose agar with chloramphenicol revealed two filamentous fungi, which on detailed microscopy morphology in Narayan stain confirmed the identity as Aspergillus flavus and A.niger. Both the fungi were found resistance to clotrimazole and Nystatin but was highly sensitive to mercurochrome. Based on the drug sensitivity test, patient was treated with 2 % solution of mercurochrome for 21 days. The drug showed good clinical response, with no side effects, and hence, it can be recommended for the management of mycotic otitis particularly in poor resource countries, which can hardly afford the expensive antifungal drugs. As Narayan stain is easy to prepare and less expensive, its routine application in microbiology and public health laboratories will help the mycologists to study the detailed morphology of various fungi, which are incriminated in clinical disorders of humans and animals. As far as it could be ascertained, this seems to be first documented record of dual mycotic infection of the ear due to A.flavus and A.niger in an immunocompetent patient from Gujarat ,India.
A study of fungi isolated from cases of otitis media diagnosed at tertiary care hospital of Gujarat, India
International Journal of Advances in Medicine, 2016
Background: Otitis media is commonest disease seen in children. Apart from bacteria fungus are responsible for majority of the cases of otitis media. The objective was to speculate the aetiological fungal flora which was responsible for the cases of otitis media. Methods: The present study was conducted by Department of Microbiology, B. J. Medical College, Ahmedabad during 1 st May 2000 to 30 th April 2002. Before conducting the study approval was obtained from institutional ethical committee for human research. Total 140 patients of otitis media were included after written informed consent. The ear discharge from each diseased middle) ear was collected and cultured on Sabouraud's dextrose agar slant and was examined for gross and the microscopic morphology of the fungi. The organisms were identified by using a standard procedure. Data was analyzed using Microsoft exel software (Trial Version). Results: Out of 140 samples 114 (81.43%) had positive culture. out of 114 cases, 64 (56.14%) were male. Majority of the cases (32.45%) were in the age group of 0-14 years. Out of 114 positive cases, single organism was isolated in 99 (86.8%) cases. Out of total 129 strains 44 (37.9%) were gram positive, 72 (62.1%) were gram negative organisms and 13 (10.07%). Out of total 13 strains of fungus isolated 6 (46.15%) were Candida albicans and 7 (53.84%) were Aspergillus niger. Aspergillus niger is predominant isolated fungus as compared to Candida albicans. Isolation of Aspergillus niger was only seen in adults. Conclusions: Aspergillus niger and Candida albicans were found to be the common fungal causes of otitis media in our study.
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Chronic bilateral otomycosis caused by Aspergillus niger. Fallbericht. Chronisch bilaterale Otomykose durch Aspergillus niger
Mycoses, 2004
Aspergillus niger, an opportunistic filamentous fungus, was identified as the cause of chronic bilateral otomycosis in a 46-year-old female patient who was unresponsive to different drugs. The patient showed signs of erythema, otalgia, itching, otorrhoea and presence of greyish black coloured mass in both the ear canals. The direct microscopical examination of the ear debris in potassium hydroxide preparations, Giemsa, phase contrast and Gram revealed many thin, branched septate hyphae, condia and conidiophores morphologically indistinguishable from Aspergillus spp. The histopathological section of the ear wax mass by haematoxylin and eosin and periodic acid-Schiff techniques also showed similar fungal elements. The patient responded to 1% solution of mercurochrome. The use of mercurochrome in developing countries like India may be recommended to treat the fungal otitis in patients. We also emphasize that ÔNarayanÕ stain should be routinely employed by microbiology and public health laboratories to study the morphology of pathogenic fungi.
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International Journal of Current Microbiology and Applied Sciences, 2016
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International Archives of Otorhinolaryngology, 2018
Introduction Otomycosis is a common problem in otolaryngology practice. However, we usually encounter some difficulties in its treatment because many patients show resistance to antifungal agents, and present high recurrence rate. Objectives To determine the fungal pathogens that cause otomycosis as well as their susceptibility to the commonly used antifungal agents. Additionally, to discover the main reasons for antifungal resistance. Methods We conducted an experimental descriptive study on 122 patients clinically diagnosed with otomycosis from April 2016 to April 2017. Aural discharge specimens were collected for direct microscopic examination and fungal culture. In vitro antifungal susceptibility testing was performed against the commonly used antifungal drugs. We tested the isolated fungi for their enzymatic activity. Results Positive fungal infection was found in 102 samples. The most common fungal pathogens were Aspergillus and Candida species, with Aspergillus niger being th...
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2006
Otomycosis is a subacute or acute superficial mycotic infection of the outer ear canal that is caused by opportunistic fungi. The infection is usually unilateral and characterized by inflammation, pruritus, scaling and severe discomfort such as suppuration and pain. In this study 15 patients (11 female and 4 male) with symptomatic otomycosis were confirmed by direct microscopy and cultures. The most common fungal pathogens were Aspergillus niger (8 cases) followed by A. flavus (2 cases), A. fumigatus, Penicillium Spp., Candida albicans, C. parapsilosis and Rhizopus Spp each 1 case.
Assessment of Risk Factors Associated with Common Fungal Pathogens Causing Otomycosis at a Tertiary Care Hospital in South India
Texila International Journal of Public Health, 2024
Otomycosis is one of the most prevalent fungal diseases of the external auditory canal in the tropical and sub-tropical regions of the world. Numerous environmental and host factors can put a person at risk for otomycosis. This cross-sectional study was undertaken over a one-year period at a tertiary care hospital, in South India after approval from Institutional Human Ethics Committee (IHEC), as there is limited data available on the clinical-mycological profile and its association with various risk factors in our region in the recent past. 90 ear swabs from clinically diagnosed otomycosis patients were sent to the laboratory for mycological examination from the Ear, Nose, and Throat (ENT) out-patient Department. Their clinical data was evaluated using a self-administered questionnaire. Mycological examination yielded 63 fungal isolates with Aspergillus niger as the predominant organism followed by other fungi; common risk factors identified were diabetes mellitus (92%), CSOM patients on steroid drops (91.6%), swimming (80%), CSOM patients on antibiotic drops (75%) with a significant association of p<0.05 between the above-mentioned risk factors and otomycosis. The current study highlights that proper identification of the causative agents is mandatory to prevent complications and recurrences, even when the patients' otoscopic findings and clinical presentations strongly suggest a fungal infection. Comparable with other superficial fungal infections, otomycosis does not represent a threat to life. However, prompt microbiological identification are essential for timely and effective therapy to avert major issues from otomycosis.
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Clinicomycological Study of Otomycosis with Antifungal Susceptibility Testing Of Fungal Isolates
IOSR Journals , 2019
Otomycosis or fungal otitis externa is a superficial, sub-acute or chronic infection of the external auditory canal, usually with unilateral presentation characterized by inflammation, pruritis, scaling and otalgia. Aim Of The Study: To find the prevalence of otomycosis along with its clinicomycologicalprofile,to explore specific predisposing factors,to isolate and identify the causative fungus and antifungal susceptibility testing for moulds by E test and for yeast by disk diffusion method. Methodology:Ear swabs were collected from 30 clinically suspected cases of otomycosis and all the samples were processed by direct microscopy of KOH mount and Gram staining. Culture was carried out on SDA.The identification process of the isolated fungus was done by standard procedures. Antifungal sensitivity of moulds was performed on RPMI 1640 agar supplemented with 2% glucose and tested for fluconazole (0.016-256 mcg/ml), Itraconazole(0.002 mcg/ml to 32 mcg/ml) and Caspofungin (0.002-32 mcg/ml) (HiMedia) by E strip .AFST for yeast was performed by the disc diffusion method on Mueller Hinton Agar supplemented with 2% glucose and 0.5mg/ L Methylene Blue (HiMedia)and tested for Fluconazole (10μg),Nystatin (100U), Amphotericin (100U), Ketoconazole (10μg) and Clotrimazole (10μg) disk (HiMedia). Result And Conclusion:Otomycosis was diagnosed in 100% of the cases with highest prevalence in 21-40 years of age group with a female preponderance.Itching was found to be the commonest symptom followed by ear pain.Ear pricking with hard objects was found to be the most common predisposing factor followed by swimming or pond bath. Seven cases were associated with tympanic membrane perforation. Of the 30 cases 32 number of fungi were isolated. Fungal isolates were predominantly mould (90.62%) while rest were yeast (9.38%). Mixed infection with more than one fungus was seen in 2 cases (6.67%). A.niger was the predominant fungus (71.88%) followed by A.flavus(18.75%) and C.tropicalis(9.37%). All the yeasts were found to be sensitive to Ketoconazole,Nystatin and Amphotericin and all moulds were found to be resistant to fluconazole.
Mycology of Otomycosis in a Tertiary Care Teaching Hospital
Journal of Research in Medical and Dental Science, 2015
Primary Otomycosis in the Indian Subcontinent: Predisposing Factors, Microbiology, and Classification
International Journal of Microbiology, 2014
Objective. To define otomycosis and determine the predisposing factors and microbiology in primary otomycosis. Study Design. Prospective study of two years and review of the literature. Setting. Academic Department of Otolaryngology in a coastal city in India. Patients. 150 immunocompetent individuals of whom 100 consecutive patients with a clinical diagnosis of otomycosis are considered as the study group and 50 consecutive patients with no otomycosis are considered as the control group. Results and Observations. Instillation of coconut oil (42%), use of topical antibiotic eardrops (20%), and compulsive cleaning of external ear with hard objects (32%) appeared to be the main predisposing factors in otomycosis. Aspergilli were the most common isolates (80%) followed by Penicillium (8%), Candida albicans (4%), Rhizopus (1%), and Chrysosporium (1%), the last being reported for the first time in otomycosis. Among aspergilli, A. niger complex (38%) was the most common followed by A. fumigatus complex (27%) and A. flavus complex (15%). Bacterial isolates associated with fungi in otomycosis were S. aureus, P. aeruginosa, and Proteus spp. In 42% of healthy external ears fungi were isolated. Conclusion. Aspergillus spp. were the most common fungi isolated, followed by Penicillium. Otomycotic ears are often associated with bacterial isolates when compared to normal ears. Fungi are also present in a significant number of healthy external auditory canals and their profiles match those in cases of otomycosis. The use of terms "primary" and "secondary" otomycosis is important to standardize reporting.
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iranian journal of pathology, 2006
Background and Objective: Otitis externa is a common condition affecting the external auditory canal. Predisposing factors implicated in the pathogenesis of the condition include preexisting aural disease, genetic factors, infection, trauma, and climatic conditions. Bacteria are the most common cause of infection and fungi play a smaller but significant role in the disease. Otomycosis is characterized by inflammation, pruritus, pain, and scaling, usually in a unilateral pattern. Otomycosis has a worldwide distribution with a higher prevalence in the hot, humid, and dusty climate of the tropical and subtropical regions. The objectives of this study were to determine the prevalence of mycotic infections in inflammatory conditions of the ear and to determine fungal species responsible for otitis. Materials and Methods: The study was conducted on 70 cases who presented with symptoms of otitis from September 2000 to December 2003. Patients were admitted in ENT clinic of AmirAl-Momenin ho...
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NATIONAL JOURNAL OF LABORATORY MEDICINE
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Otomycosis due to Aspergillus flavus and Aspergillus niger in a flour mill worker
2015
In this paper, we report an interesting case of dual mycotic infections of the ear in a young male, flour mill worker due to Aspergillus flavus and A.niger from Gujarat, India. The patient was having pain in his left ear for the last 45 days. Direct microscopical examination of the ear wax by potassium hydroxide technique showed hyaline, septate, thin branched hyphae morphologically simulating to Aspergillus. Fungal elements were also observed in the methylene blue stained smears. The culture of the ear swabs and ear wax on Sabouraud dextrose agar with chloramphenicol revealed two filamentous fungi, which on detailed microscopy morphology in Narayan stain confirmed the identity as Aspergillus flavus and A.niger. Both the fungi were found resistance to clotrimazole and Nystatin but was highly sensitive to mercurochrome. Based on the drug sensitivity test, patient was treated with 2 % solution of mercurochrome for 21 days. The drug showed good clinical response, with no side effects, ...
A microbiological study of otomycosis
innovative publication, 2017
Aim of the study: To determine the fungi causing otomycosis and the associated bacterial pathogens in a rural set up in clinically suspected cases of otomycosis. Methodology: Ear swabs were collected from 100 clinically suspected cases of otomycosis and from 50 persons who were apparently healthy. All the samples were processed by direct microscopy of KOH mount and Gram staining. Cultures were carried out for both fungal and bacterial isolates, which were identified by standard procedures. The data were statistically analysed. Results: Among 150 samples, 51.3% yielded only fungal growth, 23.3% grew bacteria only and 19.3% showed mixed growth of fungi and bacteria. Major fungal isolates were Aspergillus spp. and Candida spp. One sample grew A. sydowii which is an uncommon agent causing otomycosis. Major bacterial isolates were Staphylococcus aureus and Pseudomonas spp. All pathogenic bacteria were sensitive to routinely used antibiotics. Samples taken from healthy persons did not yield any fungal or bacterial pathogens.
Fungal profile of otomycosis in a sample of egyptian patients in Zagazig university hospitals: A prospective study
Microbes and Infectious Diseases, 2020
Background: Otomycosis has been described as fungal infection of the external auditory canal with infrequent complications involving the middle ear. Otomycosis is challenging for both patients and otolaryngologist as it frequently requires long term treatment and follow up. Inspite of proper treatment and follow up, the recurrence rate remains high. The aim of current study is to detect the most common fungi in otomycosis patients and determine its risk factors. Methods: The study included 194 patients clinically diagnosed with otomycosis. Each swab is subjected to direct microscopic examination with 10 % KOH and culture on Sabroud's dextrose agar (SDA) and blood agar. Filamentous fungal growth is identified by macro-and micro morphological characteristics. Yeast like growth is identified by (API 20C) AUX. Results: The mean age ±SD of the patients was 24.18± 15.9 years. Males (n=106,54%), were more vulnerable to otomycosis than females (n=88, 45%). The most common presenting symptom was otorrhea and pruritus (n= 78 ,40%) with unilateral involvement being more common. The most common predisposing factor is self-cleaning (n=84 ,43%) followed by topical antibiotic ear drops with steroid use (n=30,15%). Aspergillus fumigatus was the most common fungus causing otomycosis in this study (n=70, 36%) followed by Candida tropicalis (n=28,16%). Positive fungal cultures were observed in 180 specimens (90%). Conclusion: Otomycosis was common in people with the bad habit of self-cleaning with unsterilized objects and using unnecessary steroid containing ear drops. Aspergillus fumigatus and Candida tropicalis were the most prevalent isolated fungi in otomycosis patients.
First molecular report of causative agent of otomycosis due to Aspergillus luchuensis
Journal of Wound Care, 2021
Otomycosis is a fungal infection of the external auditory canal caused mainly by the genus Aspergillus. Aspergillus luchuensis, an industrially important fungus, is a member of Aspergillus section Nigri. In this report, we present a case of otomycosis due to Aspergillus luchuensis in a 43-year-old female patient. We performed a partial PCR-sequencing of β-tubulin and calmodulin genes to identify the isolate to the species level. Further, we determined the in vitro susceptibility of the isolate to nystatin, clotrimazole and itraconazole according to the Clinical & Laboratory Standards Institute (CLSI) M38-A2 protocol. Accordingly, the minimum inhibitory concentrations of clotrimazole, nystatin and itraconazole were 0.25μg/mL, 0.5μg/mL and 1μg/mL, respectively. This is the first report of clinically relevant isolation of Aspergillus luchuensis identified by a molecular technique as a causative agent of otomycosis.
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