Evaluation of the Prevalence of Otomycosis in Patients Referred to the ENT Clinic

Objective: Otomycosis is a common fungal infection of the outer ear that is seen in tropical and subtropical regions of the world. This disease is one of the common problems that ENT specialists, face. Therefore, this study was conducted to evaluate the status and frequency of this disease in patients referred to the ENT clinic of Salmaniya Medical Complex, Kingdom of Bahrain for one year (2019-2020). Materials & Methods: Thirty-five patients (23 males and 12 females) were mycologically examined with a clinical diagnosis of otomycosis. In order to diagnose the disease, first ear sampling done and then the collected samples directly tested with 10% KOH and culture of samples was performed on Saburo dextrose agar and Saburo dextrose agar containing chloramphenicol. In order to determine the fungus species, various laboratory methods and differential tests were used. Results: In this study, out of 56 patients with clinical diagnosis of otomycosis, according to laboratory results, only 38 patients (67.8%) were diagnosed with otomycosis. Of these, 18 patients (32.1%) were male and 20 (35.7%) were female. The highest number of cases was observed in the age group of 30 - 40 years. Isolated fungal agents were: Aspergillus niger 24 cases (63.1%), Candida albicans 9 cases (23.7%), Aspergillus fumigatus 2 cases (5.3%), Aspergillus glaucous 2 cases (5.3%), and Penicillium one case (2.6%). Conclusion: In this study, the most common fungi isolated from patients with otomycosis were Aspergillus and Candida species, which is consistent with other studies. The present study showed, otomycosis cannot be diagnosed by clinical symptoms alone and it requires laboratory diagnosis.

Bayesian analysis of two methods MALDI-TOF-MS system and culture test in otomycosis infection

Objective:Identification of otomycotic fungi using matrix-assisted laser desorption ionization (MALDI) time of flight (TOF) mass spectroscopy (MS) and to quantify pervasive errors with Bayes rule;values of sensitivity and specificity of culture test and MALDI-TOF-MS method are quantified.Method:Fungi cultured ear discharge samples were identified with culture test and MALDITOF-MS system.Minimum inhibitory concentration (MIC) or MEC (minimum effective concentration) for 6 antifungals were determined by antifungal susceptibility testing in vitro.With Bayes rule,sensitivity and specificity of both MALDI-TOF MS and culture test methods were computed.Results:Cultures yielded 42 fungal isolates which were confirmed as species (specified against each species) belonging to 8 genera,A.niger 22,Candida sp.7,A.fumigatus 3,A.flavus 3,mixed Aspergillus sp.3,Mucor sp.2,Rhizopus sp.1,and Scopulariopsis sp.1;and MALDITOF-MS system also confirmed those isolates.In vitro antifungal susceptibility testing with terms of MIC 50 and MIC 90,isolates fungi were highly susceptible to 6 antifungals;and caspofungin was the most active antifungal.The high value of specificity 84.6%,suggested a limited loss of confidence on the culture test at the absence of an infection,in comparison to MALDI-TOF-MS.Sensitivity of the culture test was 87.5%;this high figure strongly approves the culture test to be the dependable method for the otomycosis diagnosis,when the infection is stable.Conclusion:Based on sensitivity and specificity together the culture test could be done in face of the gold-standardMALDI-TOF-MS system the estimating both methods.

Acute middle ear Aspergillus niger infection in a patient with Stevens-Johnson syndrome: a case report

Rationale: Stevens-Johnson syndrome is a disorder mostly attributed to drug use, which can cause different skin problems. Patient concerns: A 31-year-old woman presented with severe pain and pounding in the left ear. Diagnosis: Fluconazole-induced Stevens-Johnson syndrome with fungal infection in ear. Intervention: Surgical and systemic antibiotic therapy. Outcomes: The patient recovered and resumed her normal life. Lessons: The prescription of fluconazole for patients with underlying conditions should be done with caution.