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Aspergillus spp. invasive external otitis: favourable outcome with a medical approach
E Marchionni1, P Parize2, A Lefevre3
1Paris Descartes University, Infectious Diseases and Tropical Medicine Department, Necker Pasteur Infectious Diseases Centre, Necker-Enfants Malades Hospital, APHP, IHU Imagine, Paris, France; Infectious Diseases Department, Marche Polytechnic University, Ancona, Italy.
Abstract:
Aspergillus spp. invasive external otitis (IEO) is a rare infection. We performed a seven-year, single-centre retrospective study from 2007 to 2014 including all patients with proven Aspergillus spp. IEO. Twelve patients were identified. All patients had a poorly controlled diabetes mellitus and one underwent solid organ transplant. The most frequently isolated species was Aspergillus flavus (n = 10) and voriconazole was the first-line therapy in all cases, with a median length of treatment of 338.5 days (158-804 days). None of the patients underwent extensive surgery. The clinical outcome was excellent. However, otological sequelae were reported, including hearing impairment (n = 7) and facial palsy (n = 3).
Insights
Invasive external otitis caused by Aspergillus species is rare, often affecting patients with uncontrolled diabetes. Treatment with voriconazole yielded excellent clinical outcomes, though hearing loss and facial palsy were noted sequelae.
Area of Science:
- Infectious Diseases
- Otolaryngology
- Mycology
Background:
- Invasive external otitis (IEO) caused by Aspergillus species is an uncommon fungal infection.
- This condition primarily affects individuals with compromised immune systems, particularly those with poorly controlled diabetes mellitus.
Purpose of the Study:
- To investigate the clinical characteristics, treatment, and outcomes of Aspergillus spp. invasive external otitis.
- To identify risk factors and sequelae associated with this rare otological infection.
Main Methods:
- A seven-year retrospective study (2007-2014) was conducted at a single center.
- Twelve patients diagnosed with proven Aspergillus spp. IEO were included in the analysis.
Main Results:
- Aspergillus flavus was the most common species identified (10 out of 12 patients).
- Voriconazole was the standard first-line treatment, with a median duration of 338.5 days.
- Excellent clinical recovery was observed, with no patients requiring extensive surgery.
Conclusions:
- Aspergillus spp. IEO, while rare, can be effectively managed with voriconazole, especially in diabetic patients.
- Despite good clinical outcomes, patients may experience otological sequelae such as hearing impairment and facial palsy.
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