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Malignant otitis externa in HIV and AIDS
J D Hern1, J Almeyda, D M Thomas
1Department of Otolarynology, St Mary's Hospital, London, UK.
Abstract:
Malignant otitis externa is a necrotising infection of the external ear canal which may spread to include the mastoid and petrous parts of the temporal bone, leading to skull base osteomyelitis. It is almost exclusively caused by infection with Pseudomonas aeruginosa, and usually occurs in elderly non-insulin-dependent diabetic patients. However isolated cases have been reported in a small number of non-diabetic patients, particularly in children who are immunocompromised due to malignancy, malnutrition and severe anaemia. In 1984 a case of malignant otitis externa was reported in a child with an acquired immunodeficiency syndrome (AIDS)-like illness, prior to identification of the human immunodeficiency virus (HIV). Since that time further sporadic cases of this invasive infection have been reported in HIV and AIDS. We present two further cases and also a review of the current literature.
Insights
Malignant otitis externa, a severe Pseudomonas aeruginosa infection, typically affects elderly diabetics but can occur in immunocompromised individuals, including those with HIV/AIDS. This review highlights its occurrence in non-diabetic patients, particularly children.
Area of Science:
- Infectious Diseases
- Otolaryngology
- Immunology
Background:
- Malignant otitis externa (MOE) is a severe necrotizing infection of the external ear canal.
- It often progresses to skull base osteomyelitis, commonly caused by Pseudomonas aeruginosa.
- MOE typically affects elderly patients with non-insulin-dependent diabetes mellitus.
Observation:
- Isolated cases of MOE occur in non-diabetic patients, especially immunocompromised children.
- Cases have been reported in patients with acquired immunodeficiency syndrome (AIDS)-like illness and subsequently in those with human immunodeficiency virus (HIV) infection.
- This study presents two additional cases of MOE in HIV/AIDS patients and reviews existing literature.
Findings:
- Pseudomonas aeruginosa is the primary pathogen in malignant otitis externa.
- Elderly, non-insulin-dependent diabetics are the most common demographic, but immunocompromised status is a significant risk factor.
- HIV/AIDS patients represent a vulnerable group for invasive otitis externa.
Implications:
- Increased awareness of MOE in immunocompromised patients, including those with HIV/AIDS, is crucial for early diagnosis and treatment.
- Understanding risk factors beyond diabetes can improve patient outcomes.
- Further research into the pathogenesis and management of MOE in specific populations is warranted.