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[Otomastoiditis caused by Aspergillus in AIDS]
A Martínez-Berriotxoa1, M Montejo, K Aguirrebengoa
1Unidad de Enfermedades Infecciosas, Hospital de Cruces, Barakaldo, Bizkaia.
Background:
Aspergillus otomastoiditis is an infrequent infection that occurs in most cases in immunocompromised hosts. Although fungal infections are common in AIDS patients, few cases of Aspergillus otomastoiditis have been reported.
Methods:
Two clinical cases of AIDS patients with Aspergillus otomastoiditis are reported, and a review of the literature is performed.
Results:
Clinical presentation in both cases was similar to those of other diseases involving middle and internal ear. Infection was linked to severe immunosuppression (C3 group).
Conclusions:
Aspergillus otomastoiditis is an infrequent infection in AIDS patients. Different routes by which Aspergillus obtains access to the middle ear have been proposed (tympanogenic, meningogenic, hematogenous and direct spread from paranasal sinuses or external auditory canal). Otorrhea, otalgia, hearing loss and facial nerve involvement are common findings. Bone destruction and invasion of brain or skull base may occur. CT or MRI are necessary to evaluate the extent of the disease. Etiologic diagnosis requires histopathologic confirmation on deep tissue biopsy or isolation from blood cultures or fistula exudates, because Aspergillus is a common saprophytic fungus in external auditory canal. Concurrent infections (i.e. Pseudomonas aeruginosa) frequently delay the correct diagnosis. Aggressive surgical resection and intravenous antifungal chemotherapy (amphotericin B or itraconazole) are the main therapeutic options. Outcome is poor as a consequence of severity, delay of etiologic diagnosis and difficulty of aggressive surgical approach in compromised patients. In patients with AIDS a low CD4 cell count would favour invasive Aspergillus infection, implying a worse outcome.
Insights
Aspergillus otomastoiditis is a rare fungal infection in immunocompromised individuals, particularly those with acquired immunodeficiency syndrome (AIDS). Early diagnosis and aggressive treatment are crucial for better outcomes in these patients.
Area of Science:
- Infectious Diseases
- Otolaryngology
- Mycology
Background:
- Aspergillus otomastoiditis is an uncommon infection, primarily affecting immunocompromised individuals.
- While fungal infections are prevalent in patients with acquired immunodeficiency syndrome (AIDS), documented cases of Aspergillus otomastoiditis are scarce.
Observation:
- Two cases of Aspergillus otomastoiditis in AIDS patients are presented, with clinical presentations mimicking other otologic diseases.
- The infections were associated with profound immunosuppression, specifically within the C3 group.
Findings:
- Common symptoms include otorrhea, otalgia, hearing loss, and facial nerve paralysis.
- Radiological imaging (CT/MRI) is essential for assessing disease extent, including potential bone destruction and intracranial invasion.
- Diagnosis requires histopathological confirmation or fungal isolation, as Aspergillus can be a commensal organism in the external auditory canal. Concurrent infections can impede diagnosis.
Implications:
- Aggressive surgical debridement and systemic antifungal therapy (e.g., amphotericin B, itraconazole) are the primary treatment strategies.
- Poor outcomes are often linked to disease severity, delayed diagnosis, and challenges in surgical management of immunocompromised patients.
- In AIDS patients, a low CD4 cell count correlates with invasive Aspergillus infections and a poorer prognosis.