Chaurasiya Ajay Kumar, Pradhananga Rabindra Bhakta, Sah Niranjan Prasad, Rijal Basista Prasad, Pokhrel Bharat Mani, Dulal Santosh
Department of Microbiology, Tribhuvan University and Teaching Hospital (TUTH), Institute of Medicine, Kathmandu, Nepal.
Department of Microbiology, Patan Academy of Health Sciences (PAHS), Lalitpur, Nepal.
Case Rep Infect Dis. 2021 Sep 27;2021:5556679. doi: 10.1155/2021/5556679. eCollection 2021.
causing chronic suppurative otitis media (CSOM) is rare in immunocompetent people; however, it can occur as a significant opportunistic pathogen in immunocompromised patients. Here, in our study, a 53-year-old diabetic patient having a history of CSOM visited the Department of Otorhinolaryngology-Head and Neck Surgery (ENT-HNS), Tribhuvan University and Teaching Hospital (TUTH), Nepal, in March 2016. Although he was on medication with an antibacterial ear drop from the last 10 days, his right ear was presented with otorrhea, pruritus, otalgia, aural fullness, hearing impairment, and tinnitus from the last 3-4 months. Preliminarily, otoscopy of the right ear revealed the presence of fungal mass. For further diagnosis, ear discharge was aseptically collected and sent to the laboratory to confirm the etiological agents. Findings of laboratory analysis indicated that Gram staining of aural discharge displayed pus cells with fungal spores but did not exhibit bacteria. Furthermore, potassium hydroxide (KOH) mount revealed the presence of fungal spores and septate hyphae with the characteristic of dichotomous branching. Culture in four different bacterial media (chocolate agar, blood agar, MacConkey agar, and Robertson's cooked meat medium) has unveiled no bacterial growth. However, fungal growth was observed in both bacterial and fungal media. Thereafter, the fungal colony was investigated via a lactophenol cotton blue (LPCB) tease mount which displayed the structure of . was microbially conformed by specifically characterizing the specific phenotypic biseriate structure of phialides and the black-coloured conidia. For medication, the patient was treated with Candid Ear Drop with clotrimazole (1% w/v) plus lidocaine (2% w/v) for 4 weeks which successfully improved his condition.
在免疫功能正常的人群中，引起慢性化脓性中耳炎（CSOM）的情况较为罕见；然而，它在免疫功能低下的患者中可作为一种重要的机会致病菌出现。在此，在我们的研究中，一名有CSOM病史的53岁糖尿病患者于2016年3月就诊于尼泊尔特里布万大学教学医院（TUTH）的耳鼻咽喉-头颈外科（ENT-HNS）。尽管他在过去10天一直在使用抗菌耳滴剂，但在过去3 - 4个月里，他的右耳出现了耳漏、瘙痒、耳痛、耳闷、听力减退和耳鸣。初步检查，右耳耳镜检查发现有真菌团块。为进一步诊断，无菌采集耳分泌物并送至实验室以确认病原体。实验室分析结果表明，耳分泌物的革兰氏染色显示有含真菌孢子的脓细胞，但未发现细菌。此外，氢氧化钾（KOH）涂片显示存在具有二叉分支特征的真菌孢子和分隔菌丝。在四种不同的细菌培养基（巧克力琼脂、血琼脂、麦康凯琼脂和罗伯逊熟肉培养基）中培养均未发现细菌生长。然而，在细菌和真菌培养基中均观察到真菌生长。此后，通过乳酚棉蓝（LPCB）涂片对真菌菌落进行检查，显示出其结构。通过特异性表征瓶梗的特定表型双列结构和黑色分生孢子，对其进行了微生物鉴定。对于治疗，该患者使用含克霉唑（1% w/v）加利多卡因（2% w/v）的念珠菌耳滴剂治疗4周，其病情成功改善。
