Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia.
Department of Otolaryngology (ENT), Military Hospital of Tunis, 1008 Monfleury, Tunis, Tunisia.
Pan Afr Med J. 2022 Apr 8;41:287. doi: 10.11604/pamj.2022.41.287.29585. eCollection 2022.
Malignant external otitis (MEO) has a frequent bacterial origin, but we are currently witnessing the emergence of fungal agents, which poses difficulties in diagnosis and management. The aim of our work is to analyze the epidemiological and clinical profile of fungal MEO and to study the antifungal susceptibility of fungi involved. Our study is retrospective collecting 43 patients treated for fungal MEO between 2010 and 2019. Clinical, biological, and radiological data were collected from patient hospitalization records. Identification of yeasts was done by YST vitek2 card. The antifungal susceptibility testing was performed for yeasts by the AST vitek2 card and for other fungi by the E-test technique. The average age was 66 (± 12) years. We noted a male predominance in 63 % (n=27). Diabetes was found in 86%. Otalgia was a constant symptom. Cranial nerve palsies were observed in 16% (n=7) of cases. CT showed bone lysis in 74% (n=31>) of cases and Tc99 bone scintigraphy revealed hyperfixation in 100% (n=43) of cases. Candida spp. (n=21), Aspergillus spp. (n=18), and Geotrichum capitatum (n=2) were isolated. No resistance to antifungals has been demonstrated for Candida yeasts. Geotrichum capitatum isolates were resistant to fluconazole and caspofungin. Aspergillus isolates were resistant to amphotericin B and caspofungin in 50% (n=9) and 72% (n=12) of cases, respectively. Our study proves the predominance of Candida yeasts and Aspergillus as the fungal agents involved in MOE. Mycological diagnosis allows the identification and antifungal susceptibility testing. Thus, it allows using of the appropriate antifungal treatment and improves the prognosis of the disease.
恶性外耳炎（MEO）常由细菌引起，但目前我们也见证了真菌病原体的出现，这给诊断和治疗带来了困难。我们的研究旨在分析真菌性 MEO 的流行病学和临床特征，并研究相关真菌的抗真菌药敏性。我们的研究是回顾性的，收集了 2010 年至 2019 年间因真菌性 MEO 接受治疗的 43 名患者。临床、生物学和放射学数据均来自患者住院记录。酵母的鉴定是通过 YST vitek2 卡完成的。酵母的抗真菌药敏试验通过 AST vitek2 卡进行，其他真菌通过 E 试验技术进行。平均年龄为 66（±12）岁。我们发现男性占 63%（n=27）。86%的患者患有糖尿病。耳痛是一种常见症状。16%（n=7）的患者出现颅神经麻痹。CT 显示 74%（n=31）的病例有骨溶解，Tc99 骨扫描显示 100%（n=43）的病例有骨固定。分离出念珠菌属（n=21）、曲霉属（n=18）和头状地霉（n=2）。未发现念珠菌属对氟康唑和卡泊芬净有耐药性。头状地霉分离株对氟康唑和卡泊芬净的耐药率分别为 50%（n=9）和 72%（n=12）。我们的研究证明了念珠菌属和曲霉属在 MEO 中占主导地位。真菌学诊断可以进行鉴定和抗真菌药敏试验。因此，可以使用适当的抗真菌治疗，改善疾病预后。
