Otomycosis Due to the Rare Fungi Talaromyces purpurogenus , Naganishia albida and Filobasidium magnum
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CASE REPORT
Otomycosis Due to the Rare Fungi Talaromyces purpurogenus, Naganishia albida and Filobasidium magnum Shima Aboutalebian . Shahram Mahmoudi . Ahmadreza Okhovat . Sadegh Khodavaisy . Hossein Mirhendi
Received: 22 August 2019 / Accepted: 19 February 2020 / Published online: 30 March 2020 Ó Springer Nature B.V. 2020
Abstract Otomycosis is a common finding in otorhinolaryngology clinics and is usually caused by species of Candida and Aspergillus, particularly black aspergilli. Meanwhile, other fungi can give rise to this infection, and the identification of these requires accurate methods. Here, we report three cases of otomycosis due to rare fungal pathogens. All the patients were young females, and manipulation of the ear canal was identified as a common potentially predisposing factor. In direct examination, filamentous fungal elements (in one case) and yeast cells (in
Handling editor: Hamid Badali. S. Aboutalebian H. Mirhendi (&) Department of Medical Parasitology and Mycology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran e-mail: [email protected]; [email protected] S. Mahmoudi Department of Medical Parasitology and Mycology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran A. Okhovat Department of Otolaryngology, Isfahan University of Medical Sciences, Isfahan, Iran S. Khodavaisy Department of Medical Parasitology and Mycology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
two other cases) were seen. Culture was positive in all cases. Based on PCR-sequencing of internal transcribed spacers and b-tubulin (for mold isolate), the isolated fungi were identified as Talaromyces purpurogenus, Naganishia albida and Filobasidium magnum. By susceptibility testing of the isolates to fluconazole, itraconazole, voriconazole and amphotericin B, the lowest minimum inhibitory concentration values were observed for amphotericin B followed by voriconazole. Patients were successfully treated by a combination of antifungals and corticosteroids with no relapse over the next year, except for the case due to F. magnum, in which, despite partial recovery, a course of relapse was reported in the 1-year follow-up call. Keywords Otomycosis Otitis externa Filobasidium magnum Talaromyces purpurogenus Naganishia albida
Introduction Fungal otitis is a common finding in otorhinolaryngology clinics and is usually linked to predisposing factors such as hot and humid climate, poor personal hygiene, repeated exposure to water and prolonged use of ototopical steroids/antibiotics [1, 2]. Species of Candida and Aspergillus, particularly black aspergilli (section Nigri), have frequently been reported as the
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main causes of disease [3–7]. However, other fungi, including species not commonly seen in mycology laboratories, have been reported to cause this infection [4, 8]. Here, we describe three cases of otomycosis due to rare fungal pathogens that were isolated in our previous cross-sec
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