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Scedosporium apiospermum infections in the middle ear and mastoid: case series and review of the literature

Published online by Cambridge University Press:  20 January 2022

J W J Lim Open the ORCID record for J W J Lim [Opens in a new window] ,
T McLean  and
F C E Hill
J W J Lim*
Affiliation:
Department of Otolaryngology, Royal Victorian Eye and Ear Hospital, East Melbourne, Victoria, Australia
T McLean
Affiliation:
Department of Otolaryngology, Royal Victorian Eye and Ear Hospital, East Melbourne, Victoria, Australia
F C E Hill
Affiliation:
Department of Otolaryngology, Royal Victorian Eye and Ear Hospital, East Melbourne, Victoria, Australia
*
Author for correspondence: Dr Jason Wei Jun Lim, Department of Otolaryngology, Royal Victorian Eye and Ear Hospital, East Melbourne, Victoria3002, Australia E-mail: [email protected]
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Abstract

Objectives

To present our case series and management of Scedosporium apiospermum infections of the middle ear and mastoid, and review the current literature on this rare yet potentially life-threatening condition.

Methods

Medical records of patients treated at the Royal Victorian Eye and Ear Hospital for S apiospermum middle ear and mastoid infections between 2009 and 2019 were reviewed. A literature search was conducted using PubMed, Medline and Cochrane Library databases.

Results

Two patients were identified in our institution: a 62-year-old diabetic woman with otogenic skull base osteomyelitis, and a 12-year-old boy with unilateral chronic suppurative otitis media which developed after tympanostomy tube insertion. The persistence of otalgia and otorrhoea despite prolonged antibiotic treatment characterised these cases. Both patients received voriconazole, and achieved disease resolution without complications. Ten relevant cases were identified after review of the literature. Despite treatment, there were three patient deaths, and four patients with otological or neurological complications.

Conclusion

The presence of a middle ear or mastoid infection refractory to appropriate topical and systemic antibiotics should prompt clinicians to consider a fungal infection. The role of surgical debridement in the treatment of S apiospermum infection of the middle ear and mastoid is equivocal.

Keywords

ScedosporiumScedosporium ApiospermumMiddle EarMastoidFungal Infections
Type
Main Article
Information
The Journal of Laryngology & Otology , Volume 136 , Issue 10 , October 2022 , pp. 979 - 985
Copyright
Copyright © The Author(s), 2022. Published by Cambridge University Press on behalf of J.L.O. (1984) LIMITED

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Footnotes

Dr J Lim takes responsibility for the integrity of the content of the paper

References

Geddes-McAlister, J, Shapiro, RS. New pathogens, new tricks: emerging, drug-resistant fungal pathogens and future prospects for antifungal therapeutics. Ann N Y Acad Sci 2019;1435:57–78Google ScholarPubMed
Mello, TP, Bittencourt, VCB, Liporagi-Lopes, LC, Aor, AC, Branquinha, MH, Santos, ALS. Insights into the social life and obscure side of Scedosporium/Lomentospora species: ubiquitous, emerging and multidrug-resistant opportunistic pathogens. Fungal Biol Rev 2019;33:16–46CrossRefGoogle Scholar
Giraud, S, Bouchara, J-P. Scedosporium apiospermum complex: diagnosis and species identification. Curr Fungal Infect Rep 2014;8:211–19CrossRefGoogle Scholar
Yao, M, Messner, AH. Fungal malignant otitis externa due to Scedosporium apiospermum. Ann Otol Rhinol Laryngol 2001;110:377–80CrossRefGoogle ScholarPubMed
Jalava-Karvinen, P, Nyman, M, Gardberg, M, Harju, I, Hohenthal, U, Oksi, J. Scedosporium apiospermum as a rare cause of central skull base osteomyelitis. Med Mycol Case Rep 2016;11:28–30CrossRefGoogle ScholarPubMed
Fuster-Escrivá, B, Chanzá-Aviñó, M, Concepción, G-C. Otomastoiditis due to Scedosporium apiospermum. Hallucinations as an adverse reaction to voriconazole [in Spanish]. Rev Iberoam Micol 2019;36:165–6Google ScholarPubMed
Heath, CH, Slavin, MA, Sorrell, TC, Handke, R, Harun, A, Phillips, M et al. Population-based surveillance for scedosporiosis in Australia: epidemiology, disease manifestations and emergence of Scedosporium aurantiacum infection. Clin Microbiol Infect 2009;15:689–93CrossRefGoogle ScholarPubMed
McLaren, O, Potter, C. Scedosporium apiospermum: a rare cause of malignant otitis externa. BMJ Case Rep 2016;2016:bcr2016217015CrossRefGoogle ScholarPubMed
Vasoo, S, Yeo, SB, Lim, PL, Ang, BS, Lye, DC. Efficacy of voriconazole for Scedosporium apiospermum skull base osteomyelitis: case report and literature review. Int J Antimicrob Agents 2008;31:184–5Google ScholarPubMed
Salamat, AA, Archer, C, Basarab, A, Eren, E, Batty, V, Patel, S et al. Scedosporium apiospermum causing otomycosis in an immunocompetent child with tympanostomy tubes: management of this rare entity. Int J Pediatr Otorhinolaryngol 2015;79:1785–7Google Scholar
Slack, CL, Watson, DW, Abzug, MJ, Shaw, C, Chan, KH. Fungal mastoiditis in immunocompromised children. Arch Otolaryngol Head Neck Surg 1999;125:73–5CrossRefGoogle ScholarPubMed
Koay, WLA, Johnson, CB, Patel, J, Aigbivbalu, LO. A rare case of Scedosporium otitis in an immunocompetent child with tympanostomy tubes. Pediatr Infect Dis J 2015;34:799Google Scholar
Doss, M, Doss, D. Skull base osteomyelitis secondary to Scedosporium apiospermum infection. Radiol Case Rep 2018;13:759–63CrossRefGoogle ScholarPubMed
Bhally, HS, Shields, C, Lin, SY, Merz, WG. Otitis caused by Scedosporium apiospermum in an immunocompetent child. Int J Pediatr Otorhinolaryngol 2004;68:975–8CrossRefGoogle Scholar
Lackner, M, Guarro, J. Pathogenesis of Scedosporium. Curr Fungal Infect Rep 2013;7:326–33Google Scholar
Ramirez-Garcia, A, Pellon, A, Rementeria, A, Buldain, I, Barreto-Bergter, E, Rollin-Pinheiro, R et al. Scedosporium and Lomentospora: an updated overview of underrated opportunists. Med Mycol 2018;56:S102–25CrossRefGoogle ScholarPubMed
Baumgartner, BJ, Rakita, RM, Backous, DD. Scedosporium apiospermum otomycosis. Am J Otolaryngol 2007;28:254–6CrossRefGoogle ScholarPubMed