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Case Reports
. 2012 Dec;32(6):416-9.

Pseudomonas and Aspergillus interaction in malignant external otitis: risk of treatment failure

R Bovo  1 , A Benatti, A Ciorba, M Libanore, M Borrelli, A Martini
Affiliations
Case Reports

Pseudomonas and Aspergillus interaction in malignant external otitis: risk of treatment failure

R Bovo et al. Acta Otorhinolaryngol Ital. 2012 Dec.

Abstract
in English, Italian

Malignant external otitis (MEO) is a rare infection of the temporal bone primarily affecting elderly patients and diabetics or immunocompromised individuals, which may have dismal prognosis if treatment is not prompt and adequate. Almost 95% of MEO cases reported in the literature are attributed to Pseudomonas aeruginosa, and this pathogen is isolated from aural drainage in > 90% of cases. However, in recent years fungal and polymicrobial temporal bone infections have been reported with increasing frequency. The aim of this paper is to discuss a possible pitfall in MEO treatment using an unusual clinical case. In this patient, bacteriological data positive for Pseudomonas delayed correct diagnosis of Aspergillus infection, which was obtained after surgical debridement and biopsy of the infra-temporal space.

RIASSUNTOL'otite esterna maligna (MEO) è una rara infezione dell'osso temporale che colpisce soprattutto pazienti anziani e diabetici o individui immunocompromessi, che può avere prognosi infausta se il trattamento non è rapido e adeguato. Quasi il 95% dei casi di MEO riportati in letteratura sono attribuiti a Pseudomonas aeruginosa e questo patogeno è isolato dal materiale di drenaggio auricolare in più del 90% dei casi. Tuttavia negli ultimi anni infezioni polimicrobiche e micotiche dell'osso temporale sono sempre più frequenti. Scopo di questo lavoro è discutere del rischio di fallimento terapeutico nell'otite esterna maligna attraverso l'illustrazione di un caso clinico in cui il tampone auricolare positivo per Pseudomonas ha ritardato la diagnosi della infezione da Aspergillus, ottenuta dopo un debridement chirurgico dello spazio infra-temporale.

Keywords: Aspergillus; Diagnosis and prognosis; Necrotizing otitis externa.

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Figures

Fig. 1.
Fig. 1.
Axial CT showing soft tissue involvement of the right external and the middle ear with bone erosion. Enlargement of the right foramen lacerum and condyloid canal, as well the facial nerve canal, can be observed.
Fig. 2.
Fig. 2.
T1 weighted with contrast magnetic resonance, axial section. Pathological tissue on T1 weighted images with contrast enhancement involves the neotympanic cavity, the lateral parapharyngeal space, the right posterior foramen lacerum, as well as the condyloid canal. It also extends posteriorly involving the right cerebellum (arrow).
See this image and copyright information in PMC

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