1887

Abstract

Otomycosis is a mycotic infection of the external auditory canal and can be caused by a wide range of fungal species. In this study, we aimed to identify fungal isolates from patients suspected of otomycosis.

External ear canal samples were taken from patients referred to the outpatient department of Shahid-Mofatteh Clinic in the city of Yasuj, Iran, and examined by direct microscopy and culture. DNA of the isolated fungi was tested by internal transcribed spacer PCR restriction fragment length polymorphism analysis for identification of yeasts and β-tubulin sequencing for identification of species.

Among 275 patients suspected of otomycosis, 144 cases (83 female and 61 male) were confirmed with otomycosis. For 89% (=128) of positive cultures, microscopy was also positive, while there were no cases with a microscopy-positive and culture-negative result. The predominant predisposing factor was self-cleaning of the external ear using unhygienic tools, and the main risk occupation was ‘housewife’. The most common isolated fungi were typically (=120), including 73 isolates of section , 43 of section , 3 of section and 1 of section . After sequencing, 44 out of 73 strains primarily identified as turned out to be . Thirty-five isolates were identified as , including (=22), (=12) and (=1).

was the most common species involved in otomycosis. This work corroborates the difficulty of precise identification of species within the black by morphological characteristics.

Loading

Article metrics loading...

/content/journal/jmm/10.1099/jmm.0.000948
2019-04-01
2019-10-14
Loading full text...

Full text loading...

References

  1. Panchal P, Pethani J, Patel D, Rathod S, Shah P. Analysis of various fungal agents in clinically suspected cases of otomycosis. Indian J Basic Appl Med Res 2013;2:865–869
    [Google Scholar]
  2. Gupta S, Mahajan B. Prevalance and demographical profile of patients presenting with otomycosis. JK Science 2015;17:138–142
    [Google Scholar]
  3. Desai KJ, Malek SS, Italia IK, Jha S, Pandya V et al. Fungal spectrum in otomycosis at tertiary care hospital. Natl J Integr Res Med 2012;3:58–61
    [Google Scholar]
  4. Moharram A, Ahmed H, Nasr SA. Otomycosis in Assiut, Egypt. J Basic App Myco 2013;4:1–11
    [Google Scholar]
  5. Jackman A, Ward R, April M, Bent J. Topical antibiotic induced otomycosis. Int J Pediatr Otorhinolaryngol 2005;69:857–860 [CrossRef]
    [Google Scholar]
  6. Prasad SC, Kotigadde S, Shekhar M, Thada ND, Prabhu P et al. Primary otomycosis in the Indian subcontinent: predisposing factors, microbiology, and classification. Int J Microbiol 2014;2014:636493 [CrossRef]
    [Google Scholar]
  7. Ong Y, Chee G. Infections of the external ear. Ann Acad Med Singapore 2005;34:330–334
    [Google Scholar]
  8. Fasunla J, Ibekwe T, Onakoya P. Otomycosis in western Nigeria. Mycoses 2008;51:67–70
    [Google Scholar]
  9. Gharaghani M, Seifi Z, Zarei Mahmoudabadi A. Otomycosis in Iran: a review. Mycopathologia 2015;179:415–424 [CrossRef]
    [Google Scholar]
  10. Ray R, Pal S, Ghosh M, Samaddar D, Banerjee M. Prevalence of fungal infection in chronic otitis media-A study at a tertiary care hospital in Eastern India. Int J Curr Microbiol App Sci 2015;4:684–690
    [Google Scholar]
  11. Ho T, Vrabec JT, Yoo D, Coker NJ. Otomycosis: clinical features and treatment implications. Otolaryngol Head Neck Surg 2006;135:787–791 [CrossRef]
    [Google Scholar]
  12. García-Agudo L, Aznar-Marín P, Galán-Sánchez F, García-Martos P, Marín-Casanova P et al. Otomycosis due to filamentous fungi. Mycopathologia 2011;172:307–310 [CrossRef]
    [Google Scholar]
  13. Viswanatha B, Naseeruddin K. Fungal infections of the ear in immunocompromised host: a review. Mediterr J Hematol Infect Dis 2011;3:e2011003 [CrossRef]
    [Google Scholar]
  14. Saki N, Rafiei A, Nikakhlagh S, Amirrajab N, Saki S. Prevalence of otomycosis in Khouzestan Province, south-west Iran. J Laryngol Otol 2013;127:25–27 [CrossRef]
    [Google Scholar]
  15. Szigeti G, Sedaghati E, Mahmoudabadi AZ, Naseri A, Kocsubé S et al. Species assignment and antifungal susceptibilities of black Aspergilli recovered from otomycosis cases in Iran. Mycoses 2012;55:333–338 [CrossRef]
    [Google Scholar]
  16. Vennewald I, Klemm E. Otomycosis: diagnosis and treatment. Clin Dermatol 2010;28:202–211 [CrossRef]
    [Google Scholar]
  17. De Hoog G, Guarro J, Gene J, Figueras M. Atlas of Clinical Fungi, Centraalbureau Voor Schimmelcultures The Netherlands: Utrecht; 2000;276–282
    [Google Scholar]
  18. Balajee SA, Houbraken J, Verweij PE, Hong SB, Yaghuchi T et al. Aspergillus species identification in the clinical setting. Stud Mycol 2007;59:39–46 [CrossRef]
    [Google Scholar]
  19. Mirhendi H, Zarei F, Motamedi M, Nouripour-Sisakht S. Aspergillus tubingensis and Aspergillus niger as the dominant black Aspergillus, use of simple PCR-RFLP for preliminary differentiation. J Mycol Med 2016;26:9–16 [CrossRef]
    [Google Scholar]
  20. Silva DM, Batista LR, Rezende EF, Fungaro MHP, Sartori D et al. Identification of fungi of the genus Aspergillus section Nigri using polyphasic taxonomy. Braz J Microbiol 2011;42:761–773 [CrossRef]
    [Google Scholar]
  21. Howard SJ, Harrison E, Bowyer P, Varga J, Denning DW. Cryptic species and azole resistance in the Aspergillus niger complex. Antimicrob Agents Chemother 2011;55:4802–4809 [CrossRef]
    [Google Scholar]
  22. Gautier M, Normand AC, L'Ollivier C, Cassagne C, Reynaud-Gaubert M et al. Aspergillus tubingensis: a major filamentous fungus found in the airways of patients with lung disease. Med Mycol 2016;54:459–470 [CrossRef]
    [Google Scholar]
  23. Nouripour-Sisakht S, Mirhendi H, Shidfar MR, Ahmadi B, Rezaei-Matehkolaei A et al. Aspergillus species as emerging causative agents of onychomycosis. J Mycol Med 2015;25:101–107 [CrossRef]
    [Google Scholar]
  24. Zarei F, Mirhendi H, Motamedi M, Ahmadi B, Nouripour-Sisakht S et al. Black Aspergillus species isolated from clinical and environmental samples in Iran. J Med Microbiol 2015;64:1454–1456 [CrossRef]
    [Google Scholar]
  25. Yamada Y, Makimura K, Merhendi H, Ueda K, Nishiyama Y et al. Comparison of different methods for extraction of mitochondrial DNA from human pathogenic yeasts. Jpn J Infect Dis 2002;55:122–125
    [Google Scholar]
  26. Mirhendi H, Makimura K, Khoramizadeh M, Yamaguchi H. A one-enzyme PCR-RFLP assay for identification of six medically important Candida species. Nippon Ishinkin Gakkai Zasshi 2006;47:225–229 [CrossRef]
    [Google Scholar]
  27. Glass NL, Donaldson GC. Development of primer sets designed for use with the PCR to amplify conserved genes from filamentous ascomycetes. Appl Environ Microbiol 1995;61:1323–1330
    [Google Scholar]
  28. Barati B, Okhovvat S, Goljanian A, Omrani M. Otomycosis in central Iran: a clinical and mycological study. Iran Red Crescent Med J 2011;13:873
    [Google Scholar]
  29. Pontes ZB, Silva AD, Lima Ede O, Guerra Mde H, Oliveira NM et al. Otomycosis: a retrospective study. Braz J Otorhinolaryngol 2009;75:367–370 [CrossRef]
    [Google Scholar]
  30. Nazeer HA, Mohiddin SK, Pakanati SS. Mycology of otomycosis in a tertiary care teaching hospital. J Res Med Den Sci 2015;3:27–30 [CrossRef]
    [Google Scholar]
  31. Rao RP, Rao R. A Mycologic study of otomycosis in a tertiary care teaching hospital in Karnataka, India. Int J Contemp Med Res 2016;3:1918–1920
    [Google Scholar]
  32. Abdelazeem M, Gamea A, Mubarak H, Elzawawy N. Epidemiology, causative agents, and risk factors affecting humanotomycosis infections. Turk J Med Sci 2015;45:820–826 [CrossRef]
    [Google Scholar]
  33. Shafi M, Ujjan ID. Otomycosis–A clinico-pathological study. Jsp 2016;21:145–148
    [Google Scholar]
  34. Sturgulewski SK, Bankaitis AU, Klodd DA, Haberkamp T. What's still growing on your patients' hearing aids?. Hear J 2006;59:45–46 [CrossRef]
    [Google Scholar]
  35. Mogadam AY, Asadi MA, Dehghani R, Hooshyar H. The prevalence of otomycosis in Kashan, Iran, during 2001–2003. Jundishapur J Microbiol 2009;2:18–21
    [Google Scholar]
  36. Vadisha SB, Shubha PB, Harish R, Satheesh KB. External ear infections in diabetics-Challenges in management. Online J Otolaryngol 2015;5:1–10
    [Google Scholar]
  37. Manuel RJ, Kibbler CC. The epidemiology and prevention of invasive aspergillosis. J Hosp Infect 1998;39:95–109 [CrossRef]
    [Google Scholar]
  38. Nowrozi H, Arabi FD, Mehraban HG, Tavakoli A, Ghooshchi G. Mycological and clinical study of otomycosis in Tehran, Iran. Bull Environ Pharmacol Life Sci 2014;3:29–31
    [Google Scholar]
  39. Kazemi A, Majidinia M, Jaafari A, Ayatollahi Mousavi SA, Zarei Mahmoudabadi A et al. Etiologic agents of otomycosis in the north-western area of Iran. Jundishapur J Microbiol 2015;8:e2176 [CrossRef]
    [Google Scholar]
  40. Kamali Sarwestani Z, Hashemi SJ, Rezaie S, Gerami Shoar M, Mahmoudi S et al. Species identification and in vitro antifungal susceptibility testing of Aspergillus section Nigri strains isolated from otomycosis patients. J Mycol Med 2018;28:279–284 [CrossRef]
    [Google Scholar]
  41. Khodavaisy S, Badali H, Hashemi SJ, Aala F, Nazeri M et al. In vitro activities of five antifungal agents against 199 clinical and environmental isolates of Aspergillus flavus, an opportunistic fungal pathogen. J Mycol Med 2016;26:116–121 [CrossRef]
    [Google Scholar]
  42. Kaur R, Mittal N, Kakkar M, Aggarwal AK, Mathur MD. Otomycosis: a clinicomycologic study. Ear Nose Throat J 2000;79:606–609
    [Google Scholar]
  43. Cheraghsahar S, Kazemi S, Birjandi M, Yarahmadi M, Mahmoudi S et al. Otomycosis in Western Iran: clinical and mycological aspects. Arch Clin Infect Dis 2017;12:e57287 [CrossRef]
    [Google Scholar]
  44. Pakshir K, Sabayan B, Javan H, Karamifar K. Mycoflora of human external auditory canal in Shiraz, southern Iran. Iran Red Crescent Med J 2008;10:27–29
    [Google Scholar]
  45. Kamiya A, Kikuchi A, Tomita Y, Kanbe T. Epidemiological study of Candida species in cutaneous candidiasis based on PCR using a primer mix specific for the DNA topoisomerase II gene. J Dermatol Sci 2005;37:21–28 [CrossRef]
    [Google Scholar]
  46. Hay RJ, Jones RM. New molecular tools in the diagnosis of superficial fungal infections. Clin Dermatol 2010;28:190–196 [CrossRef]
    [Google Scholar]
  47. White TJ, Bruns T, Lee S, Taylor J. Amplification and direct sequencing of fungal ribosomal RNA genes for phylogenetics PCR Protocols: a Guide to Methods and ApplicationsVol. 18 1990;315–322
    [Google Scholar]
  48. Chen YC, Eisner JD, Kattar MM, Rassoulian-Barrett SL, Lafe K et al. Polymorphic internal transcribed spacer region 1 DNA sequences identify medically important yeasts. J Clin Microbiol 2001;39:4042–4051 [CrossRef]
    [Google Scholar]
  49. Trost A, Graf B, Eucker J, Sezer O, Possinger K et al. Identification of clinically relevant yeasts by PCR/RFLP. J Microbiol Methods 2004;56:201–211 [CrossRef]
    [Google Scholar]
http://instance.metastore.ingenta.com/content/journal/jmm/10.1099/jmm.0.000948
Loading
/content/journal/jmm/10.1099/jmm.0.000948
Loading

Data & Media loading...

This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error