1887

Abstract

Purpose. To elucidate the clinical and microbial epidemiology of otomycosis in Isfahan, Iran.

Methodology. From January 2016 to January 2017 all patients clinically suspected of otomycosis at Al-Zahra Hospital, Isfahan, Iran were recruited. Specimens were taken using sterile swabs by an otorhinolaryngologist and subjected to culture and microscopy using potassium hydroxide and Giemsa stain. Isolated fungi were identified based on morphological and molecular characteristics.

Results. Otomycosis was confirmed in 97/120 patients (80.8 %). Females (72.2 %) and patients aged 30–39 years (33 %) were more commonly affected than others. Manipulation of ear canal (62.9 %) was the most common predisposing factor. Pruritus was observed in 84.54  % of the patients followed by hearing impairment (81.4 %), and most episodes were detected over the summer (50.5 %). Culture was positive for 81 (83.5  %) of confirmed cases and molds were the most prevalent causative agents (n=51, 63 %) followed by yeasts (n=19, 23.4 %) and yeast/mold mixes (n=11, 13.6 %). For the 16 remaining patients, no growth was seen in culture despite a positive result on direct examination. In total, 92 isolates (63 molds and 29 yeasts) were recovered in culture. Application of molecular methods showed 18 fungal species and the vast majority of them belonged to Aspergillus (n=53, 57.6 %) and Candida genus. Among the species involved, Candida parapsilosis (n=22, 22.7 %) and Aspergillus tubingensis (n=15, 15.5 %) were the most encountered species.

Conclusion. Outcomes from this study showed a different picture of prevalence, where C. parapsilosis and A. tubingensis but not Aspergillus niger were the most species encountered from patients suffering from otomycosis.

Keyword(s): Epidemiology , Iran , Otitis and Otomycosis
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2019-05-07
2020-01-22
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References

  1. 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]
  2. Aneja KR, Sharma C, Joshi R. Fungal infection of the ear: a common problem in the North eastern part of Haryana. Int J Pediatr Otorhinolaryngol 2010;74:604–607 [CrossRef]
    [Google Scholar]
  3. Cheraghsahar S, Kazemi S, Birjandi M et al. Otomycosis in Western Iran: clinical and mycological aspects. Arch Clin Infect Dis 2017;12:e57287
    [Google Scholar]
  4. Jia X, Liang Q, Chi F, Cao W. Otomycosis in Shanghai: aetiology, clinical features and therapy. Mycoses 2012;55:404–409 [CrossRef]
    [Google Scholar]
  5. Vennewald I, Klemm E. Otomycosis: diagnosis and treatment. Clin Dermatol 2010;28:202–211 [CrossRef]
    [Google Scholar]
  6. Gharaghani M, Seifi Z, Zarei Mahmoudabadi A. Otomycosis in Iran: a review. Mycopathologia 2015;179:415–424 [CrossRef]
    [Google Scholar]
  7. Nemati S, Hassanzadeh R, Khajeh Jahromi S, Delkhosh Nasrollah Abadi A, Jahromi SK. Otomycosis in the North of Iran: common pathogens and resistance to antifungal agents. Eur Arch Otorhinolaryngol 2014;271:953–957 [CrossRef]
    [Google Scholar]
  8. Fasunla J, Ibekwe T, Onakoya P. Otomycosis in western Nigeria. Mycoses 2008;51:67–70
    [Google Scholar]
  9. Szigeti G, Kocsubé S, Dóczi I, Bereczki L, Vágvölgyi C et al. Molecular identification and antifungal susceptibilities of black Aspergillus isolates from otomycosis cases in Hungary. Mycopathologia 2012;174:143–147 [CrossRef]
    [Google Scholar]
  10. 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]
  11. Sabz G, Gharaghani M, Mirhendi H, Ahmadi B, Gatee MA et al. Clinical and microbial epidemiology of otomycosis in the city of Yasuj, Southwest Iran, revealing Aspergillus tubingensis as the dominant causative agent. J Med Microbiol 2019; 25 Feb 2019 [CrossRef]
    [Google Scholar]
  12. Hyde KD, Al-Hatmi AMS, Andersen B, Boekhout T, Buzina W et al. The world’s ten most feared fungi. Fungal Divers 2018;93:161–194 [CrossRef]
    [Google Scholar]
  13. Satoh K, Makimura K, Hasumi Y, Nishiyama Y, Uchida K et al. Candida auris sp. nov., a novel ascomycetous yeast isolated from the external ear canal of an inpatient in a Japanese hospital. Microbiol Immunol 2009;53:41–44 [CrossRef]
    [Google Scholar]
  14. Abdelazeem M, Gamea A, Mubarak H, Elzawawy N. Epidemiology, causative agents, and risk factors affecting human otomycosis infections. Turk J Med Sci 2015;45:820–826 [CrossRef]
    [Google Scholar]
  15. Ali K, Hamed MA, Hassan H, Esmail A, Sheneef A et al. Identification of fungal pathogens in otomycosis and their drug sensitivity: our experience. Int Arch Otorhinolaryngol 2018;22:400–403 [CrossRef]
    [Google Scholar]
  16. Bineshian F, Irajian G, Koochak-Alavi SK et al. A study on the frequency of fungal agents in otitis externa in Semnan. Iran J Pathol 2006;1:141–144
    [Google Scholar]
  17. 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:e21776 [CrossRef]
    [Google Scholar]
  18. Kiakojuri K, Rajabnia R, Jalili B, Khafri S, Omran SM et al. Otomycosis in adolescent patients referred to the therapeutic centers in Babol City, Iran. Jundishapur J Microbiol 2015;8:e17138 [CrossRef]
    [Google Scholar]
  19. Pradhan B, Tuladhar NR, Amatya RM. Prevalence of otomycosis in outpatient department of otolaryngology in Tribhuvan University Teaching Hospital, Kathmandu, Nepal. Ann Otol Rhinol Laryngol 2003;112:384–387 [CrossRef]
    [Google Scholar]
  20. Alarid-Coronel J, Celis-Aguilar E, Escobar-Aispuro L, Muñoz-Estrada V. Otomycosis in immunocompetent patients: clinical and mycological features. our experience with 40 cases. Clin Otolaryngol 2018;43:373–377 [CrossRef]
    [Google Scholar]
  21. Silva GAda, Bernardi TL, Schaker PDC, Menegotto M, Valente P et al. Rapid yeast DNA extraction by boiling and freeze-thawing without using chemical reagents and DNA purification. Braz Arch Biol Technol 2012;55:319–327 [CrossRef]
    [Google Scholar]
  22. Ahmadi B, Mirhendi H, Makimura K, de Hoog GS, Shidfar MR et al. Phylogenetic analysis of dermatophyte species using DNA sequence polymorphism in calmodulin gene. Med Mycol 2016;54:500–514 [CrossRef]
    [Google Scholar]
  23. 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]
  24. White T, Bruns T, Lee S, Taylor J.Amplification and direct sequencing of fungal ribosomal RNA genes for phylogenetics In Innis MA, Gelfand DH, Sninsky JJ, White TJ. (editors) PCR Protocols: A Guide to Methods and Applications New York: Academic Press, Inc; 1990; pp315–322
    [Google Scholar]
  25. 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]
  26. de la Paz Cota BR, Cepero Vega PP, Matus Navarrete JJ, Aguado Mulgado GE, Narváez Huerta JJ et al. Efficacy and safety of eberconazole 1% otic solution compared to clotrimazole 1% solution in patients with otomycosis. Am J Otolaryngol 2018;39:307–312 [CrossRef]
    [Google Scholar]
  27. Pontes ZBVdaS, Silva ADF, Lima EdeO, Guerra MdeH, Oliveira NMC et al. Otomycosis: a retrospective study. Braz J Otorhinolaryngol 2009;75:367–370 [CrossRef]
    [Google Scholar]
  28. Sarwestani HK, Daie Ghazvini R, Hashemi SJ, Rezaie S, Elahi M et al. Investigation of etiologic agents and clinical presentations of otomycosis at a tertiary referral center in Tehran, Iran. Iran J Public Health 2019;48:331–337
    [Google Scholar]
  29. Zarei F, Ahmadi B, Mirhendi H, Jalalizand N, Motamedi M et al. Black Aspergillus species isolated from clinical and environmental samples in Iran. J Med Microbiol 2015;64:1454–1456 [CrossRef]
    [Google Scholar]
  30. Zanganeh E, Zarrinfar H, Rezaeetalab F, Fata A, Tohidi M et al. Predominance of non-fumigatus Aspergillus species among patients suspected to pulmonary aspergillosis in a tropical and subtropical region of the Middle East. Microb Pathog 2018;116:296–300 [CrossRef]
    [Google Scholar]
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