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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

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