Hostname: page-component-78c5997874-dh8gc Total loading time: 0 Render date: 2024-11-11T10:28:39.287Z Has data issue: false hasContentIssue false
  • English
  • Français

Treatment of refractory Aspergillus otomycosis with voriconazole: case series and review

Published online by Cambridge University Press:  09 June 2014

Hsu-Chueh Ho ,
Shih-Hsuan Hsiao ,
Cheng-Yung Lee  and
Chen-Chi Tsai
Hsu-Chueh Ho
Affiliation:
Division of Otorhinolaryngology, Department of Surgery, Buddhist Dalin Tzu Chi Hospital, Chiayi, Taiwan School of Medicine, Tzu Chi University, Hualien, Taiwan
Shih-Hsuan Hsiao
Affiliation:
Division of Otorhinolaryngology, Department of Surgery, Buddhist Dalin Tzu Chi Hospital, Chiayi, Taiwan School of Medicine, Tzu Chi University, Hualien, Taiwan
Cheng-Yung Lee
Affiliation:
Division of Otorhinolaryngology, Department of Surgery, Buddhist Dalin Tzu Chi Hospital, Chiayi, Taiwan School of Medicine, Tzu Chi University, Hualien, Taiwan
Chen-Chi Tsai*
Affiliation:
School of Medicine, Tzu Chi University, Hualien, Taiwan Division of Infectious Diseases, Department of Medicine, Buddhist Dalin Tzu Chi Hospital, Chiayi, Taiwan
*
Address for correspondence: Dr Chen-Chi Tsai Division of Infectious Disease, Department of Medicine, Buddhist Dalin Tzu Chi Hospital, No. 2, Minsheng Road, Dalin Township, Chiayi County 62247, Taiwan Fax: +886 5 2648999 E-mail: antibody_1@msn.com
Get access Rights & Permissions [Opens in a new window]

Abstract

Background:

Voriconazole is a broad-spectrum azole exhibiting strong anti-Aspergillus activity and good long-term tolerance. However, the evidence for voriconazole efficacy against refractory Aspergillus otomycosis is weak.

Method:

We reviewed the medical records of patients with Aspergillus otomycosis treated with voriconazole from January 2008 to June 2012 in a Taiwanese regional hospital. Demographic data and information regarding underlying diseases, clinical features, treatment and outcome were assessed.

Results:

In total, 14 cases of Aspergillus otomycosis were treated with voriconazole, including 5 patients with Aspergillus invasive otitis externa. All patients had failed to respond to local treatment, antibiotics or topical agents. One case was lost to follow up. The symptoms of two patients recurred after voriconazole treatment: one patient received a second 12-week course of voriconazole and was cured; and symptoms of the other patient recurred after a second 12-week course of voriconazole, leading to surgical debridement. The remaining 11 patients were cured by voriconazole treatment without extensive surgical debridement.

Conclusion:

This study demonstrates that voriconazole can be a very effective and convenient therapeutic option for the management of refractory Aspergillus otomycosis.

Keywords

VoriconazoleAspergillusOtitis ExternaOtomycosis
Type
Clinical Records
Information
The Journal of Laryngology & Otology , Volume 128 , Issue 6 , June 2014 , pp. 547 - 551
Copyright
Copyright © JLO (1984) Limited 2014 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1Chandler, JR. Malignant external otitis. Laryngoscope 1968;78:1257–94CrossRefGoogle ScholarPubMed
2Vennewald, I, Klemm, E. Otomycosis. Diagnosis and treatment. Clin Dermatol 2010;28:202–11CrossRefGoogle ScholarPubMed
3Latgé, JP. Aspergillus fumigatus and aspergillosis. Clin Microbiol Rev 1999;12:310–50Google Scholar
4Gupta, S, Koirala, J, Khardori, R, Khardori, N. Infections in diabetes mellitus and hyperglycemia. Infect Dis Clin North Am 2007;21:617–38CrossRefGoogle ScholarPubMed
5Bellini, C, Antonini, P, Ermanni, S, Dolina, M, Passega, E, Bernasconi, E. Malignant otitis externa due to Aspergillus niger. Scand J Infect Dis 2003;35:284–8Google Scholar
6Shelton, JC, Antonelli, PJ, Hackett, R. Skull base fungal osteomyelitis in an immunocompetent host. Otolaryngol Head Neck Surg 2002;126:76–8CrossRefGoogle Scholar
7Parize, P, Chandesris, MO, Lanternier, F, Poirée, S, Viard, JP, Bienvenu, B et al. Antifungal therapy of Aspergillus invasive otitis externa: efficacy of voriconazole and review. Antimicrob Agents Chemother 2009;53:1048–53Google Scholar
8Ling, SS, Sader, C. Fungal malignant otitis externa treated with hyperbaric oxygen. Int J Infect Dis 2008;12:550–2CrossRefGoogle ScholarPubMed
9Yang, SC, Ho, HC, Lay, CJ, Tsai, CC. Aspergillus invasive otitis externa as a complication of herpes zoster oticus. Tzu Chi Med J 2011;23:28–30Google Scholar
10van Tol, A, van Rijswijk, J. Aspergillus mastoiditis, presenting with unexplained progressive otalgia, in an immunocompetent (older) patient. Eur Arch Otorhinolaryngol 2009;266:1655–7CrossRefGoogle Scholar
11Petrak, R, Pottage, J, Levin, S. Invasive external otitis caused by Aspergillus fumigatus in an immunocompetent patient. J Infect Dis 1985;151:196CrossRefGoogle Scholar
12Walsh, TJ, Anaissie, EJ, Denning, DW, Herbrecht, R, Kontoyiannis, DP, Marr, KA et al. Infectious Diseases Society of America: Treatment of aspergillosis: clinical practice guidelines of the Infectious Diseases Society of America. Clin Infect Dis 2008;46:327–60Google Scholar
13Denes, E, Boumediene, A, Durox, H, Oksman, A, Saint-Marcoux, F, Darde, ML et al. Voriconazole concentrations in synovial fluid and bone tissues. J Antimicrob Chemother 2007;59:818–19Google Scholar
14Lewis, RE, Wiederhold, NP, Klepser, ME. In vitro pharmacodynamics of amphotericin B, itraconazole, and voriconazole against Aspergillus, Fusarium, and Scedosporium spp. Antimicrob Agents Chemother 2005;49:945–51Google Scholar
15Herbrecht, R, Denning, DW, Patterson, TF, Bennett, JE, Greene, RE, Oestmann, JW et al. Voriconazole versus amphotericin B for primary therapy of invasive aspergillosis. N Engl J Med 2002;347:408–15Google Scholar
16Muijsers, RB, Goa, KL, Scott, LJ. Voriconazole: in the treatment of invasive aspergillosis. Drugs 2002;62:2655–64CrossRefGoogle ScholarPubMed
17Mouas, H, Lutsar, I, Dupont, B, Fain, O, Herbrecht, R, Lescure, FX et al. Voriconazole/Bone Invasive Aspergillosis Study Group: Voriconazole for invasive bone aspergillosis: a worldwide experience of 20 cases. Clin Infect Dis 2005;40:1141–7CrossRefGoogle Scholar
18Tan, K, Brayshaw, N, Tomaszewski, K, Troke, P, Wood, N. Investigation of the potential relationships between plasma voriconazole concentrations and visual adverse events or liver function test abnormalities. J Clin Pharmacol 2006;46:235–43Google Scholar