ABSTRACT
Abstract Candida is a rare cause of infected aortic aneurysms. We report the case of a diabetic patient with end stage kidney disease who underwent repair of a leaking abdominal aortic aneurysm. He was on long-term antibiotic treatment for malignant otitis externa. Candida albicans was isolated from the culture of the excised aneurysm wall. An infected aortic aneurysm due to Candida has not been previously reported in a patient with malignant otitis externa. This case report aims to highlight that Candida should be suspected as a cause of infected aortic aneurysms in patients with debilitation and chronic immunosuppression. Management of such cases can be extremely challenging, especially in resource-poor settings, and we will be touching upon the advantages and disadvantages of various treatment options.
Resumo A cândida é uma causa rara de aneurismas da aorta infecciosos. Relatamos o caso de um paciente diabético com doença renal terminal, que foi submetido a reparo de aneurisma da aorta abdominal com vazamento. Ele estava em tratamento de longo prazo com antibióticos para otite externa maligna. A Candida albicans foi isolada da cultura da parede do aneurisma que sofreu a excisão. Não há relatos prévios de aneurisma da aorta infeccioso causado por cândida em pacientes com otite externa maligna. Este relato de caso visa reforçar que a cândida deve ser uma das suspeitas de causa de aneurisma da aorta infeccioso em pacientes debilitados e com imunossupressão crônica. O manejo desses casos pode ser extremamente desafiador, principalmente em contextos em que os recursos são escassos, e mencionaremos as vantagens e desvantagens das diversas opções de tratamento.
Subject(s)
Humans , Male , Aged , Otitis Externa/complications , Aneurysm, Infected/complications , Aortic Aneurysm, Abdominal/complications , Aneurysm, Infected/etiology , Candida albicans/pathogenicity , Aortic Aneurysm, Abdominal/therapy , Immune Tolerance/immunology , Anti-Bacterial Agents/adverse effectsABSTRACT
Necrotizing otitis externa (NOE), also known as malignant otitis externa (MOE), is a severe and rare infectious disease of the external auditory canal (EAC). Without treatment, it may progress to skull base involvement. The bacteria Pseudomonas aeruginosa is the most common causative agent (90% of the cases), and affects immunocompromised subjects, particularly diabetic patients. Severe chronic otalgia, otorrhea, and cranial nerve palsy are the most common clinical presentations. Patients with NOE are frequently referred to neurosurgery because of the neurological impairment and skull base compromise. The definitive diagnosis is frequently elusive, requiring a high index of suspicion. Several laboratorial tests, imaging modalities, and the histologic exclusion of malignancy may be required. An early diagnosis and aggressive treatment reduce morbidity and mortality. We present four NOE cases to illustrate the spectrum of clinical presentation and complementary exams. According to the literature, more effort for early diagnosis and treatment is required, and neurosurgeons play an important role in this task.
Subject(s)
Humans , Male , Female , Middle Aged , Aged , Aged, 80 and over , Otitis Externa/complications , Otitis Externa/diagnosis , Otitis Externa/physiopathology , Otitis Externa/drug therapy , Diagnosis, Differential , NeurosurgeryABSTRACT
Otite externa necrotizante (OEN), conhecida antigamente como otite externa maligna (OEM), atinge o conduto auditivo externo, causando otalgia intensa, otorreia fétida, e em casos mais severos, comprometimento dos ossos do crânio e déficit neurológico. O agente etiológico mais comum é a Pseudomonas aeruginosa. Acomete principalmente pacientes idosos, diabéticos e imunodeprimidos. O comprometimento de nervo craniano levando a paralisia facial e trombose dos seios intracranianos são de piores prognósticos. O diagnóstico depende da suspeita clínica inicialmente. Os exames complementares são imprecisos, embora essenciais no seguimento. A abordagem multidisciplinar é sempre recomendada. O objetivo do trabalho é relatar as complicações clínicas de um caso de otite externa necrotizante com paralisia facial que evoluiu para trombose do seio cavernoso, levando ao óbito.
Necrotizing external otitis (NEO), formerly known as malignant external otitis (MEO), strikes the external auditory canal, causing severe otalgia, fetid otorrhea, and in more severe cases, impairment of the skull bones and neurological deficit. The most common etiological agent is Pseudomonas aeruginosa. It mainly affects elderly, diabetic and immunodepressed patients. Cranial nerve impairment leading to facial paralysis and intracranial sinus thrombosis are of bad prognos. The diagnosis depends on the clinical suspicion. Complementary exams are imprecise, although essential in the follow-up. The multidisciplinary approach is always recommended. The objective of this paper is to report the clinical complications of a case of necrotizing external otitis with facial paralysis and cavernous sinus thrombosis, leading to death.
Subject(s)
Humans , Male , Aged , Otitis Externa/complications , Cavernous Sinus , Intracranial Thrombosis , Facial Paralysis/complications , ImmunityABSTRACT
To report ear drum disintegration in cases of otomycosis. Case series study. E.N.T and Head and Neck Surgery Department PNS Shifa Hospital Karachi and E N T Department of Combined Military Hospital, Quetta Cantt from August 2009 to October 2010. 242 patients with clinical diagnosis of otomycosis were registered over a period of 15 months. On registration ear was meticulously cleaned under microscope removing fungal debris to establish the integrity of eardrum. In the same sitting cream with combination of triamcinolone acetonide, neomycin sulphate, gramicidin, nystatin was applied all around within external auditory meatus [EAM] on effected walls and same drops were advised locally thrice daily for 3 to 5 days. Every patient was advised to report back immediately on occurrence of irritation, earache, ear discharge, blockage of ear and pain. Out of 242patients [140 males and 102 females] 110 [45.45%] were cured after single visit as outpatient adopting a regimen of single application of antifungal cream and thrice daily antifungal ear drops for 5 days after proper cleaning of fungal debris from EAM. 73 [30.16%] cases were cured of otomycosis after two sittings of same regimen. 59 [24%] patients neglected the otomycosis for days to weeks till the time pain became unbearable. In 18 [7.43%] patients ear drum was perforated by otomycosis and all these patients had neglected the disease. Neglected Qtomyeosis has all the potentials to create a defect in ear drum causing chronic disability .Meticulous cleaning and local antifungal therapy still remains the gold standards for curing otomycQsis
Subject(s)
Humans , Male , Female , Otomycosis/complications , Otomycosis/pathology , Tympanic Membrane/pathology , Otitis Externa/complications , Otitis Externa/microbiology , RecurrenceABSTRACT
La otitis externa constituye entre el 5 por ciento y 30 por ciento de las consultas de urgencia ORL y afecta al 10 por ciento de la población al menos 1 vez en la vida. La gran mayoría son de causa bacteriana, sólo el 15 por ciento a 20 por ciento son atribuidas a hongos. Las complicaciones son poco frecuentes alcanzando el 10 por ciento a 20 por ciento de los casos según la serie, siendo la perforación timpánica la más frecuente. Se presenta la evolución y tratamiento de 2 casos.
External otitis constitutes among 5 percent-30 percent of urgency ORL consultations and affects 10 percent of the population at least 1 time in their life. Most of them had a bacterial origin, only 15 percent to 20 percent are attributed to fungi. Otomycosis complications are slightly frequent reaching 10 percent to 20 percent of the cases according to diferent series, being the tympanic perforation the most frequent. We present 2 cases, their evolution and treatment.
Subject(s)
Humans , Female , Adult , Aged , Mycoses/complications , Mycoses/therapy , Otitis Externa/complications , Otitis Externa/therapy , Tympanic Membrane Perforation/etiology , Aspergillus/isolation & purification , Clinical Evolution , Otitis Externa/microbiology , Staphylococcus/isolation & purificationABSTRACT
Eczematous external otitis, because of its basic allergic nature, tends to be chronic or recurrent. The purpose of our study was to investigate the association between allergic contact dermatitis and chronic eczematous external otitis. Sixty-six patients with eczematous external otitis and 48 healthy volunteers were included in this study. All the patients were tested with an epicutaneous patch test. In the study group, the average recurrent attack rate was 6.1+/-1.5 (between 4-9 times during the last year) in the patch test positive eczematous external otitis patients, and 4.9+/-1.3 (between 4-8 times during the last year) in the patch test negative patients (p = 0.002). The epicutaneous patch test was positive in 19 (28.8%) out of 66 cases with chronic eczematous external otitis, and in 3 (6.3%) out of 48 cases in the control group. The difference between the two groups was statistically significant (p = 0.003). The most common reactions were due to neomycin sulfate and potassium dichromate in this study. These results suggest that, in some cases eczematous external otitis may be considered as a form of delayed type hypersensitivity to allergen stimuli. Patients suffering from eczematous external otitis symptoms should be investigated for allergens.
Subject(s)
Adolescent , Adult , Chronic Disease , Dermatitis, Allergic Contact/diagnosis , Eczema/complications , Female , Humans , Male , Middle Aged , Otitis Externa/complications , Patch Tests , Prevalence , Recurrence , Turkey/epidemiologyABSTRACT
Os autores apresentam o caso de um paciente de oito anos de idade que desenvolveu tétano generalizado, cujo foco suspeito foi uma infecçäo otológica associada com corpo estranho. Fazem um relato do tratamento cirúrgico da fonte suspeita de infecçäo tetânica e o seu resultado