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| CASE REPORT: MYCOLOGY |
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| Year : 2013 | Volume
: 15
| Issue : 2 | Page : 79-80 |
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A case of Scedosporium apiospermum Otomycosis
Manjusree Shanmugham, M Renuka, Ramani Bai Joseph Theodore
Department of Microbiology, Government Medical College, Thiruvanathapuram, Kerala, India
| Date of Web Publication | 7-Jan-2014 |
Correspondence Address:
Manjusree Shanmugham
Department of Microbiology, Government Medical College, Thiruvanathapuram, Kerala
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/0972-1282.124595
Otitis externa caused by Scedosporium apiospermum is extremely rare. We report a case of otomycosis in a chronic alcoholic who presented at the Otorhinolaryngology Outpatient Department with complains of right ear discharge and hearing loss. Scedosporium apiospermum (Pseudallescheria boydii) was isolated repeatedly from ear discharge. The patient was treated with surgical debridment and topically with Clotrimazole. Keywords: Otitis externa, Otomycosis, Scedosporium apiospermum
How to cite this article:
Shanmugham M, Renuka M, Theodore RJ. A case of Scedosporium apiospermum Otomycosis. J Acad Clin Microbiol 2013;15:79-80 |
| Case Report | |  |
A 59 year old male head load worker presented at the Otorhinolaryngology outpatient with persistent purulent ear discharge right side and hearing loss for the past 6 months. He was treated at the local hospital for Chronic suppurative otitis media (CSOM) several times. Since there was no relief he was referred to this centre and the case was dignosed as otomycosis.
He was not a known Diabetic or Hypertensive., but was a chronic alcoholic. He was not on Steroid therapy. Audiometry result showed moderate hearing loss on the right side.
Saline extraction was done at the ENT OP and otomycotic debris was removed. Debris was sent to the clinical microbiology lab for fungal culture. Patient was given surgical debridment. Patient was advised topical application of Clotrimazole and discharged. The surgeon was planning to do a mastoid exploration later.
10% KOH revealed no fungal elements. Two slopes of Sabourauds Dextrose Agar (SDA) were inoculated, one kept at 37°C, other at 22°C . SDA at 37°C showed growth after 5 days, while there was no growth on SDA at 22°C.
White and fluffy colonies were seen which later turned grey in colour. House mouse grey appearance of the colonies is characteristic [Figure 1]. Reverse is grey to black.
Lactophenol cotton blue mount of growth showed mass of long hyaline branching septate hyphae. Unicellular, subglobose, colourless conidia arising singly and in small groups on elongate and branched conidiophores or laterally on hyphae were seen. With the characteristic appearance of lollipops on a stick [Figure 2]. Large, narrow, erect dark conidiophores can be seen in bundles with conidia in tufts. This Graphium synnemata has the characteristic appearance of wheat sheaf [Figure 2]. The fungus was identified as Scedosporium apiospermum (asexual form). Subculture on SDA slopes also yielded similar growth both at 37°C and 22°C, confirmed by microscopy.
The patient came for review after two months, with persisting otorrhoea again. The ENT Surgeon did saline extraction and sent a repeat specimen of ear swab to the Microbiology Lab which also yielded the same organism. Patient was advised topical application of Clotrimazole again. He was relieved of the symptoms. Now he is awaiting a mastoid exploration for Chronic Suppurative Otitis Media.
| Discussion | | |
Scedosporium apiospermum is a perfect fungus. It can reproduce both sexually and asexually in culture in standard media.
Sexual form or Telomorph is Psuedallescheria boydii. Asexual forms or Anamorphs are 1) Scedosporium apiospermum 2) Graphium synnemata
Presence of Cleistothecia indicates sexual form. They are found enmeshed in the hyphae of anamorphs. They contain numerous asci that are released when cleistothecia ruptures. Each ascus contain eight ascospores.
S. apiospermum is found in soil, sewage, and polluted water. It is an uncommon laboratory isolate This organism usually causes infection in immunocompromised individuals. Recently it has emerged as a pathogen in both immunocompromised and non-immunocompromised patients. S. apiospermum infections include invasive pulmonary disease, sinusitis, brain abscess, endocarditis, osteomyelitis, fungemia, etc. [1],[2] Otitis externa caused by S. apiospermum is extremely rare.
Patil et al reported a case of S. apiospermum external otitis in an immunocompetent man. Here the patient was treated successfully with topical Itraconazole. [3] Yao and Messner diagnosed malignant otitis externa caused by S. apiospermum in Acquired Immune Deficiency Syndrome patient. [4] Otitis media and externa by S. apiospermum was reported in an immunocompetent woman who had symptoms of chronic mastoiditis and otorrhoea. [5] Braz et al reported only one case of S. apiospermum otitis externa, in their six year retrospective study on otomycosis [6] In the present case the patient was a chronic alcoholic and was suffering from right sided chronic otitis media. The ENT Surgeon is planning a mastoid explorarion. Most probably, this might be to find out whether there is otitis interna and mastoid bone involvement. Early diagnosis is very much important especially in case of S. apiospermum otitis externa because most case reports of S. apiospermum brain abscess in immunocompetent patients have documented CSOM to be the risk factor. [2],[7]
The present case highlights the importance of early diagnosis of S. apiospermum otomycosis as it can lead to serious central nervous complication as brain abscess.
| Acknowledgement | | |
Department of Otorhinolaryngology, Government Medical College, Thiruvananthapuram, Kerala, India.
| References | | |
| 1. | Chander J. A text book of Medical Mycology. 3 rd ed. Mehta Publishers, New Delhi 2009; Chapter 28: 418-21. 
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| 2. | Acharya A, Ghimire A, Khanal B, Bhattacharya S, Kumari N, Kanungo R, et al. Brain Abscess due to S. apiospermum in a non immunocompromised child. Indian J Med Microbiol 2006;24:231-2.
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| 3. | Patil SS, Kulkarni SA, Udgaonkar US, Magdum VK. S. apiospermum Otomycosis in an Immunocompetent man. Al Ameen J Med Sci 2011;4:299-302.
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| 4. | Yao M, Messener AH. Fungal malignant otitis externa due to S. apiospermum. Ann Otol Rhinol Laryngol 2001;110:377-80.
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| 5. | Baumgartner BJ, Rakita RM, Backous DD. S. apiospermum otomycosis. Am J Otolaryngol 2007;28:254-6.
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| 6. | Pontes ZB, Silva AD, Lima Ede O, Guerra Mde H, Oliveira NM, Carvalho Mde F, et al. Otomycosis: A retrospective study. Braz J Otorhinolaryngol 2009;75:367-70.
[PUBMED] |
| 7. | Guarro J, Kantarcioglu AS, Horré R, Rodriguez-Tudela JL, Cuenca Estrella M, Berenguer J, et al. S. apiospermum: Changing clinical spectrum of a therapy-refractory opportunist. Med Mycol 2006;44:295-327.
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[Figure 1], [Figure 2]
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