Mycotic aortic aneurysm in a debilitated patient with compromised immunity; beware of Candida! / Aneurisma micótico da aorta em paciente debilitado com imunidade comprometida - um alerta para Cândida

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.

Necrotizing Otitis Externa: A Disease Barely Known to Neurosurgeons

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.

Otite externa necrotizante com paralisia facial periférica e trombose do seio cavernoso: relato de caso / Necrotizint external otitis with peripheral facial paralysis and cavernous sinus thrombosis: case report

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.

Otitis externa micótica y perforación timpánica: reporte de dos casos / Otomycosis and perforated tympanic membrane: two cases

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.

Association of Raillietia caprae with the presence of Mycoplasmas in the external ear canal of goats.

We did a descriptive study to determine whether the presence in the external ear canal of the Raillietia caprae mites and Mycoplasmas were associated. For that we sampled 360 goats slaughtered at abattoirs in the summer to identify those infested with the mite. We found only 20 infested, so used all of those plus another 47 uninfested goats selected systematically from the population negative for the isolation of Mycoplasmas. These goats came from the regions of Queretaro, Guanajuato, Sinaloa and Estado de México. Sterile swabs were taken from each ear canal of the carcass after removal of the pinna for microscopic observation of the mites and for the isolation of Mycoplasmas in both study groups. The swab samples were inoculated in Friis media for the isolation of Mycoplasmas; then, the isolates were biochemically characterized and identified serologically. We recovered isolates from the earwax of only nine of the 47 control goats, but from the earwax of 11 of the 20 infested goats; another four infested goats had Mycoplasma isolated from the mites but not from the earwax. Mycoplasma cottewii and Mycoplasma yeatsii were the only Mycoplasmas isolated from the uninfested goats, and also were the predominant (29 of 34) isolates from the infested goats and/or from the mites.

[Malignant external otitis. Experience with 12 cases]. / Otitis externa maligna. Experiencia en 12 casos.

Malignant external otitis is a life-threatening infection occurring in aging diabetic and immunocompromised patients. The development of new antimicrobial and diagnostic aids has modified the therapy and prognosis of the disease. We describe our experience in 12 cases seen between 1982 and 1991, and review the diagnostic and therapeutic criteria during this lapse. Ten cases were males and 11 were diabetics. The most common symptoms were unilateral otalgia and otorrhea. All had edema of the external auditory channel and nine, proliferation of granulation tissue. Four had cranial nerve palsy. In ten patients Pseudomonas aeruginosa was recovered. All had axial computed tomographic scans and six sequential radionuclide scanning performed at diagnosis and follow-up. Eleven patients received combined therapy with an aminoglucoside and an anti-pseudonomas beta-lactam antibiotic; in four ambulatory treatment was continued with a quinolone. Only one patient received a quinolone as only treatment due to unavailability of other drugs in the mexican market. Presentation of granulation tissue or bone sequestrum was performed in nine patients. Only three required extensive surgical debridement procedures. We conclude that a combined antimicrobial therapy and the use of quinolones has favorably modified the prognosis and avoids extensive surgery and disminishes hospital stay.

[Malignant otitis externa with disfunction of the temporomandibular articulation]. / Otitis externa maligna con disfunción de la articulación temporomandibular.

Here we present a case of a female patient 70 years old stricken with diabetes mellitud 40 years of evolution with manifestations of malignant external otitis accompanied by disfunction of the temporomandibular articulation. Here we will show the clinical characteristics and the diagnosis in our patient likewise its treatment. We will expound the most important aspects of the entity at this present time.

Tétano otogênico: relato de um caso / Otogenic tetanus: report of a case

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

[Otorhinolaryngological pathology in pediatric hematology: diagnosis and therapy]. / Patología otorrinolaringológica en hematología pediátrica: diagnóstico y terapéutica.

Two hundred and 19 children and adolescent patients were studied at the Hematology Department of the Hospital Infantil de México from 1973 to 1979. Eighty-five percent of such patients requirer E.N.T. consultation, arriving to diagnoses in problems of the specialty, in 57% of them. a description of made, concerning the otorhinolaryngological pathology present in hematological, non-oncological diseases, as well as the complications and therapy carried out.