The Role of Candida Albicans in Routine Clinically Suspected Otomycosis.

BACKGROUND: Candida albicans and non-albicans Candida species are considered as commensal yeasts of many cavities including the external auditory canal (EAC) in healthy individuals. These fungal microorganisms can also act as opportunist pathogens and cause otomycosis. In this study, the patients of clinically suspected otomycosis were specifically investigated mycologically to elucidate the role of Candida albicans and non-albicans Candida species. MATERIAL AND METHODS: A prospective observational study was conducted from July 2016 and June 2017 at the Laboratory of Parasitology and Mycology of the Sourô SANOU University Hospital in Bobo-Dioulasso, Burkina Faso. Identification of Candida isolates was using conventional phenotypic methods. Antifungal susceptibility tests were carried out by disk diffusion method in accordance with CLSI standard document M44-A for yeasts. RESULTS: Out of 160 patients with clinically diagnosed otomycosis, 77(48.1%) were investigated positive for Candida species. Candida albicans (61%) was the most isolated species and non-albicans Candida species accounted for 39% of the isolates, with mainly Candida spp (22.1%), Candida krusei (10.4%), Candida dubliniensis (5.2%) and Candida glabrata (1.3%). Nystatin showed the highest efficacy (95.9%), followed by ketoconazole (90.4%), clotrimazole (83.6%), miconazole (72.6%) and amphotericin B (63.0%). CONCLUSION: Otomycosis due to Candida species should be especially considered, since they have a wide number of potential virulence factors that cause fungal infections. Also, antifungal susceptibility testing should be performed in order to select the appropriate antifungal therapy.

CONTEXTE: Candida albicans et les espèces de Candida non albicans sont considérées comme des levures commensales de nombreuses cavités, y compris le conduit auditif externe (CAE) chez les individus sains. Ces micro-organismes fongiques peuvent également agir comme des agents pathogènes opportunistes et provoquer une otomycose. Dans cette étude, les patients cliniquement suspectés d'otomycose ont été spécifiquement étudiés mycologiquement pour élucider le rôle des espèces de Candida albicans et non albicans Candida. MATÉRIEL ET METHODS: Une étude observationnelle prospective a été menée de juillet 2016 à juin 2017 au Laboratoire de Parasitologie et Mycologie du CHU Sourô SANOU à BoboDioulasso, Burkina Faso. L'identification des isolats de Candida utilisait des méthodes phénotypiques conventionnelles. Des tests de sensibilité aux antifongiques ont été réalisés par la méthode de diffusion sur disque selon le document standard CLSI M44-A pour les levures. RÉSULTATS: Sur 160 patients atteints d'otomycose cliniquement diagnostiquée, 77 (48,1 %) ont été testés positifs pour les espèces de Candida. Candida albicans (61 %) était l'espèce la plus isolée et les espèces non albicans Candida représentaient 39 % des isolats, avec principalement Candida spp (22,1 %), Candida krusei (10,4 %), Candida dubliniensis (5,2 %) et Candida glabrata (1,3%). La nystatine a montré l'efficacité la plus élevée (95,9 %), suivie du kétoconazole (90,4 %), du clotrimazole (83,6 %), du miconazole (72,6 %) et de l'amphotéricine B (63,0 %). CONCLUSION: L'otomycose due aux espèces de Candida doit être particulièrement considérée, car elles ont un grand nombre de facteurs de virulence potentiels qui provoquent des infections fongiques. En outre, des tests de sensibilité aux antifongiques doivent être effectués afin de sélectionner le traitement antifongique approprié. Mots-clés: Candida albicans; Otomycoses; routine; sensibilité antifongique; Burkina Faso.

Histoplasmosis Caused by Histoplasma capsulatum var. duboisii: A Comprehensive Review of Cases From 1993 to 2019.

BACKGROUND: Histoplasmosis caused by Histoplasma capsulatum var. duboisii (Hcd) is a rare, but probably underestimated, endemic infection described in intertropical Africa. Therefore, the epidemiology of the infection remains unclear, and there is no consensus on therapeutic management. METHODS: Using a comprehensive search on different Internet databases, we collected case reports of Hcd infection published from 1993 to 2019. Epidemiological and clinical charts and therapeutic strategies were analyzed. RESULTS: We found 94 well-documented cases of Hcd infection, and 30.1% of the patients were under 18 years old. Symptoms occurred in some patients several decades after leaving the endemic area. Cutaneous/subcutaneous lesions, bone infections, and lymphadenopathies, both isolated and combined, were the most frequent presentations. The human immunodeficiency virus (HIV) coinfection rate was at 20.8%, with fever, lymphadenopathies, and an absence of bone infection being the differentiating elements from patients living without HIV. The rate of disseminated forms (60.6% in our review) significantly increased as compared to studies published before 1993, but without correlation with HIV infection. The global mortality rate was at 23.4% by the end of follow-up. The outcome was not correlated with the antifungal drug prescribed, nor with HIV serologic status, but was correlated with the initiation of an antifungal therapy. CONCLUSIONS: Hcd histoplasmosis is a severe fungal infection for which the precise mode of acquisition remains to be determined. There is a need for affordable and more specific diagnostic tools. Itraconazole and amphotericin B are the best therapeutic alternatives and should be available in all low-income countries of the endemic area.