A retrospective study of 43 cases of fungal malignant external otitis.

Malignant external otitis (MEO) has a frequent bacterial origin, but we are currently witnessing the emergence of fungal agents, which poses difficulties in diagnosis and management. The aim of our work is to analyze the epidemiological and clinical profile of fungal MEO and to study the antifungal susceptibility of fungi involved. Our study is retrospective collecting 43 patients treated for fungal MEO between 2010 and 2019. Clinical, biological, and radiological data were collected from patient hospitalization records. Identification of yeasts was done by YST vitek®2 card. The antifungal susceptibility testing was performed for yeasts by the AST vitek®2 card and for other fungi by the E-test technique. The average age was 66 (± 12) years. We noted a male predominance in 63 % (n=27). Diabetes was found in 86%. Otalgia was a constant symptom. Cranial nerve palsies were observed in 16% (n=7) of cases. CT showed bone lysis in 74% (n=31>) of cases and Tc99 bone scintigraphy revealed hyperfixation in 100% (n=43) of cases. Candida spp. (n=21), Aspergillus spp. (n=18), and Geotrichum capitatum (n=2) were isolated. No resistance to antifungals has been demonstrated for Candida yeasts. Geotrichum capitatum isolates were resistant to fluconazole and caspofungin. Aspergillus isolates were resistant to amphotericin B and caspofungin in 50% (n=9) and 72% (n=12) of cases, respectively. Our study proves the predominance of Candida yeasts and Aspergillus as the fungal agents involved in MOE. Mycological diagnosis allows the identification and antifungal susceptibility testing. Thus, it allows using of the appropriate antifungal treatment and improves the prognosis of the disease.

[Tinea capitis: epidemiological study in Tunis from 2012 to 2020]. / Les teignes du cuir chevelu: étude épidémiologique dans la région de Tunis de 2012 à 2020.

Tinea capitis (TC) is the most common superficial mycosis seen in children before puberty. The distribution of these dermatophytes changes over time and varies from country to country. The purpose of this study was to investigate the epidemiological and mycological characteristics of TC in Tunis. We conducted a retrospective study, involving 474 patients referred for mycological analysis of the scalp between January 2012 and December 2020. For each patient, a Clinical Information Sheet was completed, and a mycological sample was taken. The identification of isolated dermatophytes was based on macroscopic and microscopic colony criteria. Molecular real-time Polymerase Chain Reaction (PCR) detection of 4 isolates was performed using the DermaGenius®2.0 kit. We collected 210 positive samples, reflecting a prevalence of 44.3% (n=210). Male patients were more frequently affected by TC (81%, n=170). The average age of patients was 6,2±3,4 years. Ring-shaped large patches were predominant (88%, n=184). Direct examination had a sensitivity of 87% (n=182). Microsporic ectothrix parasitism was detected in (79%, n=166) of cases and trichophytic endothrix in (7%, n=14) of cases. Culture was positive in (98%, n=207) of cases and five dermatophyte species were isolated: Microsporum canis (87%, n=182), Trichophyton violaceum (9%, n=19), Trichophyton mentagrophytes var mentagrophytes (3%, n=6), Microsporum gypsum (0.5%, n=1) and Trichophyton verrucosum (0.5%, n=1). This study reveals the occurrence of zoophilic dermatophytes, in particular M. canis. Mycological examination is essential to confirm the diagnosis, conduct epidemiological surveillance of dermatophytes in the districts and for therapeutic management.

Neuromeningeal cryptoccocosis revealing IgA-λ multiple myeloma.

Cryptococcosis is an opportunistic fungal infection that is commonly associated with an immune-compromised state. Cases of cryptococcosis have rarely been reported in patients with multiple myeloma (MM). However, cryptococcosis as a presenting symptom of MM has never been reported. We presented here a case of neuromeningeal cryptococcosis in a patient without underlying diseases, who has revealed IgA-λ MM. Early detection and treatment of cryptococcosis are essential to reduce morbidity.