[Otomastoiditis caused by Aspergillus in AIDS].
BACKGROUND
Aspergillus otomastoiditis is an infrequent infection that occurs in most cases in immunocompromised hosts. Although fungal infections are common in AIDS patients, few cases of Aspergillus otomastoiditis have been reported.


METHODS
Two clinical cases of AIDS patients with Aspergillus otomastoiditis are reported, and a review of the literature is performed.


RESULTS
Clinical presentation in both cases was similar to those of other diseases involving middle and internal ear. Infection was linked to severe immunosuppression (C3 group).


CONCLUSIONS
Aspergillus otomastoiditis is an infrequent infection in AIDS patients. Different routes by which Aspergillus obtains access to the middle ear have been proposed (tympanogenic, meningogenic, hematogenous and direct spread from paranasal sinuses or external auditory canal). Otorrhea, otalgia, hearing loss and facial nerve involvement are common findings. Bone destruction and invasion of brain or skull base may occur. CT or MRI are necessary to evaluate the extent of the disease. Etiologic diagnosis requires histopathologic confirmation on deep tissue biopsy or isolation from blood cultures or fistula exudates, because Aspergillus is a common saprophytic fungus in external auditory canal. Concurrent infections (i.e. Pseudomonas aeruginosa) frequently delay the correct diagnosis. Aggressive surgical resection and intravenous antifungal chemotherapy (amphotericin B or itraconazole) are the main therapeutic options. Outcome is poor as a consequence of severity, delay of etiologic diagnosis and difficulty of aggressive surgical approach in compromised patients. In patients with AIDS a low CD4 cell count would favour invasive Aspergillus infection, implying a worse outcome.
Martínez-Berriotxoa
A
A
Unidad de Enfermedades Infecciosas, Hospital de Cruces, Barakaldo, Bizkaia.
Montejo
M
M
Aguirrebengoa
K
K
González de Zárate
P
P
Aguirre
C
C
D017088:AIDS-Related Opportunistic Infections / Q000175:diagnosis / Q000382:microbiology*; D000328:Adult; D001228:Aspergillosis / Q000175:diagnosis; D001232:Aspergillus fumigatus / Q000302:isolation & purification*; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D008297:Male; D008417:Mastoiditis / Q000175:diagnosis / Q000382:microbiology*; D010035:Otitis Media, Suppurative / Q000175:diagnosis / Q000382:microbiology*; D015819:Substance Abuse, Intravenous / Q000150:complications