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Molecular Identification and Antifungal Susceptibility of Yeasts and Molds Isolated from Patients with Otomycosis

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Abstract

Fungal otitis externa, an infection of the external auditory canal caused by molds and yeasts, accounts for approximately 10–20% of ear canal infections accompanying high recurrence. The purpose of the current study was to assess the pattern of etiological agents of otomycosis and resistance profile as well as the rate of tympanic membrane perforation. A total of 1040 patients with symptoms of fungal otitis externa, in a period of two years, were investigated. The mycological tests revealed the presence of different fungi in 237 ears (22.8%). Fungal otitis was more related to filamentous fungi of the species Aspergillus flavus (54.43%), A. tubingensis (10.97%), and A. niger (8.86%), followed by yeasts, Candida orthopsilosis (7.59%), C. albicans (6.75%), and C. parapsilosis (5.06%). Tympanic membrane perforation rate was found to be 6.75% and was more common with otomycosis caused by A. flavus, A. tubingensis and C. albicans. In antifungal susceptibility tests, all tested drugs showed generally good activity against most isolates of molds and yeasts, while tolnaftate, clotrimazole, nystatin, and terbinafine had lowest effects. We found that among Aspergillus isolates, one A. niger isolate was resistant to voriconazole, and one A. flavus isolate was resistant to amphotericin B. Furthermore, among Candida species, three isolates of C. orthopsilosis showed high MIC values to fluconazole, two C. albicans isolates were considered fluconazole resistant and one isolate of C. parapsilosis was resistant to caspofungin and 3 isolates were resistant to fluconazole. Regarding the existence of the cases with perforated tympanic membrane and emerging species causing fungal otitis in the current report, the importance of the early physical examination, precise molecular identification, and the antifungal susceptibility evaluation is highlighted.

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Acknowledgements

The work of M.A was supported by Mazandaran University of Medical Sciences, Sari, Iran (grant no. 1222), which we gratefully acknowledge.

Funding

This work was supported by Mazandaran University of Medical Sciences Deputy of Research, Sari, Iran.

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Authors and Affiliations

  1. Department of Ear, Nose, and Throat, Faculty of Medicine, Roohani Hospital, Babol University of Medical Sciences, Babol, Iran

    Keyvan Kiakojuri

  2. Department of Medical Mycology, School of Medicine, Babol University of Medical Sciences, 47745-47176, Babol, Iran

    Saeid Mahdavi Omran & Mojtaba Taghizadeh Armaki

  3. Invasive Fungi Research Center, Communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran

    Somayeh Roodgari, Mohammad Taghi Hedayati, Tahereh Shokohi, Iman Haghani, Javad Javidnia, Firoozeh Kermani, Hamid Badali & Mahdi Abastabar

  4. Department of Medical Mycology, School of Medicine, Mazandaran University of Medical Sciences, 48175-1665, Sari, Iran

    Somayeh Roodgari, Mohammad Taghi Hedayati, Tahereh Shokohi, Iman Haghani, Javad Javidnia, Firoozeh Kermani, Hamid Badali & Mahdi Abastabar

  5. Student Research Committee, Mazandaran University of Medical Sciences, Sari, Iran

    Somayeh Roodgari, Javad Javidnia & Firoozeh Kermani

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  1. Keyvan Kiakojuri
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Kiakojuri, K., Mahdavi Omran, S., Roodgari, S. et al. Molecular Identification and Antifungal Susceptibility of Yeasts and Molds Isolated from Patients with Otomycosis. Mycopathologia 186, 245–257 (2021). https://doi.org/10.1007/s11046-021-00537-1

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