Antifungal Therapy of Aspergillus Invasive Otitis Externa: Efficacy of Voriconazole and Review
Author:
Parize P, Chandesris MO, Lanternier F, PoirÉe S, Viard JP, Bienvenu B, Mimoun M, MÉchai F, Mamzer MF, Herman P, Bougnoux ME, Lecuit M, Lortholary O
Date: 14 January 2009
Abstract:
Invasive otitis externa due to Aspergillus is a rare potentially life-threatening invasive fungal infection affecting immunocompromised patients. The invasive process may lead to skull base osteomyelitis with progressive cranial nerve palsies and can result in irreversible hearing and neurological impairments. We report two cases of Aspergillus invasive otitis externa (IOE) treated with voriconazole alone and a literature review of antifungal therapy of Aspergillus IOE. A total of 25 patients, including the two present reports, was analysed. Eighteen patients were treated with amphotericin B and nine of them received itraconazole as an additional agent. Three patients received initial therapy with itraconazole and one patient was treated with both voriconazole and caspofungin therapy. The two present patients received voriconazole therapy alone with good clinical and biological tolerance despite prolonged treatment. The last patient did not receive antifungal therapy, as the diagnosis was made post-mortem. Eighteen patients underwent an initial extensive surgical debridement. The majority of patients had a favourable outcome, seventeen patients experienced a complete recovery and six a partial improvement. Both of the reported patients had favourable outcome and no aggressive surgical debridement was required. Although voriconazole has been shown to be effective for the treatment of invasive aspergillosis, its precise role in the management of Aspergillus IOE had not been documented. These observations demonstrate that voriconazole could be an effective and well tolerated therapeutic option for the management of Aspergillus IOE.
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