Mycological investigation in patients with acute otitis media

Middle ear swabbed samples from 272 patients with acute otitis media (AOM) attending Ear, Nose and Throat clinics were collected and cultured using standard mycological technique. Deoxyribonuclease and In-vitro susceptibility of the fungal isolates to Flucytosine (Flu), Nystatin (Nys), Voriconazole (Vor) and Ketoconazole (Ket) were evaluated using DNase agar and disc diffusion techniques, respectively. The results showed the highest prevalence of AOM in age group ≤ 10 years with 84 (30.9%) cases and lowest prevalence in age group ≥ 61 having 12 (4.4%) cases. Only 124 (45.6%) samples showed positive growth, while 148 (54.4%) showed no growth. Of the 124 samples with growth, 9(36.4%) samples showed growth of single fungal isolate, while 18 (6.6%) and 7 (2.6%) showed growth of two and three fungal isolates, respectively. Aspergillus niger was the predominant fungal isolate, followed by Candida albicans with 38 (24.4%), Cryptococcus neoformans 32 (20.5%), Candida spp 21 (13.5%) and Aspergillus flavus 14 (9.0%). Only 46 (29.5%) of fungal isolates were deoxyribonuclease producers, with 30/38 (78.9%) being C. albicans and 16/21 (76.2%) being Candida spp. The results of antifungal susceptibility showed that between 65.8 to 71.1% C. albicans, 64.3 to 85.7% A. flavus, 64.7 to 78.4% A. niger, 53.1 to 75.0% C. neoformans, and 52.4 to 57.1% Candida spp. were sensitive to Ket, Vor and Flu, while between 81.6-84.4% of C. albicans and C. neoformans were sensitive to Nys. In overall, 72.4%, 76.3%, 67.9% and 62.2% of the fungal isolates were sensitive to Flu, Nys, Vor and Ket, respectively. Consequently, Nystatin will be highly effective in treating AOM caused by fungi.

Keywords:

Acute otitis media , , Deoxyribonuclease , Antifungal , Prevalence , Fungi