Malignant otitis externa is an inflammation of the external auditory canal with preceding osteomyelitis of the temporal bone and the adjacent structures that could be potentially lethal. Malignant otitis externa may present with cranial nerve involvements and massive spread of disease mimicking nasopharyngeal carcinoma or any other malignancies on imaging. Two elderly patients who presented with severe otalgia and significant facial nerve palsy and lower cranial nerve palsies showing extensive spread of disease are reported in this case series. They both had resolution of disease after a prolonged course of antibiotics and cortical mastoidectomy for disease clearance in one of them.

• Klíčová slova
• Pseudomonas aeruginosa, cranial nerves palsies, malignant otitis externa, osteomyelitis,
• MeSH
• antibakteriální látky terapeutické užití   MeSH
• biologické markery krev   MeSH
• diferenciální diagnóza MeSH
• faciální paralýza diagnóza   terapie   MeSH
• kombinovaná farmakoterapie MeSH
• lidé středního věku MeSH
• lidé MeSH
• magnetická rezonanční tomografie MeSH
• mastoidektomie MeSH
• otitis externa diagnóza   patologie   terapie   MeSH
• počítačová rentgenová tomografie MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH
• Názvy látek
• antibakteriální látky MeSH
• biologické markery MeSH

Skull base osteomyelitis (SBO) also commonly known as malignant otitis externa was first described by Meltzer and Kelemen in 1959. Prior to the advent of the antibiotic era, this disease carried a poor prognosis with significant morbidity. It often proved fatal with mortality rates as high as 50%. Commonly seen in the immunocompromised patients, diabetes mellitus is an important associated comorbidity in the pathophysiologic development of this disease. Treatment is instituted by medical therapy with surgery having a limited role. Surgical intervention has a limited role, for example, in fungal SBO. Such cases may require local debridement and intraoperative tissue biopsies for histopathologic confirmation. This is to demonstrate fungal invasion into the skull base, as well as to exclude other sinister differential diagnoses like squamous cell carcinoma of temporal bone. In this case report, we present a rare case of candida SBO and the literature review.

• Klíčová slova
• candida, fungal, osteomyelitis, otitis externa, skull base,
• MeSH
• antibakteriální látky terapeutické užití   MeSH
• antifungální látky terapeutické užití   MeSH
• baze lební MeSH
• flukonazol terapeutické užití   MeSH
• kandidóza komplikace   MeSH
• komplikace diabetu komplikace   MeSH
• lidé středního věku MeSH
• lidé MeSH
• osteomyelitida farmakoterapie   mikrobiologie   MeSH
• otitis externa farmakoterapie   mikrobiologie   MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH
• přehledy MeSH
• Názvy látek
• antibakteriální látky MeSH
• antifungální látky MeSH
• flukonazol MeSH

OBJECTIVE: To present the first case of a patient with oral bisphosphonates-associated ear canal osteonecrosis (BPECO), review previously published cases, and suggest a definition of BPECO. PATIENT: A 79-year-old woman with left otorrhea and earache was treated for otitis externa for 2 months. The examination revealed a deep floor of the left ear canal defect. The bisphosphonates were discontinued. By the end of the 6-week-course of intravenous antibiotics, the bone defect progression ceased. Already a month later, the defect was lined from approximately 50%. Unfortunately, the patient was lost to follow-up at this stage. She was on oral bisphosphonates for 10 years for severe osteoporosis. She had never been exposed to radiotherapy or had any surgery in the left ear. She admitted to be a habitual cotton bud user for aural toilet. RESULTS: A CT scan showed an aggressive lobulated mass consistent with carcinoma. A biopsy suggested osteomyelitis with no evidence of malignancy. The final diagnosis was agreed to be the first case of oral BPECO. INTERVENTION: Debridement, intravenous antibiotics, and cessation of bisphosphonates CONCLUSION: The BPECO is not very well-known clinical diagnosis among ENT surgeons and, therefore, often misdiagnosed for ear canal cholesteatoma, malignant otitis externa, or temporal bone malignancies. It seems reasonable to re-review patient's medical history with focus on BP medication in cases with negative biopsy. Although the BP osteonecrosis is a rare phenomenon, the large volume of BP prescription makes the number of patients at risk significant.

• MeSH
• antibakteriální látky terapeutické užití   MeSH
• bisfosfonátová osteonekróza čelistí komplikace   diagnóza   patologie   MeSH
• bisfosfonáty škodlivé účinky   terapeutické užití   MeSH
• bolest ucha etiologie   MeSH
• inhibitory kostní resorpce škodlivé účinky   terapeutické užití   MeSH
• lidé MeSH
• nemoci ucha chemicky indukované   diagnóza   patologie   MeSH
• osteoporóza komplikace   farmakoterapie   MeSH
• otitis externa etiologie   MeSH
• radiografie MeSH
• senioři MeSH
• zvukovod diagnostické zobrazování   patologie   MeSH
• Check Tag
• lidé MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH
• Názvy látek
• antibakteriální látky MeSH
• bisfosfonáty MeSH
• inhibitory kostní resorpce MeSH

A collection of 178 Aspergillus isolates, recovered from Czech patients, mostly from 2007-2011, was subjected to multilocus DNA sequence typing using the ITS region, β-tubulin, and calmodulin genes. An unusually wide spectrum of etiologic agents that included 36 species of Aspergillus is discussed in the context of recent taxonomic and clinical reports. Invasive aspergillosis (IA), onychomycosis, and otitis externa were the predominant clinical entities. Five cases due to species newly proven as etiologic agents of human mycoses, as well as cases with unique clinical manifestations caused by unusual agents are discussed in more detail. Three species (i.e., A. insulicola, A. westerdijkiae and A. tritici) were identified as the confirmed etiologic agents of non-dermatophytic onychomycosis. Emericella rugulosa was recovered from a premature newborn with a fatal necrotising disseminated infection and is reported for only the second time as the cause of IA. Furthermore, we document the first infection due to A. calidoustus in a patient with chronic granulomatous disease. The infection manifested as a latent brain aspergilloma with an unusual clinical-laboratory finding. In addition to the well-known agents of human mycosis, several rarely isolated or poorly documented species were identified. An undescribed cryptic species related to A. versicolor was found to be common among isolates linked to proven and probable onychomycosis. An isolate representing A. fresenii, or an unnamed sister species, were causal agents of otomycosis. Three well defined, and tentative new species belonging to section Cervini, Candidi and Aspergillus (Eurotium spp.), were associated with cases of probable onychomycosis.

• MeSH
• Aspergillus klasifikace   genetika   izolace a purifikace   patogenita   MeSH
• aspergilóza farmakoterapie   epidemiologie   mikrobiologie   MeSH
• DNA fungální analýza   genetika   MeSH
• Emericella genetika   izolace a purifikace   patogenita   MeSH
• geny hub * MeSH
• lidé středního věku MeSH
• lidé MeSH
• mikrobiologické techniky metody   MeSH
• mladiství MeSH
• novorozenec nedonošený MeSH
• novorozenec MeSH
• onychomykóza farmakoterapie   epidemiologie   mikrobiologie   MeSH
• otitis externa mikrobiologie   MeSH
• sekvenční analýza DNA metody   MeSH
• tubulin genetika   MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mladiství MeSH
• mužské pohlaví MeSH
• novorozenec MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH
• práce podpořená grantem MeSH
• Geografické názvy
• Česká republika epidemiologie   MeSH
• Názvy látek
• DNA fungální MeSH
• tubulin MeSH

Chaetomium species have been rarely described as aetiological agents of invasive and dermatomycotic infections in humans. The majority of cases have been reported within the last two decades. Treatment failed in most of these cases. In this paper we present two cases in which Chaetomium spp. can be clearly identified as an aetiological agent in pathological conditions. In the first report, we describe a new aetiological agent, Chaetomium brasiliense, which was implicated in a case of otitis externa in a patient with spinocellular carcinoma basis cranii. The patient had been repeatedly treated for relapsing otitis externa and had previously undergone surgery several times for otitis media. The fungal aetiology was confirmed by repeated positive culture and histologic studies. The second case involved onychomycosis with strikingly brown nail discoloration due to Chaetomium globosum in an otherwise healthy patient. The nail lesion was successfully cured by oral terbinafine. The determination of both species was supported by sequencing of rDNA regions. The morphological aspect of Chaetomium spp. identification is also discussed. In vitro antifungal susceptibility tests demonstrated that both isolates were susceptible to terbinafine and azole derivates except fluconazole. Amphotericin B was effective only against the C. brasiliense strain. We review the literature to summarize clinical presentations, histologic findings, and treatment strategies.

• MeSH
• antifungální látky farmakologie   MeSH
• Chaetomium klasifikace   genetika   izolace a purifikace   MeSH
• DNA fungální chemie   genetika   MeSH
• fylogeneze MeSH
• histocytochemie MeSH
• lidé středního věku MeSH
• lidé MeSH
• mezerníky ribozomální DNA chemie   genetika   MeSH
• mikrobiální testy citlivosti MeSH
• mikroskopie MeSH
• molekulární sekvence - údaje MeSH
• onychomykóza diagnóza   mikrobiologie   MeSH
• otitis externa diagnóza   mikrobiologie   patologie   MeSH
• phaeohyphomykóza diagnóza   mikrobiologie   patologie   MeSH
• ribozomální DNA chemie   genetika   MeSH
• sekvenční analýza DNA MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH
• práce podpořená grantem MeSH
• Názvy látek
• antifungální látky MeSH
• DNA fungální MeSH
• mezerníky ribozomální DNA MeSH
• ribozomální DNA MeSH

The bacterial and fungal flora of the external ear canal of dogs with otitis externa and of healthy dogs were studied. The most frequently isolated microorganism from otitic ears was Staphylococcus intermedius (58.8%), followed by Malassezia pachydermatis (30.9%), Streptococcus canis (29.9%), Proteus spp. (14.4%) and Escherichia coli (10.3%). A statistical analysis of our results showed that the prevalence of these microorganisms is significant in dogs with otitis externa. Furthermore, the antimicrobial susceptibility patterns of isolated strains were determined. Majority of all bacterial isolates were most susceptible to gentamicin. Malassezia pachydermatis, the most prevalent yeast in this study, showed an excellent level of susceptibility to all antifungal agents tested.

• MeSH
• antibakteriální látky farmakologie   MeSH
• bakteriální léková rezistence * MeSH
• fungální léková rezistence * MeSH
• Malassezia účinky léků   růst a vývoj   MeSH
• mikrobiální testy citlivosti veterinární   MeSH
• nemoci psů farmakoterapie   mikrobiologie   MeSH
• otitis externa farmakoterapie   mikrobiologie   veterinární   MeSH
• psi MeSH
• Staphylococcus účinky léků   růst a vývoj   MeSH
• Streptococcus účinky léků   růst a vývoj   MeSH
• ucho mikrobiologie   MeSH
• výsledek terapie MeSH
• vztah mezi dávkou a účinkem léčiva MeSH
• zvířata MeSH
• Check Tag
• mužské pohlaví MeSH
• psi MeSH
• ženské pohlaví MeSH
• zvířata MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• Názvy látek
• antibakteriální látky MeSH

Mycological analysis of swabs and scraping samples from the external ear canals of 40 patients with clinically diagnosed otomycosis (10 neonates, 30 adults) revealed the presence of fungi as etiological agents. They were investigated microscopically using 20 % potassium hydroxide, and by cultivation on Sabouraud's glucose agar. The Candida species were identified using the germ-tube test, micromorphology observations of colonies on rice agar, and particularly by the commercial kit AUXAcolor. The following Candida species were identified in the aural material examined: C. albicans (n = 21; 52.5 %), C. parapsilosis (11; 27.5), C. tropicalis (3; 7.5), C. krusei (3; 7.5), C. guilliermondii (2; 5.0). The above yeasts were present in samples together with Staphylococcus epidermidis (31), S. aureus (16), alpha-hemolytic streptococci (14), Neisseria spp. (14), Proteus mirabilis (3), Pseudomonas aeruginosa (3), Escherichia coli (1) and Haemophilus influenzae (1). The most frequent predisposing factors for otomycosis were swimming in public pools and/or bath, spa and diabetes mellitus.

• MeSH
• Candida klasifikace   izolace a purifikace   patogenita   MeSH
• dospělí MeSH
• druhová specificita MeSH
• kandidóza mikrobiologie   MeSH
• lidé MeSH
• novorozenec MeSH
• otitis externa mikrobiologie   MeSH
• rizikové faktory MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• novorozenec MeSH
• Publikační typ
• časopisecké články MeSH
• Geografické názvy
• Slovenská republika MeSH

Advances in the diagnosis and treatment of necrotizing external otitis (NEO) during the past 20 years improved substantially the prognosis of this disease. The use of hyperbaric oxygen therapy greatly potentiates the effect of newly developed highly effective antibiotics. Radioisotope examination of the petrous bones facilitates the diagnosis and indicates the time to terminate treatment. Medicamentous treatment is preferable to surgical treatment, which is reserved for exceptional very advanced cases of the disease. As NEO has been known for 30 years and the means to control it have been improved, it is no longer "malignant" for the majority of patients where the disease is diagnosed in time and treated adequately.

• MeSH
• lidé MeSH
• nekróza MeSH
• otitis externa patologie   terapie   MeSH
• pseudomonádové infekce patologie   terapie   MeSH
• senioři MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• Publikační typ
• anglický abstrakt MeSH
• časopisecké články MeSH
• kazuistiky MeSH

• MeSH
• lidé MeSH
• nekróza MeSH
• otitis externa * patologie   terapie   MeSH
• senioři MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• Publikační typ
• anglický abstrakt MeSH
• časopisecké články MeSH
• kazuistiky MeSH

• MeSH
• chrániče sluchu * MeSH
• chronická nemoc MeSH
• lidé MeSH
• ochranné prostředky * MeSH
• otitis externa prevence a kontrola   MeSH
• otitis media etiologie   prevence a kontrola   MeSH
• plavání * MeSH
• recidiva MeSH
• tělovýchovné lékařství * MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• anglický abstrakt MeSH
• časopisecké články MeSH