M-2179. Antifungal Therapy of Aspergillus Malignant External Otitis: Efficacy of Voriconazole and Review
Session: Poster Session: Clinical Mycology II
Monday, October 27, 2008: 12:00 AM
Room: Hall C
Background: Aspergillus malignant external otitis (MEO) are rare potentially life-threatening invasive fungal infections affecting immunocompromised patients. The invasive process may lead to skull base osteomyelitis with cranial nerve palsies and can result in irreversible hearing and neurological impairments. Methods: We report the first two cases of Aspergillus MEO treated with voriconazole alone and a literature review of antifungal therapy of Aspergillus invasive external otitis. Results: A total of 22 patients, including the two present reports, were analyzed. One of the patients did not receive antifungal therapy, as the diagnosis was only made post-mortem. Seventeen patients were initially treated with amphotericin B and nine of them received itraconazole as an additional agent. Two patients received initial therapy with itraconazole and the two present patients were treated with voriconazole alone. Fifteen patients underwent an initial extensive surgical debridement. Most of the patients had a favorable outcome, fifteen patients experienced a complete recovery and five exhibited a partial improvement. Two patients died of invasive aspergillosis and four patients with initial improvement died of complications of their underlying conditions . The two present patients had a favorable outcome under long-term oral voriconazole therapy. Conclusions: Although voriconazole has been shown effective for the treatment of invasive aspergillosis, its precise role for the management of MEO had not been documented. These observations demonstrate that voriconazole is now an effective therapeutic option for the management of Aspergillus MEO.
Olivier Lortholary, MD, PhD1, Boris Bienvenu2, Fanny Lanternier, MD3, Frédéric Mechai2, Jean Viard2, Marc Lecuit, MD PhD4, Marie Chandesris2, Marie Mamzer2, Marie Bougnoux2, Michaël Mimoun2, Perrine Parize5, Philippe Herman2, Sylvain Poiree2 and  P. Parize, None., (1)AP-HP; Univ. Paris V, (2)AP-HP, (3)Cochin Hospital, Paris, France, (4)Institut Pasteur, Paris, France, (5)AP-HP, Paris Cedex 15, France

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