Fungal necrotizing otitis externa in diabetic patients: Clinical features and diagnostic difficulties

Background: Necrotizing otitis externa is an infection affecting immune-compromised and elderly diabetic patients resulting in complications with significant morbidity and mortality. We present our experience with this disease, along with the investigative tools and treatment modalities that benefitted most. The objective being to analyze the course of the disease and the benefit of having an institutional protocol for its management.Methods: This is a retrospective observational study on patients diagnosed with necrotizing otitis externa between 2013-2019.Results: Out of 38 patients 36 were diabetics, the commonest clinical presentation included otalgia in 37 patients, granulations in 35, facial nerve palsy in 14 and Pseudomonas aeruginosa was isolated in 19 patients. They were managed with multidrug combination antibiotic therapy, topical dressing and drops with 27 showing improvement.Conclusions: We recommend a diagnostic triad for NOE comprising of otalgia in an elderly diabetic patient with granulations in the external auditory canal. It is best managed by controlling diabetes, appropriate antibiotic combination, topical dressing, and sometimes surgical debridement.

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Necrotizing Otitis Externa: A Disease Barely Known to Neurosurgeons

Arquivos Brasileiros de Neurocirurgia Brazilian Neurosurgery ◽

10.1055/s-0036-1596052 ◽

2016 ◽

Vol 38 (03) ◽

pp. 239-245

Author(s):

Sérgio Augusto Vieira Cançado ◽

Lucídio Duarte de Souza ◽

Rodrigo Moreira Faleiro ◽

José Maurício Siqueira

Keyword(s):

Early Diagnosis ◽

Skull Base ◽

Otitis Externa ◽

Clinical Presentation ◽

Neurological Impairment ◽

Diabetic Patients ◽

Necrotizing Otitis Externa ◽

Clinical Presentations ◽

Malignant Otitis Externa ◽

High Index Of Suspicion

AbstractNecrotizing otitis externa (NOE), also known as malignant otitis externa (MOE), is a severe and rare infectious disease of the external auditory canal (EAC). Without treatment, it may progress to skull base involvement. The bacteria Pseudomonas aeruginosa is the most common causative agent (∼ 90% of the cases), and affects immunocompromised subjects, particularly diabetic patients. Severe chronic otalgia, otorrhea, and cranial nerve palsy are the most common clinical presentations. Patients with NOE are frequently referred to neurosurgery because of the neurological impairment and skull base compromise. The definitive diagnosis is frequently elusive, requiring a high index of suspicion. Several laboratorial tests, imaging modalities, and the histologic exclusion of malignancy may be required. An early diagnosis and aggressive treatment reduce morbidity and mortality. We present four NOE cases to illustrate the spectrum of clinical presentation and complementary exams. According to the literature, more effort for early diagnosis and treatment is required, and neurosurgeons play an important role in this task.

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Complicated necrotizing otitis externa in diabetic patients

Endocrine Abstracts ◽

10.1530/endoabs.70.ep185 ◽

2020 ◽

Author(s):

Mohamed Masmoudi ◽

Malika Omri ◽

Mehdi Hasnaoui ◽

Rihab Lahmar ◽

Khalifa Mighri ◽

...

Keyword(s):

Otitis Externa ◽

Diabetic Patients ◽

Necrotizing Otitis Externa

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Hypoglycemia in non-diabetic patients: clinical features and causes

Endocrine Abstracts ◽

10.1530/endoabs.56.p281 ◽

2018 ◽

Author(s):

Imen Sakka ◽

Ibtissem Oueslati ◽

Melika Chihaoui ◽

Meriem Yazidi ◽

Fatma Chaker ◽

...

Keyword(s):

Clinical Features ◽

Diabetic Patients

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When Uncontrolled Diabetes Mellitus and Severe COVID-19 Converge: The Perfect Storm for Mucormycosis

Journal of Fungi ◽

10.3390/jof7040298 ◽

2021 ◽

Vol 7 (4) ◽

pp. 298

Author(s):

Teny M. John ◽

Ceena N. Jacob ◽

Dimitrios P. Kontoyiannis

Keyword(s):

Diabetes Mellitus ◽

Risk Factors ◽

Clinical Features ◽

The Other ◽

Diabetic Patients ◽

Epidemiological Factors ◽

Uncontrolled Diabetes ◽

Diagnostic Certainty ◽

Patients With Diabetes ◽

Perfect Storm

Mucormycosis (MCR) has been increasingly described in patients with coronavirus disease 2019 (COVID-19) but the epidemiological factors, presentation, diagnostic certainty, and outcome of such patients are not well described. We review the published COVID-19-associated mucormycosis (CAMCR) cases (total 41) to identify risk factors, clinical features, and outcomes. CAMCR was typically seen in patients with diabetes mellitus (DM) (94%) especially the ones with poorly controlled DM (67%) and severe or critical COVID-19 (95%). Its presentation was typical of MCR seen in diabetic patients (mostly rhino-orbital and rhino-orbital-cerebral presentation). In sharp contrast to reported COVID-associated aspergillosis (CAPA) cases, nearly all CAMCR infections were proven (93%). Treating physicians should have a high suspicion for CAMCR in patients with uncontrolled diabetes mellitus and severe COVID-19 presenting with rhino-orbital or rhino-cerebral syndromes. CAMR is the convergence of two storms, one of DM and the other of COVID-19.

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651. Comparative Analysis Between Bacterial And Fungal Malignant Otitis Externa

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.845 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S383-S384

Author(s):

Fatma Hammami ◽

Makram Koubaa ◽

Amal Chakroun ◽

Fatma Smaoui ◽

Khaoula Rekik ◽

...

Keyword(s):

Otitis Externa ◽

Clinical Presentation ◽

The Elderly ◽

Causative Organism ◽

Diabetic Patients ◽

Duration Of Treatment ◽

Evolutionary Features ◽

Significant Difference ◽

Malignant Otitis Externa ◽

History Of

Abstract Background Malignant otitis externa is a fatal infection of the external ear and temporal bone. Pseudomonas aeruginosa is the most common causative organism, while fungi are a rare cause of malignant otitis externa. We aimed to compare the clinical, therapeutic and evolutionary features between bacterial and fungal malignant otitis externa. Methods We conducted a retrospective study including all patients hospitalized for malignant otitis externa in the infectious diseases department between 2000 and 2018. Results Overall, we encountered 82 cases of malignant otitis externa, among which there were 54 cases (65.9%) of bacterial malignant otitis externa (BMO) and 28 cases (34.1%) of fungal malignant otitis externa (FMO). The males were predominant among BMO cases (57.4% vs 50%; p=0.5). Patients with FMO were significantly older (70±9 years vs 61±10 years; p< 0.001) and had medical history of diabetes mellitus more frequently (96.4% vs 77.8%; p=0.03). The use of topical corticosteroids was significantly more reported among FMO cases (28.6% vs 5.6%; p=0.006). Otalgia (96.4% vs 81.5%), otorrhea (75% vs 66.7%) and cephalalgia (46.4% vs 42.6%) were the revealing symptoms among FMO and BMO, respectively, with no significant difference. Tenderness to palpation of the mastoid bone (64.3% vs 38.9%; p=0.02) and stenosis of the external auditory canal (92.9% vs 72.2%; p=0.02) were significantly more frequent among FMO cases. Complications were significantly more frequent among FMO cases (42.9% vs 9.3%; p< 0.001). Treatment duration was significantly longer among FMO cases (70[40-90] days vs 45[34-75] days; p=0.03). Conclusion Our study showed that FMO affected more frequently the elderly and diabetic patients, when compared with BMO. Regardless of the causative agent, the clinical presentation was similar. However, the outcome was poor among FMO cases with the occurrence of complications, requiring a longer duration of treatment. Disclosures All Authors: No reported disclosures

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Retraction: Multi-country Study on the Prevalence and Clinical Features of Peripheral Arterial Disease in Type 2 Diabetic Patients Who are at High Risk for Atherosclerosis

Journal of Korean Endocrine Society ◽

10.3803/jkes.2007.22.6.478 ◽

2007 ◽

Vol 22 (6) ◽

pp. 478

Author(s):

Sang Youl Rhee ◽

Seungjoon Oh ◽

Young-Kil Choi ◽

Doo-Man Kim ◽

Bong-Yun Cha ◽

...

Keyword(s):

High Risk ◽

Peripheral Arterial Disease ◽

Clinical Features ◽

Arterial Disease ◽

Diabetic Patients ◽

Type 2 Diabetic Patients ◽

Country Study ◽

Peripheral Arterial ◽

Type 2 Diabetic

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Clinical features in insulin-treated diabetes with comorbid diabulimia, disordered eating behaviors and eating disorders

European Psychiatry ◽

10.1016/j.eurpsy.2016.01.029 ◽

2016 ◽

Vol 33 (S1) ◽

pp. S81-S81

Author(s):

V. Deiana ◽

E. Diana ◽

F. Pinna ◽

M.G. Atzeni ◽

F. Medda ◽

...

Keyword(s):

Eating Disorders ◽

Disordered Eating ◽

Clinical Features ◽

Eating Behaviors ◽

Blood Glucose Control ◽

Diabetic Patients ◽

Disordered Eating Behaviors ◽

Dsm 5 ◽

Combining Data ◽

Diet Pills

Adherence to self-management and medication regimens is required to achieve blood glucose control in diabetic patients. Therefore, diabulimia, the deliberate insulin restriction/omission to lose weight, and other disordered eating behaviors (DEBs) or eating disorders (EDs), place these patients at risk of complications.We aimed to establish the frequency of diabulimia, DEBs and EDs among patients with type 1 and 2 diabetes (T1DM and T2DM) and their association with other clinical features.A total of 211 insulin-treated diabetic patients (13–55 years old) answered the Diabetes Eating Problem Survey-Revised (DEPS-R), a diabetes-specific screening tool for DEBs, and the Eating Disorders Inventory-3 (EDI-3). SCID-I modified according to DSM-5 criteria was used to diagnose EDs.At the DEPS-R, 20.8% of the sample scored above the cutoff, more frequently females (P = 0.005), patients with T1DM (P = 0.045), with a diagnosis of ED (P < 0.001), positive to the EDI-3 (P ≤ 0.001), with physical comorbidities (P = 0.003), with HbA1c > 7% (P = 0.020). Combining data from the interview with the results at the DEPS-R, 60.2% of the sample presented diabulimia. Dividing the sample by gender, we found that diabulimic females more frequently used diet pills (P = 0.006), had significantly higher HbA1c (P = 0.019) and STAI-Y1 scores (P = 0.004). Other DEBs comprised dietary restraint (51.8% of the sample), binge eating (42.2%), vomiting (6.2%), diet pills (7.1%) or laxatives (1.9%) or diuretics use (4.3%). Overall, 21.8% of the sample, mostly females (P < 0.001) met criteria for at least one DSM-5 diagnosis of ED.Diabetic patients, especially women, should be carefully monitored for the presence of diabulimia, BEDs and EDs.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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