Candida auris colonization or infection in the ear of four patients with chronic otitis externa: A case series and literature review
نویسندگان
1 Department of Microbiology, Falavarjan Branch, Islamic Azad University, Isfahan, Iran
2 Department of Medical Parasitology and Mycology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
3 Department of Otolaryngology, School of Medicine, Al-Zahra Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
4 Infectious Diseases and Tropical Medicine Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
5 Department of Medical Parasitology and Mycology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
doi
10.22034/cmm.2025.345406.1658چکیده
Background and Purpose: Candida auris, a globally emerging multidrug-resistant pathogen, was first isolated from the external ear canal of a Japanese patient. Subsequently, most cases were reported from invasive or non-ear infections, while in Iran, the increasing numbers of otologic infections as the dominant clinical form of C. auris infections are being reported.Materials and Methods: In this study, the clinical, microbiological, and outcome of 4 C. auris otomycotic cases that have been identified during our previous large-scale survey on 1,029 patients/specimens in a single center have been described alongside a literature review of C. auris cases reported till 2023 from Iran.Results: Six culture-proven C. auris cases were reported, of which, four belonged to clade V and two to clade I. Three culture negative PCR-identified cases also were documented. The clinical table of the infection in Iran where shows different clade of C. auris is differed from other countries where other clades and other clinical forms like candidemia are predominated. No case of candidemia was noted. Although fluconazole resistance was documented in 50% of the isolates, no resistance to echinocandins and amphotericin B were noted.Conclusion: This review highlights several notable points; (a) C. auris infection is a challenging condition which usually misdiagnosed or diagnosed untimely, (b) the clinical table and cladal distribution of C. auris in Iran is different from other countries, (c) cases with C. auris may provide negative culture, underscoring the importance of utilization of specific direct PCR for ruling out/in C. auris, particularly in cases with chronic otomycosis, (d) ongoing patient follow-up and antifungal susceptibility testing in patients who does do not respond to antifungal drug are recommended, (e) relying on non specific, insensitive, and time-consuming approaches such as culture, not only would postpone the detection, but it could be also misleading for the isolation of C. auris in a setting where molds are predominated.
