The Pediatric Infectious Disease Journal • Volume 34, Number 7, July 2015
Wei Zhou, MD
Department of Clinical Microbiology Laboratory West China Second Hospital Sichuan University Chengdu, China
Min Shu, MD Shan Tan, MD Yu Zhu, MD Jianjun Deng, MD Qin Guo, MD Chaomin Wan, MD, PhD
Department of Pediatrics West China Second Hospital Sichuan University Chengdu, China
REFERENCES 1. Walker CL, Rudan I, Liu L, et al. Global burden of childhood pneumonia and diarrhoea. Lancet. 2013;381:1405–1416. 2. Ince OT, Yalçin SS, Yurdakök K, et al. Salmonella gastroenteritis in children (clinical characteristics and antibiotic susceptibility): comparison of the years 1995-2001 and 20022008. Turk J Pediatr. 2012;54:465–473. 3. Li Y, Xie X, Xu X, et al. Nontyphoidal salmonella infection in children with acute gastroenteritis: prevalence, serotypes, and antimicrobial resistance in Shanghai, China. Foodborne Pathog Dis. 2014;11:200–206. 4. Galanis E, Lo Fo Wong DM, Patrick ME, et al.; World Health Organization Global Salm-Surv. Web-based surveillance and global Salmonella distribution, 2000-2002. Emerg Infect Dis. 2006;12:381–388. 5. Lee HY, Su LH, Tsai MH, et al. High rate of reduced susceptibility to ciprofloxacin and ceftriaxone among nontyphoid Salmonella clinical isolates in Asia. Antimicrob Agents Chemother. 2009;53:2696–2699. 6. Allerberger F, Liesegang A, Grif K, et al. Occurrence of Salmonella enterica serovar Dublin in Austria. Wien Med Wochenschr. 2003;153:148–152. 7. Helms M, Vastrup P, Gerner-Smidt P, et al. Short and long term mortality associated with foodborne bacterial gastrointestinal infections: registry based study. BMJ. 2003;326:357. 8. Cui S, Li J, Sun Z, et al. Characterization of Salmonella enterica isolates from infants and toddlers in Wuhan, China. J Antimicrob Chemother. 2009;63:87–94.
A Rare Case of Scedosporium Otitis in an Immunocompetent Child with Tympanostomy Tubes To the Editors:
S
cedosporium apiospermum is a rare cause of infection, particularly in immunocompetent hosts. Localized infection
Letters to the Editor
with S. apiospermum can progress to cause serious sequelae such as brain abscesses and osteomyelitis. We report a rare case of S. apiospermum otomycosis in an immunocompetent 4-year-old male with chronic otorrhea and otitis media. This patient had multiple episodes of otitis media since 8 month old that were treated with several short courses of antibiotics, including oral amoxicillin, oral cefdinir, topical ciprofloxacin-dexamethasone, topical ofloxacin and topical gentamicin. Due to recurrent ear infections and conductive hearing loss, bilateral tympanostomy tubes were placed at 22 month old. These were replaced after 5 months due to persistent symptoms and displacement of the right tube. The patient continued to have intermittent right otorrhea with pruritis for the next 2 years, treated with a combination of oral and topical eardrops before being reevaluated by his otolaryngologist. He was found to have a retained tympanostomy tube in his right ear canal with large amounts of white debris that was cultured and grew Scedosporium sp. not prolificans. The retained tube was replaced with a Duravent tympanostomy tube, but the otorrhea continued. We prescribed clotrimazole topical drops to be used three times a day for 14 days due to a repeat positive culture with S. apiospermum. The isolate was susceptible to amphotericin (minimum inhibitory concentration, MIC 2 mg/mL), itraconazole (MIC 2 mg/mL), posaconazole (MIC 1 mg/ mL) and voriconazole (MIC 0.5 mg/mL). According to a telephone encounter with the patient’s mother, 2 months after the treatment visit, the patient’s symptoms of pruritis, otalgia and otorrhea resolved within the first week of antifungal therapy. Four months after this treatment course, he had an episode of otorrhea that was not cultured, but was successfully treated with ofloxacin eardrops, implying a bacterial cause. He has subsequently been free of ear infections. Otorrhea due to fungal organisms is often discovered after multiple oral and topical antibacterial medications have been used. Before a fungal ear culture was collected on our patient, he had had 10 visits with his primary care provider and 5 visits with his otolaryngologist, with multiple courses of topical antibiotics prescribed without specific cultures. Even after S. apiospermum was initially cultured, no specific therapy was provided until referral to the Infectious Disease clinic.
One other documented pediatric case of otitis externa caused by S. apiospermum in an immunocompetent 8-yearold child was successfully treated with surgical debridement and topical clotrimazole.1 The patient described had chronic otorrhea that was diagnosed as S. apiosperumum infection after surgical management and antibacterial therapy. Our case supports the use of monotherapy with topical clotrimazole for the treatment of S. apiospermum otitis externa. It also indicates that chronic otorrhea refractory to surgical and antibacterial therapy should prompt a search for atypical organisms and fungi. Although Scedosporium sp. otitis externa and media are rare in immunocompetent children, its early diagnosis and management are important to prevent severe complications.
The authors have no conflicts of interest or funding to disclose. Address for correspondence: Lemuel Ose Aigbivbalu, MD; E-mail: [email protected]. Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved. ISSN: 0891-3668/15/3407-0799 DOI: 10.1097/INF.0000000000000651
The authors have no funding or conflicts of interest to disclose. Address for correspondence: Matti Korppi, MD, PhD; E-mail: [email protected].
© 2015 Wolters Kluwer Health, Inc. All rights reserved.
ACKNOWLEDGMENTS The authors thank Bhavani Vishwanath for providing assistance with the identification of the organism.
Wei Li Adeline Koay, MBBS Chelseá Briana Johnson, BS Janak Patel, MD Lemuel Ose Aigbivbalu, MD
Department of Pediatric Infectious Disease The University of Texas Medical Branch Galveston, TX REFERENCES 1. Bhally HS, Shields C, Lin SY, et al. Otitis caused by Scedosporium apiospermum in an immunocompetent child. Int J Pediatr Otorhinolaryngol. 2004;68:975–978.
Bronchiolitis: the Disease of
Wei Zhou, MD
Department of Clinical Microbiology Laboratory West China Second Hospital Sichuan University Chengdu, China
Min Shu, MD Shan Tan, MD Yu Zhu, MD Jianjun Deng, MD Qin Guo, MD Chaomin Wan, MD, PhD
Department of Pediatrics West China Second Hospital Sichuan University Chengdu, China
REFERENCES 1. Walker CL, Rudan I, Liu L, et al. Global burden of childhood pneumonia and diarrhoea. Lancet. 2013;381:1405–1416. 2. Ince OT, Yalçin SS, Yurdakök K, et al. Salmonella gastroenteritis in children (clinical characteristics and antibiotic susceptibility): comparison of the years 1995-2001 and 20022008. Turk J Pediatr. 2012;54:465–473. 3. Li Y, Xie X, Xu X, et al. Nontyphoidal salmonella infection in children with acute gastroenteritis: prevalence, serotypes, and antimicrobial resistance in Shanghai, China. Foodborne Pathog Dis. 2014;11:200–206. 4. Galanis E, Lo Fo Wong DM, Patrick ME, et al.; World Health Organization Global Salm-Surv. Web-based surveillance and global Salmonella distribution, 2000-2002. Emerg Infect Dis. 2006;12:381–388. 5. Lee HY, Su LH, Tsai MH, et al. High rate of reduced susceptibility to ciprofloxacin and ceftriaxone among nontyphoid Salmonella clinical isolates in Asia. Antimicrob Agents Chemother. 2009;53:2696–2699. 6. Allerberger F, Liesegang A, Grif K, et al. Occurrence of Salmonella enterica serovar Dublin in Austria. Wien Med Wochenschr. 2003;153:148–152. 7. Helms M, Vastrup P, Gerner-Smidt P, et al. Short and long term mortality associated with foodborne bacterial gastrointestinal infections: registry based study. BMJ. 2003;326:357. 8. Cui S, Li J, Sun Z, et al. Characterization of Salmonella enterica isolates from infants and toddlers in Wuhan, China. J Antimicrob Chemother. 2009;63:87–94.
A Rare Case of Scedosporium Otitis in an Immunocompetent Child with Tympanostomy Tubes To the Editors:
S
cedosporium apiospermum is a rare cause of infection, particularly in immunocompetent hosts. Localized infection
Letters to the Editor
with S. apiospermum can progress to cause serious sequelae such as brain abscesses and osteomyelitis. We report a rare case of S. apiospermum otomycosis in an immunocompetent 4-year-old male with chronic otorrhea and otitis media. This patient had multiple episodes of otitis media since 8 month old that were treated with several short courses of antibiotics, including oral amoxicillin, oral cefdinir, topical ciprofloxacin-dexamethasone, topical ofloxacin and topical gentamicin. Due to recurrent ear infections and conductive hearing loss, bilateral tympanostomy tubes were placed at 22 month old. These were replaced after 5 months due to persistent symptoms and displacement of the right tube. The patient continued to have intermittent right otorrhea with pruritis for the next 2 years, treated with a combination of oral and topical eardrops before being reevaluated by his otolaryngologist. He was found to have a retained tympanostomy tube in his right ear canal with large amounts of white debris that was cultured and grew Scedosporium sp. not prolificans. The retained tube was replaced with a Duravent tympanostomy tube, but the otorrhea continued. We prescribed clotrimazole topical drops to be used three times a day for 14 days due to a repeat positive culture with S. apiospermum. The isolate was susceptible to amphotericin (minimum inhibitory concentration, MIC 2 mg/mL), itraconazole (MIC 2 mg/mL), posaconazole (MIC 1 mg/ mL) and voriconazole (MIC 0.5 mg/mL). According to a telephone encounter with the patient’s mother, 2 months after the treatment visit, the patient’s symptoms of pruritis, otalgia and otorrhea resolved within the first week of antifungal therapy. Four months after this treatment course, he had an episode of otorrhea that was not cultured, but was successfully treated with ofloxacin eardrops, implying a bacterial cause. He has subsequently been free of ear infections. Otorrhea due to fungal organisms is often discovered after multiple oral and topical antibacterial medications have been used. Before a fungal ear culture was collected on our patient, he had had 10 visits with his primary care provider and 5 visits with his otolaryngologist, with multiple courses of topical antibiotics prescribed without specific cultures. Even after S. apiospermum was initially cultured, no specific therapy was provided until referral to the Infectious Disease clinic.
One other documented pediatric case of otitis externa caused by S. apiospermum in an immunocompetent 8-yearold child was successfully treated with surgical debridement and topical clotrimazole.1 The patient described had chronic otorrhea that was diagnosed as S. apiosperumum infection after surgical management and antibacterial therapy. Our case supports the use of monotherapy with topical clotrimazole for the treatment of S. apiospermum otitis externa. It also indicates that chronic otorrhea refractory to surgical and antibacterial therapy should prompt a search for atypical organisms and fungi. Although Scedosporium sp. otitis externa and media are rare in immunocompetent children, its early diagnosis and management are important to prevent severe complications.
The authors have no conflicts of interest or funding to disclose. Address for correspondence: Lemuel Ose Aigbivbalu, MD; E-mail: [email protected]. Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved. ISSN: 0891-3668/15/3407-0799 DOI: 10.1097/INF.0000000000000651
The authors have no funding or conflicts of interest to disclose. Address for correspondence: Matti Korppi, MD, PhD; E-mail: [email protected].
© 2015 Wolters Kluwer Health, Inc. All rights reserved.
ACKNOWLEDGMENTS The authors thank Bhavani Vishwanath for providing assistance with the identification of the organism.
Wei Li Adeline Koay, MBBS Chelseá Briana Johnson, BS Janak Patel, MD Lemuel Ose Aigbivbalu, MD
Department of Pediatric Infectious Disease The University of Texas Medical Branch Galveston, TX REFERENCES 1. Bhally HS, Shields C, Lin SY, et al. Otitis caused by Scedosporium apiospermum in an immunocompetent child. Int J Pediatr Otorhinolaryngol. 2004;68:975–978.
Bronchiolitis: the Disease of
