P329 A tele of fungal burden in chronic suppurative otitis media (CSOM) patients of a tertiary care center of Nepal

Abstract

Objectives: The study was designed to find out the fungal etiological agents in chronic suppurative otitis media (CSOM) patients attending the tertiary care center of Nepal. Methods: The laboratory-rooted study was performed at the Department of Clinical Microbiology. Specimen was col-lected in the ENT and Head and Neck Surgery Department of Tribhuvan University Teaching Hospital (TUTH), Nepal from February 2016 to July 2016.All clinical specimens were collected from hospitalized as well as outdoor patients having CSOM. Specimens were processed according to standard methodology. A total of 117 patients having CSOM were confirmed cases by the otolaryngologists and their 123 specimens were included in the study. Ear discharge was collected using sterile swab sticks which were labeled and sent to the laboratory for potassium hydroxide (KOH) mount and fungal culture studies. Results: A total of 123 specimens were collected and processed. Distribution of patients according to the site among the total patients (n = 117), 69 (59.0%) were specimens from the left ear, 42 (35.9%) right ear, and 6 (5.1%) from both ears (bilateral) (Table 1). The 19-30 years age group was highest (34.1%) and followed by 31-50 years having 23.6%. Occupa-tionally students were higher in number (29.9%) and it was followed by housewives (27.4%). A total of 47.8% of cases are from Kathmandu and remain from different regions of Nepal. Out of 123 specimens, 23 (18.7%) were found KOH mount positive (Table 2). The distribution of fungal isolates is as follows-among total isolates Aspergillus flavus 7, A. fumigatus 6, Acremonium 3, Candida albicans 2, Penicillium 2 A. niger 1, C. krusei 1, C. tropicalis 1, Curvularia 1, Fusarium 1, Mucor 1, and Syncephalastrum racemosum 1 (Table 3). Conclusion: The prevalence of fungi in CSOM patients was quite high (21.9%). This observation was different from the study of India conducted by Kumar et al. (15%) and in contrast with another researcher in Singapore, Loy et al. (8.8%).Aslam et al. from Pakistan study revealed only 2.1% and Khwakhali et al. study from Nepal estimated about 1.94% of the Nepalese population suffer from a serious fungal infection annually (commonly in HIV/AIDS and immunocompromised hosts) which are diluted by our findings.The possible reason may be due to location, temperature, negligence on mycological complications, and their treatment in Nepal. Treatment of CSOM should be based on the result of fungal culture. CSOM cases are found in all age groups (2-80 years) with various health statuses, different occupations, and in dispersed regions of Nepal. Phenotyping identification is cumbersome and have risk of infections which increases the chance of applying genotyping technique will be beneficial.Antifungal susceptibility testing should be mandatory sinceit helps in improving clinical outcomes by optimization of antifungal practices.Many CSOM patients complained that they were not cured even long time of use of antibacterial drugs.It clears thatfungal etiological agents can'tbe neglected.IfIamnot wrong, Nepalhas no separate designatedmycology laboratory. There is also a lack of funding for clinical fungal studies and their awareness regarding fungal pathogens.