Otitis externa laboratory findings: Difference between revisions

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{{Otitis externa}}
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==Overview==  
==Overview==
Laboratory findings consistent with diagnosis of all forms of otitis externa include evidence of [[bacterial]] or [[fungal]] infection. Findings may also include markers of [[inflammation]] such as an elevated [[erythrocyte sedimentation rate]], [[C-reactive protein]], and elevated [[white blood cell]] count.


==Laboratory Findings==
==Laboratory Findings==
Laboratory findings will vary based on the suspected source of otitis externa.
===Bacterial===
Otitis externa from a suspected [[bacterial]] infection may be determined by the following tests:
*Culture of the [[ear canal]] to determine if the infection is caused by ''[[Pseudomonas aeruginosa]]'' or ''[[Staphylococcus aureus]]''.<ref name="LlorMcNulty2014">{{cite journal|last1=Llor|first1=C.|last2=McNulty|first2=C. A. M.|last3=Butler|first3=C. C.|title=Ordering and interpreting ear swabs in otitis externa|journal=BMJ|volume=349|issue=sep01 2|year=2014|pages=g5259–g5259|issn=1756-1833|doi=10.1136/bmj.g5259}}</ref>
***This test will be performed in the event that the symptoms do not resolve with the treatment and the otitis externa becomes recurrent.
*[[Gram stain]] test: If the cause is determined to be [[bacterial]], the gram-stain test will determine whether the cause is ''[[Psuedomonas aeruginosa]]'' (Gram negative) or ''[[Staphylococcus aureus]]'' (Gram positive):<ref name="pmid11475313">{{cite journal |vauthors=Beveridge TJ |title=Use of the gram stain in microbiology |journal=Biotech Histochem |volume=76 |issue=3 |pages=111–8 |year=2001 |pmid=11475313 |doi= |url=}}</ref>
*[[Polymerase chain reaction|Real-time polymerase chain reaction]] to detect and determine the exact [[bacterial]] pathogen<ref name="pmid7986047">{{cite journal |vauthors=Khan AA, Cerniglia CE |title=Detection of Pseudomonas aeruginosa from clinical and environmental samples by amplification of the exotoxin A gene using PCR |journal=Appl. Environ. Microbiol. |volume=60 |issue=10 |pages=3739–45 |year=1994 |pmid=7986047 |pmc=201881 |doi= |url=}}</ref><ref name="pmid1629319">{{cite journal |vauthors=Brakstad OG, Aasbakk K, Maeland JA |title=Detection of Staphylococcus aureus by polymerase chain reaction amplification of the nuc gene |journal=J. Clin. Microbiol. |volume=30 |issue=7 |pages=1654–60 |year=1992 |pmid=1629319 |pmc=265359 |doi= |url=}}</ref>


===Bacterial===
===Fungal===
*Otitis externa from a suspected [[bacterial]] infection will be determined by the following tests:
Otitis externa from a suspected [[fungal]] infection will be determined by the following tests:
**Swab of the [[ear canal]] to determine if the infection is caused by ''[[Psuedomonas aeruginosa]]'' or ''[[Staphylococcus aureus]]''.<ref name="LlorMcNulty2014">{{cite journal|last1=Llor|first1=C.|last2=McNulty|first2=C. A. M.|last3=Butler|first3=C. C.|title=Ordering and interpreting ear swabs in otitis externa|journal=BMJ|volume=349|issue=sep01 2|year=2014|pages=g5259–g5259|issn=1756-1833|doi=10.1136/bmj.g5259}}</ref>
*Culture of the [[ear canal]] to determine if the infection is caused by ''[[Aspergillus niger]]'', ''[[Aspergillus fumigatus]]'', or ''[[Candida albicans]]''<ref name="pmid10969470">{{cite journal |vauthors=Kaur R, Mittal N, Kakkar M, Aggarwal AK, Mathur MD |title=Otomycosis: a clinicomycologic study |journal=Ear Nose Throat J |volume=79 |issue=8 |pages=606–9 |year=2000 |pmid=10969470 |doi= |url=}}</ref>
***This test will be performed in the event that the symptoms do not relieve with treatment and the otitis externa becomes recurrent
**[[Immunofluorescent]] microscopy may reveal the following results:<ref name="urlAspergillus Otomycosis | Aspergillus & Aspergillosis Website">{{cite web |url=http://www.aspergillus.org.uk/content/aspergillus-otomycosis |title=Aspergillus Otomycosis &#124; Aspergillus & Aspergillosis Website |format= |work= |accessdate=}}</ref>
**[[Gram stain]] test: If the cause is determined to be [[bacterial]], the gram-stain test will determine whether the cause is ''[[Psuedomonas aeruginosa]]'' or ''[[Staphylococcus aureus]]'':<ref name="pmid11475313">{{cite journal |vauthors=Beveridge TJ |title=Use of the gram stain in microbiology |journal=Biotech Histochem |volume=76 |issue=3 |pages=111–8 |year=2001 |pmid=11475313 |doi= |url=}}</ref>
**Fungal [[hyphae]]
***Results are purple: indicates that the culture is [[gram-positive]] and is indicative of ''[[Staphylococcus aureus]]''.
**Arthrospores
***Results that are pink: indicates that the culture is [[gram-negative]] and is indicative of ''[[Psuedomonas aeruginosa]]''.
**[[Arthroconidia]]
*[[Polymerase chain reaction|Real-time polymerase chain reaction]] to detect and determine the exact [[fungal]] pathogen.<ref name="pmid9574670">{{cite journal |vauthors=Van Burik JA, Myerson D, Schreckhise RW, Bowden RA |title=Panfungal PCR assay for detection of fungal infection in human blood specimens |journal=J. Clin. Microbiol. |volume=36 |issue=5 |pages=1169–75 |year=1998 |pmid=9574670 |pmc=104793 |doi= |url=}}</ref>
 
===Common Laboratory Findings===
 
===Complete blood count===
*A [[complete blood count]] test performed on otitis externa patients may reveal abnormal  [[white blood cell]] counts.


===Inflammatory markers===
Otitis externa patients may display the following findings on inflammatory marker tests:
*[[Erythrocyte sedimentation rate]] and [[CRP]] are commonly elevated in cases of malignant necrotizing otitis externa<ref name="pmid23349563">{{cite journal |vauthors=Bovo R, Benatti A, Ciorba A, Libanore M, Borrelli M, Martini A |title=Pseudomonas and Aspergillus interaction in malignant external otitis: risk of treatment failure |journal=Acta Otorhinolaryngol Ital |volume=32 |issue=6 |pages=416–9 |year=2012 |pmid=23349563 |pmc=3552534 |doi= |url=}}</ref>


==References==
==References==
{{reflist|2}}
{{reflist|2}}


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Latest revision as of 23:29, 29 July 2020

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Luke Rusowicz-Orazem, B.S.; Tarek Nafee, M.D. [2]

Overview

Laboratory findings consistent with diagnosis of all forms of otitis externa include evidence of bacterial or fungal infection. Findings may also include markers of inflammation such as an elevated erythrocyte sedimentation rate, C-reactive protein, and elevated white blood cell count.

Laboratory Findings

Bacterial

Otitis externa from a suspected bacterial infection may be determined by the following tests:

Fungal

Otitis externa from a suspected fungal infection will be determined by the following tests:

Common Laboratory Findings

Complete blood count

Inflammatory markers

Otitis externa patients may display the following findings on inflammatory marker tests:

References

  1. ↑ Llor, C.; McNulty, C. A. M.; Butler, C. C. (2014). "Ordering and interpreting ear swabs in otitis externa". BMJ. 349 (sep01 2): g5259–g5259. doi:10.1136/bmj.g5259. ISSN 1756-1833.
  2. ↑ Beveridge TJ (2001). "Use of the gram stain in microbiology". Biotech Histochem. 76 (3): 111–8. PMID 11475313.
  3. ↑ Khan AA, Cerniglia CE (1994). "Detection of Pseudomonas aeruginosa from clinical and environmental samples by amplification of the exotoxin A gene using PCR". Appl. Environ. Microbiol. 60 (10): 3739–45. PMC 201881. PMID 7986047.
  4. ↑ Brakstad OG, Aasbakk K, Maeland JA (1992). "Detection of Staphylococcus aureus by polymerase chain reaction amplification of the nuc gene". J. Clin. Microbiol. 30 (7): 1654–60. PMC 265359. PMID 1629319.
  5. ↑ Kaur R, Mittal N, Kakkar M, Aggarwal AK, Mathur MD (2000). "Otomycosis: a clinicomycologic study". Ear Nose Throat J. 79 (8): 606–9. PMID 10969470.
  6. ↑ "Aspergillus Otomycosis | Aspergillus & Aspergillosis Website".
  7. ↑ Van Burik JA, Myerson D, Schreckhise RW, Bowden RA (1998). "Panfungal PCR assay for detection of fungal infection in human blood specimens". J. Clin. Microbiol. 36 (5): 1169–75. PMC 104793. PMID 9574670.
  8. ↑ Bovo R, Benatti A, Ciorba A, Libanore M, Borrelli M, Martini A (2012). "Pseudomonas and Aspergillus interaction in malignant external otitis: risk of treatment failure". Acta Otorhinolaryngol Ital. 32 (6): 416–9. PMC 3552534. PMID 23349563.

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