Bilophila wadsworthia in Ear Infections: A Report of Three Cases

During a 3-year period routine anaerobic cultures were examined for the presence of Bilophila wadsworthia. Using taurine-supplemented Bacteroides–Bile–Esculin agar for isolation, we observed three cases of complicated polybacterial ear infections where B. wadsworthia was involved. The first case involved a 69-year-old female patient presenting an otitis externa following stapedectomy where B. wadsworthia was isolated. The second patient, 30-year-old woman, with a 2-decade history of otitis and otorrhoea presented with a cholesteatoma, complicated by brain abscess formation and B. wadsworthia was isolated from the purulent ear secretion as well as from the abscess material. The third case, a 39-year-old male patient suffering from cholesteatoma presented with otorrhoea and otalgia, B. wadsworthia was isolated from purulent ear secretion. In all cases, B. wadsworthia was part of mixed aerobic–anaerobic infections. Because this species was not found in 200 ear swabs from 100 healthy volunteers and was not detectable in throat swabs or saliva from of these patients, an exogenous origin of these outer and middle ear infections as well as an infection by fecal contamination seems more probable than ascending infections from the pharynx or the ear canal.