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Yan P, Chen J, Wang H, Jia Q, Xie J, Mo G. A systemic infection involved in lung, brain and spine caused by Scedosporium apiospermum species complex after near-drowning: a case report and literature review. BMC Infect Dis 2024; 24:342. [PMID: 38515075 PMCID: PMC10956195 DOI: 10.1186/s12879-023-08279-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 04/25/2023] [Indexed: 03/23/2024] Open
Abstract
Scedosporium apiospermum species complex are widely distributed fungi that can be found in a variety of polluted environments, including soil, sewage, and decaying vegetation. Those opportunistic pathogens with strong potential of invasion commonly affect immunosuppressed populations However, few cases of scedosporiosis are reported in immunocompetent individuals, who might be misdiagnosed, leading to a high mortality rate. Here, we reported an immunocompetent case of systemtic infection involved in lung, brain and spine, caused by S. apiospermum species complex (S. apiospermum and S. boydii). The patient was an elderly male with persistent fever and systemtic infection after near-drowning. In the two tertiary hospitals he visited, definite diagnosis was extremely difficult. After being admitted to our hospital, he was misdiagnosed as tuberculosis infection, before diagnosis of S. apiospermum species complex infection by the metagenomic next-generation sequencing. His symptoms were alleviated after voriconazole treatment. In the present case, the details associated with its course were reported and published studies on Scedosporium spp. infection were also reviewed, for a better understanding of this disease and reducing the misdiagnosis rate.
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Affiliation(s)
- Peng Yan
- College of Pulmonary and Critical Care Medicine, Chinese People's Liberation Army General Hospital, No. 17, Heishanhu Road, Haidian District, Beijing, 100091, China
- China Aerospace Science & Industry Corporation 731 Hospital, Beijing, China
| | - Junfeng Chen
- College of Pulmonary and Critical Care Medicine, Chinese People's Liberation Army General Hospital, No. 17, Heishanhu Road, Haidian District, Beijing, 100091, China
- The Fifth People's Hospital of Zunyi City, Zunyi City, Guizhou Province, China
| | - Haodi Wang
- Vision Medicals for Infection Diseases, Guangzhou, Guangdong, China
| | - Qi Jia
- Vision Medicals for Infection Diseases, Guangzhou, Guangdong, China
| | - Jungang Xie
- Pulmonary and Critical Care Medicine, Tongji Hospital Affiliated to Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Ave., Wuhan, Hubei, China.
| | - Guoxin Mo
- College of Pulmonary and Critical Care Medicine, Chinese People's Liberation Army General Hospital, No. 17, Heishanhu Road, Haidian District, Beijing, 100091, China.
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Salah H, Houbraken J, Boekhout T, Almaslamani M, Taj-Aldeen SJ. Molecular epidemiology of clinical filamentous fungi in Qatar beyond Aspergillus and Fusarium with notes on the rare species. Med Mycol 2023; 61:6967136. [PMID: 36592959 PMCID: PMC9874029 DOI: 10.1093/mmy/myac098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 12/12/2022] [Accepted: 12/30/2022] [Indexed: 01/04/2023] Open
Abstract
Due to an increasing number of patients at risk (i.e., those with a highly compromised immune system and/or receiving aggressive chemotherapy treatment), invasive fungal infections (IFI) are increasingly being reported and associated with high mortality rates. Aspergillus spp., particularly A. fumigatus, is the major cause of IFI caused by filamentous fungi around the world followed by Fusarium spp., however, other fungi are emerging as human pathogens. The aim of this study was to explore the epidemiology and prevalence of the non-Aspergillus and non-Fusarium filamentous fungi in human clinical samples over an 11-year period in Qatar using molecular techniques. We recovered 53 filamentous fungal isolates from patients with various clinical conditions. Most patients were males (75.5%), 9.4% were immunocompromised, 20.7% had IFI, and 11.3% died within 30 days of diagnosis. The fungal isolates were recovered from a variety of clinical samples, including the nasal cavity, wounds, respiratory samples, body fluids, eye, ear, tissue, abscess, and blood specimens. Among the fungi isolated, 49% were dematiaceous fungi, followed by Mucorales (30%), with the latter group Mucorales being the major cause of IFI (5/11, 45.5%). The current study highlights the epidemiology and spectrum of filamentous fungal genera, other than Aspergillus and Fusarium, recovered from human clinical samples in Qatar, excluding superficial infections, which can aid in the surveillance of uncommon and emerging mycoses.
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Affiliation(s)
- Husam Salah
- To whom correspondence should be addressed. Husam Salah, M.Sc. Division
of Microbiology, Department of Laboratory Medicine and Pathology, Hamad Medical
Corporation, Doha, Qatar, PO Box 3050. Tel: +97-444-391-047. E-mail: ;
| | - Jos Houbraken
- Applied and Industrial Mycology, Westerdijk Fungal Biodiversity
Institute, Utrecht, Netherlands
| | - Teun Boekhout
- Yeast Research, Westerdijk Fungal Biodiversity Institute,
Utrecht, Netherlands,Institute of Biodiversity and Ecosystem Dynamics (IBED), University of
Amsterdam, Amsterdam, The
Netherlands
| | | | - Saad J Taj-Aldeen
- Division of Microbiology, Department of Laboratory Medicine and
Pathology, Hamad Medical Corporation, Doha,
Qatar,Department of Biology, College of Science, University of
Babylon, Hilla, Iraq
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Seidel D, Meißner A, Lackner M, Piepenbrock E, Salmanton-García J, Stecher M, Mellinghoff S, Hamprecht A, Durán Graeff L, Köhler P, Cheng MP, Denis J, Chedotal I, Chander J, Pakstis DL, Los-Arcos I, Slavin M, Montagna MT, Caggiano G, Mares M, Trauth J, Aurbach U, Vehreschild MJGT, Vehreschild JJ, Duarte RF, Herbrecht R, Wisplinghoff H, Cornely OA. Prognostic factors in 264 adults with invasive Scedosporium spp. and Lomentospora prolificans infection reported in the literature and FungiScope®. Crit Rev Microbiol 2019; 45:1-21. [DOI: 10.1080/1040841x.2018.1514366] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Danila Seidel
- Department I of Internal Medicine, University Hospital of Cologne, Cologne, Germany
- Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), University of Cologne, Cologne, Germany
| | - Arne Meißner
- Department I of Internal Medicine, University Hospital of Cologne, Cologne, Germany
- Department of Hospital Hygiene and Infection Control, University Hospital Cologne, Cologne, Germany
| | - Michaela Lackner
- Division of Hygiene and Medical Microbiology, Medical University of Innsbruck (MUI), Innsbruck, Austria
| | - Ellen Piepenbrock
- Department of Immunology and Hygiene, Institute for Medical Microbiology, University of Cologne, Cologne, Germany
| | - Jon Salmanton-García
- Department I of Internal Medicine, University Hospital of Cologne, Cologne, Germany
| | - Melanie Stecher
- Department I of Internal Medicine, University Hospital of Cologne, Cologne, Germany
- Partner site Bonn - Cologne, German Centre for Infection Research (DZIF), Cologne, Germany
| | - Sibylle Mellinghoff
- Department I of Internal Medicine, University Hospital of Cologne, Cologne, Germany
| | - Axel Hamprecht
- Division of Hygiene and Medical Microbiology, Medical University of Innsbruck (MUI), Innsbruck, Austria
| | - Luisa Durán Graeff
- Department I of Internal Medicine, University Hospital of Cologne, Cologne, Germany
| | - Philipp Köhler
- Department I of Internal Medicine, University Hospital of Cologne, Cologne, Germany
- Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), University of Cologne, Cologne, Germany
- Partner site Bonn - Cologne, German Centre for Infection Research (DZIF), Cologne, Germany
| | - Matthew P. Cheng
- Division of Infectious Diseases and Department of Medical Microbiology, McGill University Health Centre, Montreal, Canada
| | - Julie Denis
- Hôpitaux Universitaires, Department of Parasitology and Mycology, Plateau Technique de Microbiologie, FMTS, Université de Strasbourg, Strasbourg, France
| | - Isabelle Chedotal
- Oncology and Hematology Department, University Hospital of Strasbourg and INSERM U1113, Strasbourg, France
| | - Jagdish Chander
- Department of Microbiology, Government Medical College Hospital, Chandigarh, India
| | | | - Ibai Los-Arcos
- Infectious Diseases Department, Hospital Universitari Vall d’Hebron, Barcelona, Spain
| | - Monica Slavin
- University of Melbourne, Melbourne, Australia, The National Centre for Infections in Cancer, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Maria Teresa Montagna
- Department of Biomedical Sciences and Human Oncology, University of Bari Aldo Moro, Bari, Italy
| | - Giuseppina Caggiano
- Department of Biomedical Sciences and Human Oncology, University of Bari Aldo Moro, Bari, Italy
| | - Mihai Mares
- Laboratory of Antimicrobial Chemotherapy, Ion Ionescu de la Brad University, Iași, Romania
| | - Janina Trauth
- Medical Clinic II – Infectious Diseases, University Hospital Giessen/Marburg, Giessen, Germany
| | - Ute Aurbach
- Laboratory Dr. Wisplinghoff, Cologne, Germany
| | - Maria J. G. T. Vehreschild
- Department I of Internal Medicine, University Hospital of Cologne, Cologne, Germany
- Partner site Bonn - Cologne, German Centre for Infection Research (DZIF), Cologne, Germany
- Center for Integrated Oncology CIO Köln/Bonn, Medical Faculty, University of Cologne, Cologne, Germany
| | - Jörg Janne Vehreschild
- Department I of Internal Medicine, University Hospital of Cologne, Cologne, Germany
- Partner site Bonn - Cologne, German Centre for Infection Research (DZIF), Cologne, Germany
- Center for Integrated Oncology CIO Köln/Bonn, Medical Faculty, University of Cologne, Cologne, Germany
| | - Rafael F. Duarte
- Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | - Raoul Herbrecht
- Oncology and Hematology Department, University Hospital of Strasbourg and INSERM U1113, Strasbourg, France
| | - Hilmar Wisplinghoff
- Department of Immunology and Hygiene, Institute for Medical Microbiology, University of Cologne, Cologne, Germany
- Laboratory Dr. Wisplinghoff, Cologne, Germany
- Institute for Virology and Clinical Microbiology, Witten/Herdecke University, Witten, Germany
| | - Oliver A. Cornely
- Department I of Internal Medicine, University Hospital of Cologne, Cologne, Germany
- Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), University of Cologne, Cologne, Germany
- Partner site Bonn - Cologne, German Centre for Infection Research (DZIF), Cologne, Germany
- Center for Integrated Oncology CIO Köln/Bonn, Medical Faculty, University of Cologne, Cologne, Germany
- Clinical Trials Centre Cologne (ZKS Köln), University of Cologne, Cologne, Germany
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Abstract
Scedosporium species are now increasingly isolated from immunocompromised and immunocompetent patients. Unfortunately, Scedosporium species infections are generally resistant to amphotericin B, and S. prolificans strains are particularly resistant to presently-available antifungal agents. Here we review the microbiology, expanding epidemiology, numerous clinical presentations, and diagnostic tools available for Scedosporium species infections. Finally, we detail the available in vitro, animal model, and clinical data on the treatment of Scedosporium species infections with special emphasis on the role of newer antifungal therapies for these recalcitrant infections.
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Affiliation(s)
- W J Steinbach
- Department of Pediatrics, Duke University, Durham, NC 27710, USA.
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Vitrat-Hincky V, Lebeau B, Bozonnet E, Falcon D, Pradel P, Faure O, Aubert A, Piolat C, Grillot R, Pelloux H. Severe filamentous fungal infections after widespread tissue damage due to traumatic injury: six cases and review of the literature. ACTA ACUST UNITED AC 2010; 41:491-500. [PMID: 19353426 DOI: 10.1080/00365540902856537] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
We describe 6 cases of severe filamentous fungal infections after widespread tissue damage due to traumatic injury in previously healthy people. Additionally, we report 69 cases from an exhaustive 20-y review of the literature to investigate the epidemiological and clinical features, the prognosis and the therapeutic management of these post-traumatic severe filamentous fungal infections. Traffic (41%) and farm accidents (25%) were the main causes of injury, which involved either the limbs only (41%) or multiple sites (41%). Necrosis was the main symptom (60%) and Mucorales (72%) and Aspergillus (11%) were the 2 most frequent fungi causing infection. These infections required substantial surgical debridement or amputation (96%) associated with aggressive antifungal therapy (81%), depending on the responsible fungi. This study underlines the need for early, repeated and systematic mycological wound samples to guide and adapt surgical and antifungal management in these filamentous fungal infections.
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Kantarcioglu AS, Guarro J, de Hoog GS. Central nervous system infections by members of the Pseudallescheria boydii species complex in healthy and immunocompromised hosts: epidemiology, clinical characteristics and outcome. Mycoses 2008; 51:275-90. [DOI: 10.1111/j.1439-0507.2008.01489.x] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Abstract
Scedosporium spp. are increasingly recognized as causes of resistant life-threatening infections in immunocompromised patients. Scedosporium spp. also cause a wide spectrum of conditions, including mycetoma, saprobic involvement and colonization of the airways, sinopulmonary infections, extrapulmonary localized infections, and disseminated infections. Invasive scedosporium infections are also associated with central nervous infection following near-drowning accidents. The most common sites of infection are the lungs, sinuses, bones, joints, eyes, and brain. Scedosporium apiospermum and Scedosporium prolificans are the two principal medically important species of this genus. Pseudallescheria boydii, the teleomorph of S. apiospermum, is recognized by the presence of cleistothecia. Recent advances in molecular taxonomy have advanced the understanding of the genus Scedosporium and have demonstrated a wider range of species than heretofore recognized. Studies of the pathogenesis of and immune response to Scedosporium spp. underscore the importance of innate host defenses in protection against these organisms. Microbiological diagnosis of Scedosporium spp. currently depends upon culture and morphological characterization. Molecular tools for clinical microbiological detection of Scedosporium spp. are currently investigational. Infections caused by S. apiospermum and P. boydii in patients and animals may respond to antifungal triazoles. By comparison, infections caused by S. prolificans seldom respond to medical therapy alone. Surgery and reversal of immunosuppression may be the only effective therapeutic options for infections caused by S. prolificans.
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Kooijman CM, Kampinga GA, Sybren de Hoog G, Goudswaard WB, Reijnen MM. Successful Treatment ofScedosporium aurantiacumOsteomyelitis in an Immunocompetent Patient. Surg Infect (Larchmt) 2007; 8:605-10. [DOI: 10.1089/sur.2006.038] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Affiliation(s)
- Carolien M. Kooijman
- Medical Center Leeuwarden, Department of Surgery, Leeuwarden, The Netherlands
- University Medical Center Groningen, Groningen, The Netherlands
| | - Greetje A. Kampinga
- Public Health Laboratory Friesland, Department of Medical Microbiology, Leeuwarden, The Netherlands
- University Medical Center Groningen, Groningen, The Netherlands
| | | | | | - Michel M.P.J. Reijnen
- Medical Center Leeuwarden, Department of Surgery, Leeuwarden, The Netherlands
- Alysis zorggroep, Rijnstate, Department of Surgery, Arnhem, The Netherlands
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Guarro J, Kantarcioglu AS, Horré R, Rodriguez-Tudela JL, Cuenca Estrella M, Berenguer J, de Hoog GS. Scedosporium apiospermum: changing clinical spectrum of a therapy-refractory opportunist*. Med Mycol 2006; 44:295-327. [PMID: 16772225 DOI: 10.1080/13693780600752507] [Citation(s) in RCA: 225] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Current knowledge on the opportunist Scedosporium apiospermum (teleomorph: Pseudallescheria boydii), generated over a period of more than 120 years, is reviewed. The natural environmental habitat of the fungus is unknown; nutrient-rich, brackish waters like river estuaria have been suggested. The fungus is strongly promoted by agricultural and particularly by industrial pollution.
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Affiliation(s)
- Josep Guarro
- Unitat de Microbiologia, Facultat de Medicina i Ciències de la Salut, Universitat Rovira i Virgili, Spain
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Husain S, Muñoz P, Forrest G, Alexander BD, Somani J, Brennan K, Wagener MM, Singh N. Infections Due to Scedosporium apiospermum and Scedosporium prolificans in Transplant Recipients: Clinical Characteristics and Impact of Antifungal Agent Therapy on Outcome. Clin Infect Dis 2005; 40:89-99. [PMID: 15614697 DOI: 10.1086/426445] [Citation(s) in RCA: 269] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2004] [Accepted: 09/01/2004] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Unique characteristics, impact of therapy with antifungal agents, and outcome of infections with Scedosporium species were assessed in transplant recipients. METHODS The patients comprised a total of 80 transplant recipients with Scedosporium infections, including 13 patients from our institutions (University of Pittsburgh Medical Center [Pittsburgh, PA], University of Maryland [Baltimore], Duke University Medical Center [Durham, NC], Emory University [Atlanta, GA], and Hospital Gregorio Maranon [Madrid, Spain]) and 67 reported in the literature. The transplant recipients were compared with 190 non-transplant recipients with scedosporiosis who were described in the literature. RESULTS Overall, 69% of the infections in hematopoietic stem cell transplant (HSCT) recipients and 53% of the infections in organ transplant recipients were disseminated. HSCT recipients, compared with organ transplant recipients, were more likely to have infections caused by Scedosporium prolificans (P=.045), to have an earlier onset of infection (P=.007), to be neutropenic (P<.0001), and to have fungemia (P=.04). Time elapsed from transplantation to Scedosporium infection in transplant recipients has increased in recent years (P=.002). The mortality rate among transplant recipients with scedosporiosis was 58%. In a logistic regression model using amphotericin B as comparison treatment, voriconazole was associated with a trend towards better survival (odds ratio [OR], 10.40; P=.08). Presence of disseminated infection (OR, 0.20; P=.03) predicted lower survival, and receipt of adjunctive surgery as treatment (OR, 5.52; P=.02) independently predicted a better survival in this model. CONCLUSIONS Scedosporium infections in transplant recipients were associated with a high rate of dissemination and a poor outcome overall. The use of newer triazole agents warrants consideration as a therapeutic modality for these infections.
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Affiliation(s)
- Shahid Husain
- University of Pittsburgh Medical Center, Pittsburgh, PA, USA
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Shand JM, Albrecht RM, Burnett HF, Miyake A. Invasive fungal infection of the midfacial and orbital complex due to Scedosporium apiospermum and mucormycosis. J Oral Maxillofac Surg 2004; 62:231-4. [PMID: 14762757 DOI: 10.1016/j.joms.2003.04.013] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Jocelyn M Shand
- Oral and Macillofacial Surgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73190, USA
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Bouza E, Muñoz P. Invasive infections caused by Blastoschizomyces capitatus and Scedosporium spp. Clin Microbiol Infect 2004; 10 Suppl 1:76-85. [PMID: 14748804 DOI: 10.1111/j.1470-9465.2004.00842.x] [Citation(s) in RCA: 68] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Blastoschizomyces capitatus, Scedosporium prolificans and S. apiospermum are emerging fungal pathogens that may cause disseminated disease in neutropenic patients. They can present as fever resistant to antibiotics and to wide-spectrum antifungal agents, although they may involve almost every organ. The proportion of recovery from blood cultures is high and they are characteristically resistant to most antifungal agents. Prognosis is poor unless patients recover from neutropenia. Voriconazole has good in-vitro activity and is currently the drug of choice for these infections.
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Affiliation(s)
- E Bouza
- Servicio de Microbiología Clínica y E. Infecciosas, Hospital General Universitario Gregorio Marañón, Universidad Complutense, Madrid, Spain.
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