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Madaan K, Bari VK. Emerging Role of Sphingolipids in Amphotericin B Drug Resistance. Microb Drug Resist 2023. [PMID: 37327022 DOI: 10.1089/mdr.2022.0353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/17/2023] Open
Abstract
Invasive fungal infections in humans are common in people with compromised immune systems and are difficult to treat, resulting in high mortality. Amphotericin B (AmB) is one of the main antifungal drugs available to treat these infections. AmB binds with plasma membrane ergosterol, causing leakage of cellular ions and promoting cell death. The increasing use of available antifungal drugs to combat pathogenic fungal infections has led to the development of drug resistance. AmB resistance is not very common and is usually caused by changes in the amount or type of ergosterol or changes in the cell wall. Intrinsic AmB resistance occurs in the absence of AmB exposure, whereas acquired AmB resistance can develop during treatment. However, clinical resistance arises due to treatment failure with AmB and depends on multiple factors such as the pharmacokinetics of AmB, infectious fungal species, and host immune status. Candida albicans is a common opportunistic pathogen that can cause superficial infections of the skin and mucosal surfaces, thrush, to life-threatening systemic or invasive infections. In addition, immunocompromised individuals are more susceptible to systemic infections caused by Candida, Aspergillus, and Cryptococcus. Several antifungal drugs with different modes of action are used to treat systemic to invasive fungal infections and are approved for clinical use in the treatment of fungal diseases. However, C. albicans can develop a variety of defenses against antifungal medications. In fungi, plasma membrane sphingolipid molecules could interact with ergosterol, which can lead to the alteration of drug susceptibilities such as AmB. In this review, we mainly summarize the role of sphingolipid molecules and their regulators in AmB resistance.
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Affiliation(s)
- Kashish Madaan
- Department of Biochemistry, School of Basic Sciences, Central University of Punjab, Bathinda, India
| | - Vinay Kumar Bari
- Department of Biochemistry, School of Basic Sciences, Central University of Punjab, Bathinda, India
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Agarwal R, Singh M, Chawla R, Kumar GD, Mishra A, Jain S. Localized cutaneous infection caused by Scedosporium apiospermum: Report of a case diagnosed on cytology. Diagn Cytopathol 2020; 49:E187-E189. [PMID: 33074579 DOI: 10.1002/dc.24643] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 08/14/2020] [Accepted: 10/06/2020] [Indexed: 02/02/2023]
Abstract
Scedosporium apiospermum (also known as Pseudallescheria boydii) is a ubiquitous filamentous fungus. This fungus is known as a cause of mycetoma, which may occur in a normal immune host following trauma and nonmycetoma-localized skin infections without grain production which are much rarer. However, in an immunocompromised host, S. apiospermum may cause a life-threatening infection. We describe a case of S. apiospermum infection of the left middle finger in an immunocompetent patient, which was diagnosed on cytology and later confirmed on culture.
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Affiliation(s)
- Radhika Agarwal
- Department of Pathology, Microbiology and Surgery, Maulana Azad Medical College and Lok Nayak Hospital, New Delhi, India
| | - Meeta Singh
- Department of Pathology, Microbiology and Surgery, Maulana Azad Medical College and Lok Nayak Hospital, New Delhi, India
| | - Rohit Chawla
- Department of Pathology, Microbiology and Surgery, Maulana Azad Medical College and Lok Nayak Hospital, New Delhi, India
| | - Guddanti D Kumar
- Department of Pathology, Microbiology and Surgery, Maulana Azad Medical College and Lok Nayak Hospital, New Delhi, India
| | - Anurag Mishra
- Department of Pathology, Microbiology and Surgery, Maulana Azad Medical College and Lok Nayak Hospital, New Delhi, India
| | - Shyama Jain
- Department of Pathology, Microbiology and Surgery, Maulana Azad Medical College and Lok Nayak Hospital, New Delhi, India
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Chandorkar A, Simkins J. Emerging Fungal Cutaneous Infections in Immunocompromised Patients. Curr Fungal Infect Rep 2020. [DOI: 10.1007/s12281-020-00395-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Tóth EJ, Nagy GR, Homa M, Ábrók M, Kiss IÉ, Nagy G, Bata-Csörgő Z, Kemény L, Urbán E, Vágvölgyi C, Papp T. Recurrent Scedosporium apiospermum mycetoma successfully treated by surgical excision and terbinafine treatment: a case report and review of the literature. Ann Clin Microbiol Antimicrob 2017; 16:31. [PMID: 28410611 PMCID: PMC5391591 DOI: 10.1186/s12941-017-0195-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2017] [Accepted: 03/21/2017] [Indexed: 12/12/2022] Open
Abstract
Background Scedosporium apiospermum is an emerging opportunistic filamentous fungus, which is notorious for its high levels of antifungal-resistance. It is able to cause localized cutaneous or subcutaneous infections in both immunocompromised and immunocompetent persons, pulmonary infections in patients with predisposing pulmonary diseases and invasive mycoses in immunocompromised patients. Subcutaneous infections caused by this fungus frequently show chronic mycetomatous manifestation. Case report We report the case of a 70-year-old immunocompromised man, who developed a fungal mycetomatous infection on his right leg. There was no history of trauma; the aetiological agent was identified by microscopic examination and ITS sequencing. This is the second reported case of S. apiospermum subcutaneous infections in Hungary, which was successfully treated by surgical excision and terbinafine treatment. After 7 months, the patient remained asymptomatic. Considering the antifungal susceptibility and increasing incidence of the fungus, Scedosporium related subcutaneous infections reported in the past quarter of century in European countries were also reviewed. Conclusions Corticosteroid treatment represents a serious risk factor of S. apiospermum infections, especially if the patient get in touch with manure-enriched or polluted soil or water. Such infections have emerged several times in European countries in the past decades. The presented data suggest that besides the commonly applied voriconazole, terbinafine may be an alternative for the therapy of mycetomatous Scedosporium infections.
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Affiliation(s)
- Eszter J Tóth
- MTA-SZTE "Lendület" Fungal Pathogenicity Mechanisms Research Group, Hungarian Academy of Sciences, University of Szeged, Közép fasor 52, Szeged, 6726, Hungary.,Department of Microbiology, Faculty of Science and Informatics, University of Szeged, Közép fasor 52, Szeged, 6726, Hungary
| | - Géza R Nagy
- Department of Dermatology and Allergology, Albert Szent-Györgyi Medical Centre, University of Szeged, Szeged, Hungary
| | - Mónika Homa
- MTA-SZTE "Lendület" Fungal Pathogenicity Mechanisms Research Group, Hungarian Academy of Sciences, University of Szeged, Közép fasor 52, Szeged, 6726, Hungary.,Department of Microbiology, Faculty of Science and Informatics, University of Szeged, Közép fasor 52, Szeged, 6726, Hungary
| | - Marianna Ábrók
- Institute of Clinical Microbiology, Albert Szent-Györgyi Medical Centre, University of Szeged, Szeged, Hungary
| | - Ildikó É Kiss
- Institute of Clinical Microbiology, Albert Szent-Györgyi Medical Centre, University of Szeged, Szeged, Hungary
| | - Gábor Nagy
- MTA-SZTE "Lendület" Fungal Pathogenicity Mechanisms Research Group, Hungarian Academy of Sciences, University of Szeged, Közép fasor 52, Szeged, 6726, Hungary.,Department of Microbiology, Faculty of Science and Informatics, University of Szeged, Közép fasor 52, Szeged, 6726, Hungary
| | - Zsuzsanna Bata-Csörgő
- Department of Dermatology and Allergology, Albert Szent-Györgyi Medical Centre, University of Szeged, Szeged, Hungary
| | - Lajos Kemény
- Department of Dermatology and Allergology, Albert Szent-Györgyi Medical Centre, University of Szeged, Szeged, Hungary
| | - Edit Urbán
- Institute of Clinical Microbiology, Albert Szent-Györgyi Medical Centre, University of Szeged, Szeged, Hungary
| | - Csaba Vágvölgyi
- Department of Microbiology, Faculty of Science and Informatics, University of Szeged, Közép fasor 52, Szeged, 6726, Hungary
| | - Tamás Papp
- MTA-SZTE "Lendület" Fungal Pathogenicity Mechanisms Research Group, Hungarian Academy of Sciences, University of Szeged, Közép fasor 52, Szeged, 6726, Hungary. .,Department of Microbiology, Faculty of Science and Informatics, University of Szeged, Közép fasor 52, Szeged, 6726, Hungary.
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Aytekin S, Güder H, Göktay F, Yaşar Ş, Aker F, Aksaray S. Pyoderma gangrenosum and necrotizing fasciitis-like opportunistic invasive cutaneous fungal infection. Int J Dermatol 2016; 55:e563-5. [PMID: 27126743 DOI: 10.1111/ijd.13296] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Revised: 12/02/2015] [Accepted: 12/27/2015] [Indexed: 11/30/2022]
Affiliation(s)
- Sema Aytekin
- Department of Dermatology, Haydarpaşa Numune Training and Research Hospital, İstanbul, Turkey.
| | - Hüsna Güder
- Department of Dermatology, Haydarpaşa Numune Training and Research Hospital, İstanbul, Turkey
| | - Fatih Göktay
- Department of Dermatology, Haydarpaşa Numune Training and Research Hospital, İstanbul, Turkey
| | - Şirin Yaşar
- Department of Dermatology, Haydarpaşa Numune Training and Research Hospital, İstanbul, Turkey
| | - Fügen Aker
- Department of Pathology, Haydarpaşa Numune Training and Research Hospital, İstanbul, Turkey
| | - Sebahat Aksaray
- Department of Microbiology, Haydarpaşa Numune Training and Research Hospital, İstanbul, Turkey
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Buonfrate D, Gobbi F, Angheben A, Marocco S, Farina C, Van Den Ende J, Bisoffi Z. Autochthonous cases of mycetoma in Europe: report of two cases and review of literature. PLoS One 2014; 9:e100590. [PMID: 24963778 PMCID: PMC4070928 DOI: 10.1371/journal.pone.0100590] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2014] [Accepted: 05/17/2014] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Mycetoma is a chronic granulomatous infection involving cutaneous and subcutaneous tissues. It is endemic in tropical and subtropical areas, but sporadic cases have been reported also in countries of temperate climate. The purpose of this paper is to review the cases of mycetoma in European subjects (and presumably acquired in Europe), to give an insight in the main factors associated with this condition, and to describe two previously unpublished cases observed at our Centre. METHODS AND FINDINGS PubMed was systematically searched for case reports and case series of mycetoma in Europeans reported between 1980 and 2014, using specific search strategies. Two further cases diagnosed by the authors are described. Forty-two cases were collected. Eleven cases were caused by Scedosporium apiospermium, mainly in immunosuppressed patients from Bulgaria, Germany, the Netherlands, Portugal, Slovenia, Spain and the United Kingdom. Excluding all patients with immunosuppression, 29 cases remain. Most of them were reported from Bulgaria and in Albanian patients (all diagnosed outside Albania). In the Bulgarian case series many different micro-organisms, both bacteria and fungi, were isolated, while all the 5 cases from Albania were caused by Actinomadura spp. Other countries reporting cases were Greece, Italy and Turkey. In general, Actinomadura spp is the most frequent causative agent isolated, followed by Nocardia spp and Madurella mycetomatis. The foot was the most reported site involved. Most patients were medically treated, but unfortunately a long-term follow up (at least one year) was available only in a few cases. CONCLUSIONS Our review and our own cases suggest that Europeans without travel history can be affected by Madura foot. The lack of a surveillance system is likely to cause an underreporting of cases. Moreover, the unfamiliarity of Western doctors with this peculiar infection may cause a mismanagement, including unnecessary amputations.
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Affiliation(s)
- Dora Buonfrate
- Center for Tropical Diseases (CTD), Sacro Cuore Hospital, Negrar, Verona, Italy
- * E-mail:
| | - Federico Gobbi
- Center for Tropical Diseases (CTD), Sacro Cuore Hospital, Negrar, Verona, Italy
| | - Andrea Angheben
- Center for Tropical Diseases (CTD), Sacro Cuore Hospital, Negrar, Verona, Italy
| | - Stefania Marocco
- Center for Tropical Diseases (CTD), Sacro Cuore Hospital, Negrar, Verona, Italy
| | - Claudio Farina
- Microbiology Institute, AO Papa Giovanni XXIII, Bergamo, Italy
| | - Jef Van Den Ende
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Zeno Bisoffi
- Center for Tropical Diseases (CTD), Sacro Cuore Hospital, Negrar, Verona, Italy
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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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Nguyen CT, Raychaudhuri SP. Authors' reply. Indian J Dermatol 2013; 58:81. [PMID: 23372224 PMCID: PMC3555385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Caroline T Nguyen
- Department of Medicine, VA Medical Center Sacramento and UC Davis School of Medicine, Division of Rheumatology, Allergy and Clinical Immunology, Hospital Way, Mather, CA 95655, USA. E-mail:
| | - Siba P Raychaudhuri
- Department of Medicine, VA Medical Center Sacramento and UC Davis School of Medicine, Division of Rheumatology, Allergy and Clinical Immunology, Hospital Way, Mather, CA 95655, USA. E-mail:
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Abstract
The relevance of infections with moulds in humans is increasing. Relevant genera are Alternaria, Cladosporium, Scopulariopsis, and Fusarium. Fusarium thereby is characterized by typical makroconidia and special makroscopical features. Known as pathogen in plants the fungi can also cause intoxications and - more seldom - infections, mainly in immunosuppressed patients. Problematic are infections of the eye, which were described in users of contact lenses, they are difficult to treat. Manifestations of skin fusariosis are necroses, ulcerations, papulo-pustular skin lesions as well as abscesses and paronychia. In immuno-compromised patients, these circumscribed lesions can merge into generalized infections. Thus, systemical fusariosis is one differential diagnosis in neutropenic fever. Thereby, systemic fusariosis is often associated with generalized papular and nodular skin lesions, which tend to ulcerate. In some cases, these lesions may be surrounded by a targetoid erythema. Altogether, the prognosis of systemic fusariosis is not favourable. Thus, early diagnosis of the disease is crucial and requires especially the dermatologist as medical consultant.
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Affiliation(s)
- F Seyfarth
- Universitätsklinikum Jena, Klinik für Dermatologie und dermatologische Allergologie, Deutschland.
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Sheu R, Bricker AO, Sahi H, Mohammed TH. Pseudallescheria boydii (Scedosporium species) in 3 Lung Transplant Recipients: Computed Tomography Findings and Literature Review. J Comput Assist Tomogr 2009; 33:247-52. [DOI: 10.1097/rct.0b013e318172d629] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Cortez KJ, Roilides E, Quiroz-Telles F, Meletiadis J, Antachopoulos C, Knudsen T, Buchanan W, Milanovich J, Sutton DA, Fothergill A, Rinaldi MG, Shea YR, Zaoutis T, Kottilil S, Walsh TJ. Infections caused by Scedosporium spp. Clin Microbiol Rev 2008; 21:157-97. [PMID: 18202441 DOI: 10.1128/CMR.00039-07] [Citation(s) in RCA: 499] [Impact Index Per Article: 31.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
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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Fiorante S, Díaz Pedroche C, Martínez-Chamorro C, San Juan R, López-Medrano F, Aguado J. Infección fúngica invasiva en una paciente inmunocomprometida. Rev Clin Esp 2007; 207:573-4. [DOI: 10.1157/13111578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Bonamigo RR, Auler A, Duro KM, Cartell A. Infecção por Scedosporium apiospermum e tratamento com Voriconazol. An Bras Dermatol 2007. [DOI: 10.1590/s0365-05962007000600011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
A infecção pelo Scedosporium apiospermum pode tornar-se grave quando afeta pacientes imunodeprimidos, contexto em que diagnóstico e tratamento são geralmente difíceis. Os autores apresentam caso de paciente diabética usuária de ciclosporina, metotrexato e corticoesteróide sistêmico para o tramento de artrite reumatóide e que apresentou úlceras cutâneas pelo S. apiospermum. Após uso de itraconazol, sem sucesso, ocorreu resolução do quadro com o uso de voriconazol, nova alternativa para determinadas infecções fúngicas.
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Affiliation(s)
- Renan Rangel Bonamigo
- Universidade Federal do Rio Grande do Sul; Hospital Mãe de Deus; Fundação Faculdade Federal de Ciências Médicas, Brasil
| | - Alexandre Auler
- Hospital Mãe de Deus; Hospitalar Conceição de Porto Alegre, Brasil
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Schaenman JM, DiGiulio DB, Mirels LF, McClenny NM, Berry GJ, Fothergill AW, Rinaldi MG, Montoya JG. Scedosporium apiospermum soft tissue infection successfully treated with voriconazole: potential pitfalls in the transition from intravenous to oral therapy. J Clin Microbiol 2005; 43:973-7. [PMID: 15695722 PMCID: PMC548045 DOI: 10.1128/jcm.43.2.973-977.2005] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
An immunocompromised patient with an invasive soft tissue infection due to Scedosporium apiospermum was successfully treated with voriconazole and surgical debridement. After transition from intravenous to oral therapy, successive adjustments of the oral dose were required to achieve complete resolution. For soft tissue infections due to molds characterized by thin, septate hyphae branching at acute angles, voriconazole should be considered a first-line antifungal agent. The potential usefulness of plasma voriconazole levels for guiding optimal therapy should be investigated.
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Affiliation(s)
- Joanna M Schaenman
- Department of Medicine, Stanford University School of Medicine, 300 Pasteur Dr., Rm. S-100, Stanford, CA 94305, USA.
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Uenotsuchi T, Moroi Y, Urabe K, Tsuji G, Koga T, Matsuda T, Furue M. Cutaneous Scedosporium apiospermum Infection in an Immunocompromised Patient and a Review of the Literature. Acta Derm Venereol 2005; 85:156-9. [PMID: 15823912 DOI: 10.1080/00015550410024553] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
Scedosporium apiospermum (also known as Pseudallescheria boydii) is a ubiquitous filamentous fungus. This fungus is known as a cause of mycetoma, which may occur in a normally immune host following trauma. However, in an immunocompromised host, S. apiospermum may cause a life-threatening infection. We describe a case of S. apiospermum infection of the right hand in a patient who was receiving long-term immunosuppressants for adult Still's disease. We also review the cases of S. apiospermum infection with cutaneous manifestations reported between 1998 and 2003.
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Affiliation(s)
- Takeshi Uenotsuchi
- Department of Dermatology, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan.
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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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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Ochiai N, Shimazaki C, Uchida R, Fuchida SI, Okano A, Ashihara E, Inaba T, Fujita N, Nakagawa M. Disseminated infection due to Scedosporium apiospermum in a patient with acute myelogenous leukemia. Leuk Lymphoma 2003; 44:369-72. [PMID: 12688361 DOI: 10.1080/1042819021000029957] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
A 62-year-old man diagnosed with acute myelogenous leukemia which had developed from myelodysplastic syndrome received cytarabine and idarubicine as an induction therapy. The patient developed pneumonia and bacterial sepsis during profound neutropenia. Fever and sepsis improved by using many anti-bacterials and anti-fungals but he became febrile again and complained of severe lumbar pain. 67Ga scintigram showed abnormal uptake in the lumbar vertebra and left sternoclavicular joint, suggesting a diagnosis of discitis and osteomyelitis in the lumbar vertebra and sternoclavicular arthritis. We biopsied the site several times but culture of the biopsy specimen could not isolate any pathogens, and high fever persisted for about 10 months despite administration of various anti-bacterials and anti-fungals. Finally we inserted a catheter into the abscess at the iliopsoas muscle and Scedosporium apiospermum was isolated in the bloody pus obtained from the catheter. Itraconazole and amphotericin B were restarted, and the high fever and lumbar pain improved rapidly. The findings of S. apiospermum infection in this patient emphasizes the importance of being aware of this pathogen in patients with hematologic malignancy during the neutropenic phase.
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Affiliation(s)
- Naoya Ochiai
- Second Department of Medicine, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyoku, Kyoto 602-8566, Japan.
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Abstract
Scedosporium apiospermum, the anamorphic form of Pseudallescheria boydii, is a filamentous fungus with low inherent virulence. Increasing numbers of cases of this infection have been reported probably related to the rising number of immunosuppressed persons. Apart from mycetoma, cutaneous and subcutaneous infection is rarely encountered in clinical practice. We describe a case of cutaneous infection caused by Scedosporium apiospermum in a subject with rheumatoid arthritis and diabetes mellitus who was submitted to long-term therapy with cyclosporin and corticosteroids. Histopathologic examination of a skin biopsy showed a granulomatous infiltrate with hyaline septate hyphae. Culture of two skin biopsies taken at two different observations of the woman, 3 weeks apart, allowed isolation of Scedosporium apiospermum. Therapy with itraconazole, 400 mg/day, for 3 months was effective in curing the infection.
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Affiliation(s)
- M A Chaveiro
- Department of Dermatology, Curry Cabral Hospital, Rua da Beneficiencia, no 8, 1069-166 Lisbon, Portugal
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