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Davies GE, Thornton CR. A Lateral-Flow Device for the Rapid Detection of Scedosporium Species. Diagnostics (Basel) 2024; 14:847. [PMID: 38667492 PMCID: PMC11048963 DOI: 10.3390/diagnostics14080847] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Revised: 04/15/2024] [Accepted: 04/17/2024] [Indexed: 04/28/2024] Open
Abstract
Scedosporium species are human pathogenic fungi, responsible for chronic, localised, and life-threatening disseminated infections in both immunocompetent and immunocompromised individuals. The diagnosis of Scedosporium infections currently relies on non-specific CT, lengthy and insensitive culture from invasive biopsy, and the time-consuming histopathology of tissue samples. At present, there are no rapid antigen tests that detect Scedosporium-specific biomarkers. Here, we report the development of a rapid (30 min) and sensitive (pmol/L sensitivity) lateral-flow device (LFD) test, incorporating a Scedosporium-specific IgG1 monoclonal antibody (mAb), HG12, which binds to extracellular polysaccharide (EPS) antigens between ~15 kDa and 250 kDa secreted during the hyphal growth of the pathogens. The test is compatible with human serum and allows for the detection of the Scedosporium species most frequently reported as agents of human disease (Scedosporium apiospermum, Scedosporium aurantiacum, and Scedosporium boydii), with limits of detection (LODs) of the EPS biomarkers in human serum of ~0.81 ng/mL (S. apiospermum), ~0.94 ng/mL (S. aurantiacum), and ~1.95 ng/mL (S. boydii). The Scedosporium-specific LFD (ScedLFD) test therefore provides a potential novel opportunity for the detection of infections caused by different Scedosporium species.
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Affiliation(s)
- Genna E. Davies
- ISCA Diagnostics Ltd., B12A, Hatherly Laboratories, Prince of Wales Road, Exeter EX4 4PS, UK;
| | - Christopher R. Thornton
- ISCA Diagnostics Ltd., B12A, Hatherly Laboratories, Prince of Wales Road, Exeter EX4 4PS, UK;
- Biosciences, Faculty of Health and Life Sciences, Prince of Wales Road, Exeter EX4 4PS, UK
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2
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Lamoth F, Kontoyiannis DP. PCR diagnostic platforms for non- Aspergillus mold infections: ready for routine implementation in the clinic? Expert Rev Mol Diagn 2024; 24:273-282. [PMID: 38501431 DOI: 10.1080/14737159.2024.2326474] [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] [Received: 11/02/2023] [Accepted: 02/29/2024] [Indexed: 03/20/2024]
Abstract
INTRODUCTION While Aspergillus spp. remain the predominant cause of invasive mold infections, non-Aspergillus molds, such as the Mucorales or Fusarium spp., account for an increasing proportion of cases. The diagnosis of non-Aspergillus invasive mold infections (NAIMI) is challenging because of the low sensitivity and delay of conventional microbiological tests. Therefore, there is a particular interest to develop molecular tools for their early detection in blood or other clinical samples. AREAS COVERED This extensive review of the literature discusses the performance of Mucorales-specific PCR and other genus-specific or broad-range fungal PCR that can be used for the diagnosis of NAIMI in diverse clinical samples, with a focus on novel technologies. EXPERT OPINION PCR currently represents the most promising approach, combining good sensitivity/specificity and ability to detect NAIMI in clinical samples before diagnosis by conventional cultures and histopathology. Several PCR assays have been designed for the detection of Mucorales in particular, but also Fusarium spp. or Scedosporium/Lomentospora spp. Some commercial Mucorales PCRs are now available. While efforts are still needed for standardized protocols and the development of more rapid and simpler techniques, PCR is on the way to becoming an essential test for the early diagnosis of mucormycosis and possibly other NAIMIs.
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Affiliation(s)
- Frederic Lamoth
- Infectious Diseases Service, Department of Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
- Institute of Microbiology, Department of Laboratory Medicine and Pathology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Dimitrios P Kontoyiannis
- Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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3
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Liang HY, Han CH, Xu WJ, Sun J, Wang Q. Pulmonary scedosporiosis in an intractable immunocompetent host: A case report and literature review. Clin Respir J 2024; 18:e13739. [PMID: 38433370 PMCID: PMC10909920 DOI: 10.1111/crj.13739] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Revised: 01/26/2024] [Accepted: 02/11/2024] [Indexed: 03/05/2024]
Abstract
Pulmonary scedosporiosis is a rare pulmonary infection that often presents with nonspecific symptoms and radiological findings. In this report, we present a case of localized pulmonary scedosporiosis in an immunocompetent patient and analyze a total of 25 immunocompetent patients with pulmonary scedosporiosis. Through this case and the literature, we highlight the importance of considering pulmonary scedosporiosis in patients with nonspecific clinical symptoms and radiological findings resembling aspergilloma. This case and the literature further emphasize the significance of surgical intervention. Regardless of the use of antifungal drugs, surgery should be conducted as soon as possible.
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Affiliation(s)
- Hong Yu Liang
- Department of Respiratory and Critical Care MedicineThe Affiliated Hospital of Qingdao UniversityQingdaoChina
| | - Chun Hua Han
- Department of Bacteriology RoomThe Affiliated Hospital of Qingdao UniversityQingdaoChina
| | - Wen Juan Xu
- Department of Respiratory and Critical Care MedicineThe Affiliated Hospital of Qingdao UniversityQingdaoChina
| | - Jian Sun
- Department of Respiratory and Critical Care MedicineThe Affiliated Hospital of Qingdao UniversityQingdaoChina
| | - Qiang Wang
- Department of Respiratory and Critical Care MedicineThe Affiliated Hospital of Qingdao UniversityQingdaoChina
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4
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Blez D, Bronnimann D, Rammaert B, Zeller V, Delhaes L, Hustache L, Grenouillet F, Traversier N, Bonhomme J, Chouaki T, Perpoint T, Persat F, Bougnoux ME, Bayle S, Quaesaet L, Nevez G, Boutoille D, Morio F, Pougnet L, Queyrel-Moranne V, Heym BE, Guillemain R, Dannaoui É, Roux A, Garcia-Hermoso D, Lanternier F. Invasive bone and joint infections from the French Scedosporiosis/lomentosporiosis Observational Study (SOS) cohort: no mortality with long-term antifungal treatment and surgery. Med Mycol 2023; 61:7051228. [PMID: 36813259 DOI: 10.1093/mmy/myad023] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Revised: 02/06/2023] [Accepted: 02/16/2023] [Indexed: 02/24/2023] Open
Abstract
Little is known about localized osteoarticular Scedosporiosis (LOS). Most data come from case reports and small case series. Here we present an ancillary study of the nationwide French Scedosporiosis Observational Study (SOS), describing 15 consecutive cases of LOS diagnosed between January 2005 and March 2017. Adult patients diagnosed with LOS defined by osteoarticular involvement without distant foci reported in SOS were included. Fifteen LOS were analyzed. Seven patients had underlying disease. Fourteen patients had prior trauma as potential inoculation. Clinical presentation was arthritis (n = 8), osteitis (n = 5), and thoracic wall infection (n = 2). The most common clinical manifestation was pain (n = 9), followed by localized swelling (n = 7), cutaneous fistulization (n = 7), and fever (n = 5). The species involved were Scedosporium apiospermum (n = 8), S. boydii (n = 3), S. dehoogii (n = 1), and Lomentospora prolificans (n = 3). The species distribution was unremarkable except for S. boydii, which was associated with healthcare-related inoculations. Management was based on medical and surgical treatment for 13 patients. Fourteen patients received antifungal treatment for a median duration of 7 months. No patients died during follow-up. LOS exclusively occurred in the context of inoculation or systemic predisposing factors. It has a non-specific clinical presentation and is associated with an overall good clinical outcome, provided there is a prolonged course of antifungal therapy and adequate surgical management.
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Affiliation(s)
- Damien Blez
- Service de Maladies Infectieuses et Tropicales, Hôpital universitaire Necker-Enfants malades, Paris, France
| | - Didier Bronnimann
- Service des pathologies infectieuses et tropicales, Université de Paris, Paris, Île-de-France, France
- Médecine interne et maladies infectieuses, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, Aquitaine, France
| | - Blandine Rammaert
- Service de médecine interne et maladies infectieuses et tropicales, CHU Poitiers, Poitiers, France
- Université de Poitiers, INSERM U1070, Poitiers, Nouvelle-Aquitaine, France
| | - Valérie Zeller
- Osteoarticular Reference Center, GH Diaconesses Croix St Simon, Paris, Île-de-France, France
| | - Laurence Delhaes
- INSERM U1045, Bordeaux, Aquitaine, France
- Service de parasitologie-mycologie, Université de Bordeaux, Talence, France
| | - Laurent Hustache
- Service de Maladies Infectieuses et Tropicales, Hôpital Jean Minjoz, Besancon, France
| | - Frédéric Grenouillet
- Chrono-Environment, UFR Santé-Pharmacie et UMR 6249 UBFC-CNRS, Besancon, Bourgogne-Franche-Comté, France
- Mycology Parasitology, University Hospital Centre Besancon, Besancon, France
| | - Nicolas Traversier
- Microbiology Saint-Denis, Felix Guyon University Hospital Center, La Réunion, France
| | - Julie Bonhomme
- Microbiology Laboratory, University Hospital Centre Caen, ToxEMAC-ABTE, Unicaen, Caen, Basse-Normandie, France
| | - Taieb Chouaki
- Mycology, University Hospital Centre Amiens-Picardie, Amiens, Hauts-de-France, France
| | - Thomas Perpoint
- Maladies Infectieuses et Tropicales, Hospices Civils de Lyon, Lyon, Auvergne-Rhône-Alpes, France
| | - Florence Persat
- Service de Parasitologie et Mycologie Médicale, Hospices Civils de Lyon, Lyon, France
- EA7426 PI3-Inflammation and Immunity of the Respiratory Epithelium, Université Claude Bernard Lyon 1, Pierre-Bénite, France
| | - Marie Elisabeth Bougnoux
- Mycology, Hopital universitaire Necker-Enfants malades, Paris, Île-de-France, France
- National Reference Center for Invasive Mycoses and Antifungals, Translational Mycology research group, Mycology Department, Institut Pasteur, Université Paris Cité, Paris, France
| | - Sophie Bayle
- Medecine interne et infectiologie aiguë polyvalente, Hospital Centre Avignon, Avignon, Provence-Alpes-Côte d'Azu, France
| | - Luc Quaesaet
- Service de Maladies Infectieuses et Tropicales, Cavale Blanche Hospital, Brest, Bretagne, France
| | - Gilles Nevez
- Parasitologie et Mycologie, Centre Hospitalier Universitaire de Brest, Brest, Bretagne, France
- Infections Respiratoires Fongiques (IRF), UFR Médecine science de la santé, Brest, France
| | - David Boutoille
- Service de Maladies Infectieuses et Tropicales, Centre Hospitalier Universitaire de Nantes, Nantes, Pays de la Loire, France
- Centre d'Investigation Clinique-Unité d'Investigation Clinique 1413 INSERM, CHU Nantes, France
| | - Florent Morio
- Centre d'Investigation Clinique-Unité d'Investigation Clinique 1413 INSERM, CHU Nantes, France
- Laboratory of Parasitology and Medical Mycology, Cibles et médicaments des infections et de l'immunité, University Hospital Centre Nantes, IICiMed, UR1155, F-44000, Nantes, Pays de la Loire, France
| | - Laurence Pougnet
- Laboratoire de biologie médicale, HIA Clermont-Tonnerre, CC41, Brest, Bretagne, France
| | - Viviane Queyrel-Moranne
- Service de rhumatologie, Hôpital Pasteur 2, CHU Nice, Nice, Provence-Alpes-Côte d'Azur, France
| | - B Eate Heym
- Osteoarticular Reference Center, GH Diaconesses Croix St Simon, Paris, Île-de-France, France
| | | | - Éric Dannaoui
- Service de parasitologie-mycologie, Hopital Européen Georges Pompidou, Paris,Île-de-France, France
- CRCM-Centre de Transplantation Pulmonaire, Service de pneumologie, Hôpital Foch, Suresnes, France
| | - Antoine Roux
- Service de parasitologie-mycologie, Hopital Européen Georges Pompidou, Paris,Île-de-France, France
| | - Dea Garcia-Hermoso
- National Reference Center for Invasive Mycoses and Antifungals, Translational Mycology research group, Mycology Department, Institut Pasteur, Université Paris Cité, Paris, France
| | - Fanny Lanternier
- Service de Maladies Infectieuses et Tropicales, Hôpital universitaire Necker-Enfants malades, Paris, France
- National Reference Center for Invasive Mycoses and Antifungals, Translational Mycology research group, Mycology Department, Institut Pasteur, Université Paris Cité, Paris, France
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Neoh CF, Chen SCA, Crowe A, Hamilton K, Nguyen QA, Marriott D, Trubiano JA, Spelman T, Kong DCM, Slavin MA. Invasive Scedosporium and Lomentospora prolificans Infections in Australia: A Multicenter Retrospective Cohort Study. Open Forum Infect Dis 2023; 10:ofad059. [PMID: 36861090 PMCID: PMC9970007 DOI: 10.1093/ofid/ofad059] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Accepted: 02/05/2023] [Indexed: 02/10/2023] Open
Abstract
Background Management of Scedosporium/Lomentospora prolificans infections remains challenging. We described predisposing factors, clinical manifestations, and outcomes of these rare mold infections, including predictors of early (1-month) and late (18-month) all-cause mortality and treatment failure. Methods We conducted a retrospective Australian-based observational study of proven/probable Scedosporium/L prolificans infections from 2005 to 2021. Data on patient comorbidities, predisposing factors, clinical manifestations, treatment, and outcomes up to 18 months were collected. Treatment responses and death causality were adjudicated. Subgroup analyses, multivariable Cox regression, and logistic regression were performed. Results Of 61 infection episodes, 37 (60.7%) were attributable to L prolificans. Forty-five of 61 (73.8%) were proven invasive fungal diseases (IFDs), and 29 of 61 (47.5%) were disseminated. Prolonged neutropenia and receipt of immunosuppressant agents were documented in 27 of 61 (44.3%) and 49 of 61 (80.3%) episodes, respectively. Voriconazole/terbinafine was administered in 30 of 31 (96.8%) L prolificans infections, and voriconazole alone was prescribed for 15 of 24 (62.5%) Scedosporium spp infections. Adjunctive surgery was performed in 27 of 61 (44.3%) episodes. Median time to death post-IFD diagnosis was 9.0 days, and only 22 of 61 (36.1%) attained treatment success at 18 months. Those who survived beyond 28 days of antifungal therapy were less immunosuppressed with fewer disseminated infections (both P < .001). Disseminated infection and hematopoietic stem cell transplant were associated with increased early and late mortality rates. Adjunctive surgery was associated with lower early and late mortality rates by 84.0% and 72.0%, respectively, and decreased odds of 1-month treatment failure by 87.0%. Conclusions Outcomes associated with Scedosporium/L prolificans infections is poor, particularly with L prolificans infections or in the highly immunosuppressed population.
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Affiliation(s)
- Chin Fen Neoh
- National Centre for Infections in Cancer, Peter MacCallum Cancer Centre, Melbourne, Australia,Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, Australia,Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia
| | - Sharon C A Chen
- Centre for Infectious Diseases and Microbiology Laboratory Services, New South Wales Health Pathology, Westmead Hospital, Sydney, Australia,Faculty of Health Sciences, Sydney Medical School, University of Sydney, Sydney, Australia
| | - Amy Crowe
- Department of Infectious Diseases, St Vincent's Hospital Melbourne, Melbourne, Australia
| | - Kate Hamilton
- Centre for Infectious Diseases and Microbiology Laboratory Services, New South Wales Health Pathology, Westmead Hospital, Sydney, Australia
| | - Quoc A Nguyen
- Department of Clinical Microbiology and Infectious Diseases, St Vincent's Hospital Sydney, Sydney, Australia,Kolling Institute, Faculty of Medicine and Health, University of Sydney and Northern Sydney Local Health District, Sydney, Australia
| | - Debbie Marriott
- Department of Clinical Microbiology and Infectious Diseases, St Vincent's Hospital Sydney, Sydney, Australia
| | - Jason A Trubiano
- National Centre for Infections in Cancer, Peter MacCallum Cancer Centre, Melbourne, Australia,Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia,Department of Infectious Diseases, Austin Hospital, Melbourne, Australia
| | - Tim Spelman
- Department of Health Services Research, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - David C M Kong
- National Centre for Antimicrobial Stewardship, Peter Doherty Institute for Infections and Immunity, Melbourne, Australia,Centre for Medicine Use and Safety, Monash Institute of Pharmaceutical Sciences, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Australia,Pharmacy Department, Grampians Health–Ballarat, Melbourne, Australia,School of Medicine, Deakin University, Geelong, Australia
| | - Monica A Slavin
- Correspondence: Monica A. Slavin, MBBS, MD, National Centre for Infections in Cancer, Peter MacCallum Cancer Centre, 305 Grattan Street, Melbourne, VIC 3000, Australia ()
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6
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Bupha-Intr O, Butters C, Reynolds G, Kennedy K, Meyer W, Patil S, Bryant P, Morrissey CO. Consensus guidelines for the diagnosis and management of invasive fungal disease due to moulds other than Aspergillus in the haematology/oncology setting, 2021. Intern Med J 2021; 51 Suppl 7:177-219. [PMID: 34937139 DOI: 10.1111/imj.15592] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [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: 12/17/2022]
Abstract
Invasive fungal disease (IFD) due to moulds other than Aspergillus is a significant cause of mortality in patients with malignancies or post haemopoietic stem cell transplantation. The current guidelines focus on the diagnosis and management of the common non-Aspergillus moulds (NAM), such as Mucorales, Scedosporium species (spp.), Lomentospora prolificans and Fusarium spp. Rare but emerging NAM including Paecilomyces variotii, Purpureocillium lilacinum and Scopulariopsis spp. are also reviewed. Culture and histological examination of tissue biopsy specimens remain the mainstay of diagnosis, but molecular methods are increasingly being used. As NAM frequently disseminate, blood cultures and skin examination with biopsy of any suspicious lesions are critically important. Treatment requires a multidisciplinary approach with surgical debridement as a central component. Other management strategies include control of the underlying disease/predisposing factors, augmentation of the host response and the reduction of immunosuppression. Carefully selected antifungal therapy, guided by susceptibility testing, is critical to cure. We also outline novel antifungal agents still in clinical trial which offer substantial potential for improved outcomes in the future. Paediatric recommendations follow those of adults. Ongoing epidemiological research, improvement in diagnostics and the development of new antifungal agents will continue to improve the poor outcomes that have been traditionally associated with IFD due to NAM.
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Affiliation(s)
- Olivia Bupha-Intr
- Department of Infection Services, Wellington Regional Hospital, Wellington, New Zealand
| | - Coen Butters
- Department of General Paediatric and Adolescent Medicine, John Hunter Children's Hospital, Newcastle, New South Wales, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia.,Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Gemma Reynolds
- Department of Infectious Diseases, Austin Health, Melbourne, Victoria, Australia
| | - Karina Kennedy
- Department of Infectious Diseases and Microbiology, Canberra Hospital and Health Services, Canberra, Australian Capital Territory, Australia.,ANU Medical School, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Wieland Meyer
- Molecular Mycology Research Laboratory, Centre for Infectious Diseases and Microbiology, Westmead Clinical School and Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.,Research and Education Network, Westmead Hospital, Sydney, New South Wales, Australia.,Westmead Institute for Medical Research, Sydney, New South Wales, Australia.,Marie Bashir Institute for Infectious Diseases and Biosecurity, The University of Sydney, Sydney, New South Wales, Australia
| | - Sushrut Patil
- Malignant Haematology and Stem Cell Transplantation Service, Department of Clinical Haematology, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Penelope Bryant
- Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia.,Department of Infectious Diseases, The Royal Children's Hospital, Melbourne, Victoria, Australia.,Infection and Immunity, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Catherine O Morrissey
- Department of Infectious Diseases, The Alfred Hospital, Melbourne, Victoria, Australia.,Department of Infectious Diseases, Central Clinical School, Monash University, Melbourne, Victoria, Australia
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Mir WAY, Shrestha DB, Khan Suheb MZ, Reddy S, Gaire S. Scedosporium apiospermum Pneumonia in an Immunocompetent Host. Cureus 2021; 13:e16891. [PMID: 34513465 PMCID: PMC8416566 DOI: 10.7759/cureus.16891] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/04/2021] [Indexed: 11/25/2022] Open
Abstract
Invasive fungal infections are being increasingly identified recently. Scedosporium is a significant cause of non-Aspergillus mold infection. It can cause disseminated disease in an immunocompromised host and localized pulmonary infection in immunocompetent ones, especially in those with preformed lung cavities. We present a case of scedosporiosis in an elderly female with bronchiectasis who presented with refractory pulmonary symptoms and infiltrates. The case emphasizes the need to keep the fungal infection in the differential diagnosis of refractory infiltrates in immunocompetent individuals without preformed cavities if they have bronchiectasis. Voriconazole monotherapy can be used as the first-line in proven cases of scedosporiosis.
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Affiliation(s)
| | | | | | - Shravani Reddy
- Department of Internal Medicine, Rush University Hospital, Chicago, USA
| | - Suman Gaire
- Department of Emergency Medicine, Palpa Hospital, Palpa, NPL
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8
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Gow-Lee VJ, Moyers JT, Rogstad DK. Fatal recurrent disseminated Lomentospora prolificans infection during autologous hematopoietic stem cell transplantation: A case report and review, and discussion on the importance of prolonged neutropenia. Transpl Infect Dis 2021; 23:e13701. [PMID: 34328649 DOI: 10.1111/tid.13701] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 04/27/2021] [Revised: 06/23/2021] [Accepted: 06/30/2021] [Indexed: 11/29/2022]
Abstract
Infections with Scedosporium and Lomentospora species, in particular Lomentospora (previously Scedosporium) prolificans, are nearly universally fatal and rapidly-progressive in the transplant population. We report a case of a patient with diffuse large B-cell lymphoma undergoing myelosuppressive chemotherapy who developed disseminated L. prolificans infection which afterward persisted in his knee joint. The infection was treated with early empiric triple antifungal therapy tailored to synergy studies, growth factors to quickly resolve neutropenia, and aggressive debridement (where possible) of infection sites, including amputation. He achieved an 11-month remission until undergoing autologous hematopoietic stem cell transplantation with deep myelosuppression, wherein recrudescent L. prolificans infection occurred, causing death. We highlight the importance of early treatment, synergy studies, and especially recovery of neutropenia in treating this devastating condition.
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Affiliation(s)
| | - Justin T Moyers
- Division of Medical Hematology-Oncology, Loma Linda University Medical Center, Loma Linda, USA
| | - Daniel K Rogstad
- Infectious Disease, Loma Linda University Medical Center, Loma Linda, USA
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9
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Kitisin T, Muangkaew W, Ampawong S, Chutoam P, Thanomsridetchai N, Tangwattanachuleeporn M, Sukphopetch P. Isolation of fungal communities and identification of Scedosporium species complex with pathogenic potentials from a pigsty in Phra Nakhon Si Ayutthaya, Thailand. New Microbiol 2021; 44:33-41. [PMID: 33582822] [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] [MESH Headings] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 03/23/2021] [Indexed: 06/12/2023]
Abstract
Soil fungal communities play an important role in regulating biogeochemical transformations, yet soil-related fungal pathogens are emerging threats to humans. Our previous studies have revealed the pathogenic Scedosporium species in soils samples from public parks with high human activities in Thailand. However, measurement and survey of soil fungal communities in other areas with high human/animal activities, such as the pigsty, are poorly determined. In this study, soil fungal pathogens from a pigsty were isolated and identified. Soil samples were collected from the surrounding drainage areas. Fungal species were identified using morphological and molecular analyses. Isolation of soil samples from the pigsty revealed at least 11 species that have been identified. The most abundant fungal species belonged to genera Aspergillus and Penicillium. Moreover, Scedo-Select III culturing and phylogenetic analysis with β-tubulin gene sequencing revealed the three environmental isolates of Scedosporium species, which were consistent with the S.apiospermum. These three Scedosporium isolates were susceptible to voriconazole and caused pathological characteristics of scedosporiosis similar to S. apiospermum in vivo. In conclusion, our findings contribute towards a better understanding of soil-borne pathogenic fungi in the pigsty. The isolation of Scedosporium species with pathogenic potentials in the present study can be beneficial for the management of public health surveillance, epidemiologists, as well as physicians to reduce the risk of soil fungal contamination among pigsty workers.
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Affiliation(s)
- Thitinan Kitisin
- Department of Microbiology and Immunology, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Watcharamat Muangkaew
- Department of Microbiology and Immunology, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Sumate Ampawong
- Department of Tropical Pathology, Faculty of Tropical Medicine, Mahidol University, Bangkok, 10400, Thailand
| | - Palatip Chutoam
- Faculty of Allied Health Sciences, Burapha University, Chon Buri, 20131, Thailand
| | | | | | - Passanesh Sukphopetch
- Department of Microbiology and Immunology, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
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10
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Bronnimann D, Garcia-Hermoso D, Dromer F, Lanternier F. Scedosporiosis/lomentosporiosis observational study (SOS): Clinical significance of Scedosporium species identification. Med Mycol 2020; 59:486-497. [PMID: 33037432 DOI: 10.1093/mmy/myaa086] [Citation(s) in RCA: 8] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 09/11/2020] [Accepted: 09/24/2020] [Indexed: 12/13/2022] Open
Abstract
Scedosporiosis/lomentosporiosis is a devastating emerging fungal infection. Our objective was to describe the clinical pattern and to analyze whether taxonomic grouping of the species involved was supported by differences in terms of clinical presentations or outcomes. We retrospectively studied cases of invasive scedosporiosis in France from 2005 through 2017 based on isolates characterized by polyphasic approach. We recorded 90 cases, mainly related to Scedosporium apiospermum (n = 48), S. boydii/S. ellipsoideum (n = 20), and Lomentospora prolificans (n = 14). One-third of infections were disseminated, with unexpectedly high rates of cerebral (41%) and cardiovascular (31%) involvement. In light of recent Scedosporium taxonomic revisions, we aimed to study the clinical significance of Scedosporium species identification and report for the first time contrasting clinical presentations between infections caused S. apiospermum, which were associated with malignancies and cutaneous involvement in disseminated infections, and infections caused by S. boydii, which were associated with solid organ transplantation, cerebral infections, fungemia, and early death. The clinical presentation of L. prolificans also differed from that of other species, involving more neutropenic patients, breakthrough infections, fungemia, and disseminated infections. Neutropenia, dissemination, and lack of antifungal prescription were all associated with 3-month mortality. Our data support the distinction between S. apiospermum and S. boydii and between L. prolificans and Scedosporium sp. Our results also underline the importance of the workup to assess dissemination, including cardiovascular system and brain.
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Affiliation(s)
- Didier Bronnimann
- Université de Paris, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris (APHP), Paris, France.,Université de Bordeaux Victor Segalen, Hôpital Saint André, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
| | - Dea Garcia-Hermoso
- Institut Pasteur, CNRS, Molecular Mycology Unit, French National Reference Center for Invasive Mycoses and Antifungals, UMR2000, Paris, France
| | - Françoise Dromer
- Institut Pasteur, CNRS, Molecular Mycology Unit, French National Reference Center for Invasive Mycoses and Antifungals, UMR2000, Paris, France
| | - Fanny Lanternier
- Université de Paris, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris (APHP), Paris, France.,Institut Pasteur, CNRS, Molecular Mycology Unit, French National Reference Center for Invasive Mycoses and Antifungals, UMR2000, Paris, France
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11
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Kitisin T, Muangkaew W, Ampawong S, Sukphopetch P. Tryptophol Coating Reduces Catheter-Related Cerebral and Pulmonary Infections by Scedosporium apiospermum. Infect Drug Resist 2020; 13:2495-2508. [PMID: 32801788 PMCID: PMC7383110 DOI: 10.2147/idr.s255489] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 03/25/2020] [Accepted: 07/09/2020] [Indexed: 11/23/2022] Open
Abstract
Introduction Central venous catheter (CVC) is a medical device that is used to administer medication for a long duration. Colonization by an emerging opportunistic pathogen Scedosporium apiospermum in the CVC lumen is frequently reported to cause severe complications in patients. Here, we describe the effect of fungal quorum-sensing molecule (QSM) known as tryptophol (TOH) to control S. apiospermum colonization in catheter tube lumens in both in vitro and in vivo models. Methods Antifungal susceptibility of TOH against S. apiospermum was compared with voriconazole, and the colony diameter was determined on days 2, 4, and 6. Experimental catheterization rat model was conducted with pre-coating of TOH and voriconazole or an uncoated control and an infection with S. apiospermum. Biofilm formation on the catheter luminal surface was assessed using the scanning electron microscopy, crystal violet, and 2,3-bis(2-methoxy-4-ni-tro-5-sulfophenyl)-5-(phenylamino)-carbonyl-2H-tetra-zolium hydroxide (XTT) reduction assays. Brain and lung samples of catheterized rats were histopathologically assessed. Serum samples from catheterized rats were injected into Galleria mellonella larvae. Survival of catheterized rats and G. mellonella was determined. Results TOH impeded the growth of S. apiospermum by reducing the colony diameter in a dose-dependent manner. TOH coating remarkably lessened S. apiospermum biofilm formation and fungal cell viability on the catheter luminal surface. Additionally, TOH coating lessens cerebral edema that is associated with abscess and invasive pulmonary damages due to S. apiospermum catheter-related infection. Furthermore, TOH coating also lessened the virulence of S. apiospermum in sera of experimental catheterized rats and extended the survival rate of larvae Galleria mellonella infection model. Conclusion An alternative modification of catheter by coating with TOH is effective in preventing S. apiospermum colonization in vivo. Our study gives a new strategy to control catheter contamination and prevents nosocomial diseases due to S. apiospermum infection.
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Affiliation(s)
- Thitinan Kitisin
- Department of Microbiology and Immunology, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Watcharamat Muangkaew
- Department of Microbiology and Immunology, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Sumate Ampawong
- Department of Tropical Pathology, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Passanesh Sukphopetch
- Department of Microbiology and Immunology, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
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12
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Lamoth F, Kontoyiannis DP. Therapeutic Challenges of Non- Aspergillus Invasive Mold Infections in Immunosuppressed Patients. Antimicrob Agents Chemother 2019; 63:e01244-19. [PMID: 31481441 DOI: 10.1128/AAC.01244-19] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
While Aspergillus spp. remain the major cause of invasive mold infections in hematologic cancer patients and transplant recipients, other opportunistic molds, such as Mucorales, Fusarium, and Scedosporium spp. are increasingly encountered in an expanding population of patients with severe and prolonged immunosuppression. High potential for tissue invasion and dissemination, resistance to multiple antifungals and high mortality rates are hallmarks of these non-Aspergillus invasive mold infections (NAIMIs). Assessment of drug efficacy is particularly difficult in the complex treatment scenarios of NAIMIs. Specifically, correlation between in vitro susceptibility and in vivo responses to antifungals is hard to assess, in view of the multiple, frequently interrelated factors influencing outcomes, such as pharmacokinetic/pharmacodynamic parameters determining drug availability at the site of infection, the net state of immune suppression, delay in diagnosis, or surgical debulking of infectious foci. Our current therapeutic approach of NAIMIs should evolve toward a better integration of the dynamic interactions between the pathogen, the drug and the host. Innovative concepts of experimental research may consist in manipulating the host immune system to induce a specific antifungal response or targeted drug delivery. In this review, we discuss the challenges in the management of NAIMIs and provide an update about the latest advances in diagnostic and therapeutic approaches.
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13
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Rammaert B, Puyade M, Cornely OA, Seidel D, Grossi P, Husain S, Picard C, Lass-Flörl C, Manuel O, Le Pavec J, Lortholary O. Perspectives on Scedosporium species and Lomentospora prolificans in lung transplantation: Results of an international practice survey from ESCMID fungal infection study group and study group for infections in compromised hosts, and European Confederation of Medical Mycology. Transpl Infect Dis 2019; 21:e13141. [PMID: 31283872 DOI: 10.1111/tid.13141] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [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: 01/31/2019] [Revised: 06/24/2019] [Accepted: 07/01/2019] [Indexed: 12/20/2022]
Abstract
BACKGROUND Scedosporium species and Lomentospora prolificans (S/L) are the second most common causes of invasive mold infections following Aspergillus in lung transplant recipients. METHODS We assessed the current practices on management of S/L colonization/infection of the lower respiratory tract before and after lung transplantation in a large number of lung transplant centers through an international practice survey from October 2016 to March 2017. RESULTS A total of 51 respondents from 45 lung transplant centers (17 countries, 4 continents) answered the survey (response rate 58%). S/L colonization was estimated to be detected in candidates by 48% of centers. Only 18% of the centers used a specific medium to detect S/L colonization. Scedosporium spp. colonization was a contraindication to transplantation in 10% of centers whereas L prolificans was a contraindication in 31%; 22% of centers declared having had 1-5 recipients infected with S/L in the past 5 years. CONCLUSIONS This survey gives an overview of the current practices regarding S/L colonization and infection in lung transplant centers worldwide and underscores the need of S/L culture procedure standardization before implementing prospective studies.
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Affiliation(s)
- Blandine Rammaert
- Faculté de médecine et pharmacie, Univ Poitiers, Poitiers, France.,Service de maladies infectieuses et tropicales, CHU Poitiers, Poitiers, France.,INSERM U1070, Poitiers, France
| | - Mathieu Puyade
- Service de médecine interne, CHU Poitiers, Poitiers, France
| | - Oliver A Cornely
- Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), Department I of Internal Medicine, Clinical Trials Centre Cologne (ZKS), German Centre for Infection Research (DZIF), Partner site Bonn-Cologne, University of Cologne, Cologne, Germany
| | - Danila Seidel
- Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), Department I of Internal Medicine, Clinical Trials Centre Cologne (ZKS), German Centre for Infection Research (DZIF), Partner site Bonn-Cologne, University of Cologne, Cologne, Germany
| | - Paolo Grossi
- Department of Medicine & Surgery, Infectious and Tropical Diseases Unit, University of Insubria, Varese, Italy
| | - Shahid Husain
- Multi-Organ Transplant Program, Division of Infectious Diseases, University Health Network, University of Toronto, Toronto, Canada
| | | | - Cornelia Lass-Flörl
- Division of Hygiene and Medical Microbiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Oriol Manuel
- Transplantation Center and Infectious Diseases Service, University Hospital (CHUV) and University of Lausanne, Lausanne, Switzerland
| | - Jérôme Le Pavec
- Université Paris-Sud, Faculté de Médecine, Université Paris Saclay, Le Kremlin Bicêtre, France.,Service de Chirurgie Thoracique, Vasculaire et Transplantation Cardio-pulmonaire, Hôpital Marie-Lannelongue, Le Plessis-Robinson, France.,UMR-S 999, Universite Paris-Sud, INSERM, Hôpital Marie Lannelongue, Le Plessis-Robinson, France
| | - Olivier Lortholary
- Université de Paris, APHP, Service des Maladies Infectieuses et Tropicales, Hôpital Necker-Enfants Malades, Centre d'Infectiologie Necker-Pasteur, Institut Imagine, Paris, France.,Institut Pasteur, Unité de Mycologie Moléculaire, Centre National de Référence Mycoses Invasives et Antifongiques, CNRS UMR 2000, Paris, France
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14
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McCarthy MW, Katragkou A, Iosifidis E, Roilides E, Walsh TJ. Recent Advances in the Treatment of Scedosporiosis and Fusariosis. J Fungi (Basel) 2018; 4:E73. [PMID: 29912161 DOI: 10.3390/jof4020073] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Revised: 06/13/2018] [Accepted: 06/16/2018] [Indexed: 12/18/2022] Open
Abstract
Species of Scedosporium and Fusarium are considered emerging opportunistic pathogens, causing invasive fungal diseases in humans that are known as scedosporiosis and fusariosis, respectively. These mold infections typically affect patients with immune impairment; however, cases have been reported in otherwise healthy individuals. Clinical manifestations vary considerably, ranging from isolated superficial infection to deep-seated invasive infection—affecting multiple organs—which is often lethal. While there have been a number of advances in the detection of these infections, including the use of polymerase chain reaction (PCR) and matrix-assisted laser desorption ionization/time-of-flight mass spectrometry (MALDI-TOF MS), diagnosis is often delayed, leading to substantial morbidity and mortality. Although the optimal therapy is controversial, there have also been notable advances in the treatment of these diseases, which often depend on a combination of antifungal therapy, reversal of immunosuppression, and in some cases, surgical resection. In this paper, we review these advances and examine how the management of scedosporiosis and fusariosis may change in the near future.
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Elizondo-Zertuche M, de J Treviño-Rangel R, Robledo-Leal E, Luna-Rodríguez CE, Martínez-Fierro ML, Rodríguez-Sánchez IP, González GM. Molecular identification and in vitro antifungal susceptibility of Scedosporium complex isolates from high-human-activity sites in Mexico. Mycologia 2018; 109:874-881. [PMID: 29494271 DOI: 10.1080/00275514.2017.1416260] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [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: 10/18/2022]
Abstract
The genus Scedosporium is a complex of ubiquitous moulds associated with a wide spectrum of clinical entities, with high mortality principally in immunocompromised hosts. Ecology of these microorganisms has been studied performing isolations from environmental sources, showing a preference for human-impacted environments. This study aimed to evaluate the presence and antifungal susceptibility of Scedosporium complex species in soil samples collected in high-human-activity sites of Mexico. A total of 97 soil samples from 25 Mexican states were collected. Identifications were performed by microscopic morphology and confirmed by sequencing of the rDNA (internal transcribed spacer [ITS], D1/D2) and β-tubulin partial loci. Antifungal susceptibility testing was performed according to the Clinical and Laboratory Standards Institute (CLSI) protocols. Soil samples of urban gardens and industrial parks constituted the best sources for isolation of Scedosporium complex species. S. apiospermum sensu stricto was the most prevalent species (69%), followed by S. boydii (16%). Voriconazole (minimal inhibitory concentration [MIC] geometric mean ≤2.08 µg/mL), followed by posaconazole (MIC geometric mean ≤2.64 µg/mL), exhibited excellent in vitro activity for most species. Amphotericin B and fluconazole demonstrated limited antifungal activity, and all of the strains were resistant to echinocandins. This is the first report in Mexico of environmental distribution and antifungal in vitro susceptibility of these emergent pathogens.
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Affiliation(s)
- Mariana Elizondo-Zertuche
- a Departamento de Microbiología, Facultad de Medicina , Universidad Autónoma de Nuevo León , Av. Francisco I. Madero & Dr. E. A. Pequeño S/N, Col. Mitras Centro, Monterrey , Nuevo León , Mexico 64460
| | - Rogelio de J Treviño-Rangel
- a Departamento de Microbiología, Facultad de Medicina , Universidad Autónoma de Nuevo León , Av. Francisco I. Madero & Dr. E. A. Pequeño S/N, Col. Mitras Centro, Monterrey , Nuevo León , Mexico 64460
| | - Efrén Robledo-Leal
- b Departamento de Microbiología e Inmunología, Facultad de Ciencias Biológicas , Universidad Autónoma de Nuevo León, Av. Universidad S/N Ciudad Universitaria , San Nicolás de los Garza , Nuevo León , Mexico 66451
| | - Carolina E Luna-Rodríguez
- a Departamento de Microbiología, Facultad de Medicina , Universidad Autónoma de Nuevo León , Av. Francisco I. Madero & Dr. E. A. Pequeño S/N, Col. Mitras Centro, Monterrey , Nuevo León , Mexico 64460
| | - Margarita L Martínez-Fierro
- c Laboratorio de Medicina Molecular, Unidad Académica de Medicina Humana y Ciencias de la Salud , Universidad Autónoma de Zacatecas , Zacatecas , Mexico
| | - Iram P Rodríguez-Sánchez
- d Departamento de Genética, Facultad de Medicina , Universidad Autónoma de Nuevo León , Av. Francisco I. Madero & Dr. E. A. Pequeño S/N, Col. Mitras Centro, Monterrey , Nuevo León , Mexico 64460
| | - Gloria M González
- a Departamento de Microbiología, Facultad de Medicina , Universidad Autónoma de Nuevo León , Av. Francisco I. Madero & Dr. E. A. Pequeño S/N, Col. Mitras Centro, Monterrey , Nuevo León , Mexico 64460
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Abela IA, Murer C, Schuurmans MM, Schmitt JW, Muller F, Imkamp F, Mueller NJ, Benden C. A cluster of scedosporiosis in lung transplant candidates and recipients: The Zurich experience and review of the literature. Transpl Infect Dis 2017; 20. [PMID: 29044831 DOI: 10.1111/tid.12792] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [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: 05/18/2017] [Revised: 06/25/2017] [Accepted: 06/26/2017] [Indexed: 12/19/2022]
Abstract
Scedosporium species are fungal pathogens increasingly recognized in cystic fibrosis (CF). They can cause multiresistant, life-threatening infections that are of particular concern in CF patients undergoing lung transplantation, as optimal treatment remains unclear. Here, we describe our Zurich experience of CF patients with Scedosporium infection. Disseminated infection occurred in one patient after transplantation and was successfully treated. We propose a step-by-step approach to treat candidates with colonization, and discuss our cases in the context of the current literature.
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Affiliation(s)
- Irene A Abela
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zurich, Switzerland
| | - Christian Murer
- Division of Pulmonology, University Hospital Zurich, Zurich, Switzerland
| | - Macé M Schuurmans
- Division of Pulmonology, University Hospital Zurich, Zurich, Switzerland
| | - Juergen W Schmitt
- Division of Trauma Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Frabci Muller
- Institute of Medical Microbiology, University of Zurich, Zurich, Switzerland
| | - Frank Imkamp
- Institute of Medical Microbiology, University of Zurich, Zurich, Switzerland
| | - Nicolas J Mueller
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zurich, Switzerland
| | - Christian Benden
- Division of Pulmonology, University Hospital Zurich, Zurich, Switzerland
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Scheffel RS, Dora JM, Weinert LS, Aquino V, Maia AL, Canani LH, Goldani LZ. Invasive fungal infections in endogenous Cushing's syndrome. Infect Dis Rep 2010; 2:e4. [PMID: 24470886 PMCID: PMC3892578 DOI: 10.4081/idr.2010.e4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2009] [Revised: 02/28/2010] [Accepted: 03/01/2010] [Indexed: 12/04/2022] Open
Abstract
Cushing's syndrome is a condition characterized by elevated cortisol levels that can result from either augmented endogenous production or exogenous administration of corticosteroids. The predisposition to fungal infections among patients with hypercortisolemia has been noted since Cushing's original description of the disease. We describe here a patient with endogenous Cushing's syndrome secondary to an adrenocortical carcinoma, who developed concomitant disseminated cryptococcosis and candidiasis in the course of his disease.
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Affiliation(s)
| | | | | | - Valério Aquino
- Microbiology Unit of the Clinical Pathology Division, and
| | | | | | - Luciano Z Goldani
- Infectious Diseases Unit, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
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