No abstract

Scopulariopsis is a common fungus in the environment, characterized by its intrinsic resistance to the available antifungal drugs. Around 70 cases of infection by this fungus have been described in the literature. Pulmonary and disseminated infections are the most common and their treatment is difficult; therefore, very diverse approaches have been taken, with varied results. A successful outcome has been reported in only a few cases, generally attributed to a multitreatment strategy combining medical and surgical procedures that ultimately led to the resection of the infected tissue if possible, identification of the mould, and an aggressive long-term antifungal therapy. Although most of the infections are caused by Scopulariopsis brevicaulis, a few other species have also been linked to these cases, although molecular evidence has not been proven for all of them. On this basis, more knowledge on the epidemiology, presentation, diagnosis, treatment, and prognosis of these unusual infections would improve their management. This review aims to compile the current data on Scopulariopsis infections.

The genera Sarocladium and Acremonium (order Hypocreales) are a very diverse group of morphologically and genetically related fungi that are generally found in the environment. Numerous species of these genera are soil saprobes and opportunistic pathogens of plants, other fungi, animals or humans. 1 They are distributed worldwide, and Acremonium isolates have even been found in rocks on continental Antarctica. 2 In addition, these fungi are very relevant in the clinical field, as they have been proven to be involved in a wide range of human conditions and manifestations. As will be discussed later, diagnosis and management of these infections are quite challenging, mostly due to the difficulties in the correct identification and to the poor antifungal response they generally show. As a matter of fact, Acremonium and Sarocladium species cannot be distinguished by histopathological examination from some other opportunistic fungi, such as Fusarium and its relatives; therefore, DNA sequence analysis is required. This review, based on an exhaustive literature search of the PubMed database, compiles and discusses the current knowledge of Sarocladium and Acremonium infections in terms of taxonomy, clinical presentations and prognoses, diagnosis, treatment, outcomes, antifungal susceptibility and their impact in animals.