Absceso de herida operatoria por Scedosporium prolificans: Primer aislamiento en Chile. Revisión de la literatura

Abstract

Absceso de herida operatoria porThe aim of this article is to report the first case of infection by Scedosporium prolificans in our country. The patient corresponds to a 27 year-old man with chronic renal failure, hypertension, submitted to a renal transplant, in treatment with cyclosporine, azathioprine and prednisone. Twenty five days after the transplant, he noticed a fluctuating increase of volume under the surgical wound. In three consecutive purulent exudates and in tissue obtained at surgery, Scedosporium prolificans was isolated as an only agent. The histopathological study revealed structures compatible with septate hyphae. The patient was treated by surgical debridement, Amphotericin B and Itraconazol obtaining a complete cicatrization of the wound. S prolificans is a hyaline filamentous fungi, resistant to Amphotericin B and azoles, considered currently an emerging pathogen. It is responsible of localized infections associated to surgery and/or trauma, as well as fatal disseminated infections in immunocompromised hosts, specially oncological, in presence of neutropenia, and transplants. It is important to consider this microorganism in the differential diagnosis of emerging fungal infections.

Lomentospora prolificans fungemia in hematopoietic stem cell transplant patients: First report in South America and literature review

“…However, until now, there were only a few cases of superficial or locally invasive infections reported in South America. Moreover, the fungal identifications were based only on macro and micromorphological characteristics and were not confirmed trough molecular methods . Thus, we described the first well‐documented L. prolificans disseminated infection in South America.…”

“…Although L. prolificans is considered an emerging pathogen, it seems to be restricted to some countries in Europe (Spain, France, and Germany), Australia, and some Southern states of United States of America . In South America, only a few cases of localized infections have been reported . We report a L. prolificans disseminated infection in a patient from Brazil that underwent hematopoietic stem cell transplantation and conducted a literature review.…”

“…1,[5][6][7][8] In South America, only a few cases of localized infections have been reported. [9][10][11] We report a L. prolificans disseminated infection in a patient from Brazil that underwent hematopoietic stem cell transplantation and conducted a literature review. A 17-year-old boy with X-linked chronic granulomatous disease received an allogeneic hematopoietic stem cell transplantation (allo-HSCT) at a reference oncologic center of São Paulo (ITACI), Brazil.…”

Infección ocular invasora por Scedosporium apioespermum en un paciente inmunocomprometido

“…En pacientes neutropénicos, el control de la neutropenia es fundamental para lograr la sobrevida del paciente 1 y los escasos reportes en Chile dan cuenta de la importancia del aseo quirúrgico en el control exitoso de la infección, incluso en presencia de inmunosupresión 20,21 . Estudios observacionales respaldan la terapia combinada de voriconazol con terbinafina, ya que las infecciones invasoras por S. apiospermum han presentado un mejor pronóstico usando este enfoque (terbinafina 250-500 mg/d) 18 .…”

El complejo Pseudallescheria/Scedosporium y taxas afines en la rutina del laboratorio micológico clínico

“…Muchos de estos cuadros clínicos derivan en micosis sistémicas, con altas tasas de mor talidad debido a la elevada virulencia y a la resistencia a los tratamientos antifúngicos convencionales que presenta este grupo de hongos, en especial S.prolificans (Alastruey-Izquierdo, et al, 2007;Cortez et al, 2008, Rodriguez-Trudela et al, 2009Lackner et al, 2011). En Chile, se han descrito diversos casos de scedosporiosis, principalmente del complejo Pseudallescheria/ Scedosporium y S. prolificans (Oddo, et al, 1985;Díaz et al, 2004;Briones et al, 2006;Chanqueo et al, 2009, entre otros). Debe destacarse el reciente aislamiento de Psudallescheria boydii sensu stricto, en un paciente con cuadro sinusal (Nota del autor).…”