Central nervous system pseudallescheriasis after near-drowning

Panichpisal, Kessarin; Nugent, Kenneth; Sarria, Juan C.

doi:10.1016/j.clineuro.2005.10.013

Cited by 17 publications

(9 citation statements)

References 15 publications

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“…However, treatment failure among immunocompetent pa-1 World Data Centre of Microorganisms: WDCM929. tients with CNS infections is reported, especially after near-drowning, where diagnosis and hence treatment are delayed [12].…”

Section: Discussionmentioning

confidence: 99%

Scedosporium apiospermumskeletal infection in an immunocompetent child

et al. 2009

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This is a case of Scedosporium apiospermum skeletal infection in a 10-year-old immunocompetent girl whose chief complaint was left knee swelling and pain. The child had a history of a bicycle accident two months before with a resultant deep penetrating trauma. Systematic administration of broad-spectrum antibiotics for 10 days was used, with no clinical improvement. Magnetic Resonance Imaging and arthrotomy of the affected joint revealed findings suggestive of osteomyelitis. Empirical intravenous antimicrobial therapy was instituted for a total of two months but one month after completion of antibacterial therapy the child returned to the hospital because of persistent knee swelling and pain. Following a new arthrotomy, Scedosporium apiospermum was isolated. The patient was cured with intravenous administration of voriconazole without any side effects and has no evidence of relapse after four years of follow-up.

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Section: Discussionmentioning

confidence: 99%

Scedosporium apiospermumskeletal infection in an immunocompetent child

et al. 2009

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“…are an increasingly important cause of life-threatening infections, not just in immunocompromised patients after cancer chemotherapy or organ transplantation (6,20) but also in immunocompetent individuals (37,45). Based on increasing numbers of published case reports, voriconazole alone or in combination with another antifungal agent such as terbinafine is becoming the therapy of choice to treat scedosporiosis; however, isolated case reports provide a limited indication of the potential of a drug and may represent publication bias.…”

Section: Discussionmentioning

confidence: 99%

Treatment of Scedosporiosis with Voriconazole: Clinical Experience with 107 Patients

Troke

Aguirrebengoa

Arteaga

et al. 2008

Antimicrob Agents Chemother

267

216

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The efficacy of voriconazole in 107 patients with scedosporiosis was analyzed. Principal infection sites were the lungs/sinuses (24%), central nervous system (CNS) (20%), and bone (18%), while 21% of patients had disseminated infection. Solid organ transplantation (22%), hematological malignancy (21%), and surgery/ trauma (15%) were the predominant underlying conditions. A successful therapeutic response was achieved in 57% of patients (median, 103 therapy days), with >98% of those responding receiving >28 days of therapy. Patients receiving primary therapy showed a 61% response versus 56% for the others. The best therapeutic responses were seen for skin/subcutaneous (91%) or bone (79%) infections, and the lowest for CNS infections (43%). Patients without major immune suppression (72%) or those with solid organ transplantation (63%) or various hematological conditions (60%) showed the best responses by underlying condition. Median known survival time was 133 days (therapy successes, 252 days; failures, 21 days). In all, 43 (40%) patients died, 73% due to scedosporiosis. Patients with Scedosporium prolificans infection had significantly reduced survival times (P ‫؍‬ 0.0259) and were more likely to die from fungal infection (P ‫؍‬ 0.002) than were Scedosporium apiospermum-infected patients. In a subset of 43 patients where voriconazole baseline MICs were available, response to voriconazole was higher for S. apiospermum-infected patients (54% response; MIC 50 , 0.25 g/ml) than for S. prolificans-infected patients (40% response; MIC 50 , 4.0 g/ml). Voriconazole demonstrated clinically useful activity in the treatment of both S. apiospermum and S. prolificans infections and was well tolerated.

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“…Additional fungal infections in children reported in the literature include Cryptococcus in immunocompromised patients (HIV disease, oncologic patients, children after bone marrow transplantation, and teenagers with rheumatologic disorders receiving immunosuppression) with imaging features ranging from minimal nonspecific changes to pseudocyst formation within the basal ganglia and thalami 55 . Unusual opportunistic infections with fungus Pseudallescheria boydii , that may present with imaging characteristics similar to invasive aspergillosis, have been described in the setting of near‐drowning 65 . Although mucor mycosis may also be seen in the setting of severe immunocompromised children and is also associated with concomitant sinus disease, progression of this infection is so rapid that imaging usually offers little support to change clinical outcomes 20 …”

Section: Fungal Infectionsmentioning

confidence: 99%