Fatal Scopulariopsis Infection in a Lung Transplant Recipient: A Case Report

Wuyts, Wim; Molzahn, Helmut; Maertens, Johan; Verbeken, Eric; Lagrou, Katrien; Dupont, Lieven; Verleden, Geert M.

doi:10.1016/j.healun.2005.06.015

Cited by 31 publications

(42 citation statements)

References 16 publications

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“…Dissemination to the skin seems to be a common event, being noted in more than half of the patients with disseminated Scopulariopsis infections (patients 2, 3, 4, 6, and 7 in Table 1). In the present case, infection occurred early (day 19) in the heart and bilateral-lung transplantation period in comparison to the case described by Wuyts et al, which involved a single-lung-transplant recipient (34). The hypothesis of possible transmission from the donor to our patient was excluded, as fungal cultures from the graft preservation fluid were negative.…”

Section: Case Reportsupporting

confidence: 43%

Fatal Invasive Infection with Fungemia Due to Microascus cirrosus after Heart and Lung Transplantation in a Patient with Cystic Fibrosis

et al. 2011

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Scopulariopsis species are rarely but increasingly recognized as opportunistic pathogens in immunocompromised patients. We report on a patient suffering from cystic fibrosis who developed disseminated fungal infection due to a rare Scopulariopsis species, Microascus cirrosus, after heart and lung transplantation. Despite antifungal combination therapy with voriconazole and caspofungin, the patient died 4 weeks after transplantation. Diagnostic difficulties and optimal management of disseminated Scopulariopsis/Microascus infections are discussed. CASE REPORTA 36-year-old man suffering from cystic fibrosis was admitted to our hospital in June 2009 for a heart and bilateral lung transplantation. He had a first lung transplantation in 1997 but had chronic rejection since 2001 in spite of several immunosuppressive regimens. His medical history also included renal failure (hemodialysis since 2007), diabetes mellitus, and airway colonization with a multiresistant Pseudomonas aeruginosa. Short antifungal therapy courses had been prescribed over the past years for various yeasts (Candida spp.) and molds (Aspergillus, Paecilomyces, and Fusarium species) colonizing his respiratory tract, but there was no evidence of previous isolation of a Scopulariopsis species. At the time of admission, sputum cultures grew only Candida albicans, and fluconazole was thus prescribed (200 mg intravenously [i.v.] after each dialysis).Following graft surgery, the immunosuppressive regimen included induction therapy with basiliximab (anti-CD25 antibody [20 mg i.v. on the day of transplantation and on day 4]) and solumedrol (10 mg/kg of body weight on the day of transplantation, followed by three 120-mg doses per day), followed by cyclosporine adjusted according to dialysis parameters to reach therapeutic blood levels (300 to 350 ng/ml) and solumedrol. Antimicrobial therapy consisted of a broad-spectrum antibiotherapy with tobramycin, vancomycin, piperacillin, and tazobactam. Although the patient seemed to do well in the early postoperative period, with apyrexia and extubation on day 3, his white blood cell count (WBC) increased slowly starting on the day after transplantation, reaching 20 ϫ 10 9 cells/liter by day 8 postsurgery. On day 11 after the operation (WBC ϭ 30 ϫ 10 9 cells/liter), a thoracic computed tomodensitometry (TDM) revealed bilateral pulmonary effusions (Fig. 1A), which were drained on day 19 without clinical improvement. Bilateral hemorrhagic pleural fluid specimens revealed several regular, hyaline, and branched septate hyphae on direct examination ( Fig. 2A), leading to the diagnosis of proven invasive fungal infection (IFI) according to the European Organization for Research and Treatment of Cancer/Invasive Fungal Infections Cooperative Group and National Institute of Allergy and Infectious Diseases Mycoses Study Group (EORTC/MSG) criteria (8). The patient was given an antifungal combination therapy of voriconazole i.v. (6 mg/kg every 12 h as a loading dose followed by two 4-mg/kg doses a day) and caspofungin (70 mg/day ...

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Section: Case Reportsupporting

confidence: 43%

Fatal Invasive Infection with Fungemia Due to Microascus cirrosus after Heart and Lung Transplantation in a Patient with Cystic Fibrosis

et al. 2011

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“…These include Acremonium, Scopulariopsis and Trichoderma species (78-80). As general rules, surgical excision should be attempted when possible and therapy should be guided by susceptibility testing.…”

Section: Specific Fungimentioning

confidence: 99%

Emerging Fungal Infections in Solid Organ Transplant Recipients

Shoham

2013

Infectious Disease Clinics of North America

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The most important emerging and rare fungal pathogens in solid organ transplant recipients are the Zygomycetes, Scedosporium, Fusarium and the dark molds. Factors impacting the emergence of these fungi include the combination of intensive immunosuppressive regimens with increasingly widespread use of long-term azole antifungal therapy; employment of aggressive diagnostic approaches (e.g. sampling of bronchoalveolar lavage fluid) and changes in patients’ interactions with the environment. Early diagnosis, differentiation between colonization and infection and institution of appropriate therapy is vital when contending with these fungi. Moreover, effective treatment often requires a multi-disciplinary approach. This article reviews the epidemiology, microbiology and clinical impact of emerging fungal infections in solid organ transplant recipients and provides up to date recommendations on their treatment.

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“…Although blood cultures are often positive in disseminated Fusarium infection, skin lesions may precede positive blood cultures by up to 5 days 31 . Similar to disseminated Aspergillus infection, blood cultures in disseminated Scopulariopsis infection are often negative 15 . However, unlike use of the galactomannan assay in diagnosing disseminated Aspergillus infection, there is no rapid blood test to confirm Scopulariopsis infection.…”

Section: Discussionmentioning

confidence: 99%

“…Third, histopathologic evaluation of a cutaneous biopsy from a suspicious cutaneous lesion cannot distinguish one disseminated mycelial infection from another. Aspergillus , Fusarium and other hyalohyphomycoses such as Scopulariopsis show identical morphology of biopsy specimens—angioinvasive hyaline and septate hyphae branching at acute angles 12,14,15,32 . Therefore, submitting tissue for appropriate culture studies at the time of biopsy is required to distinguish the above listed mycelial fungi.…”

Section: Discussionmentioning

confidence: 99%

“…The spectrum of reported human mycoses ranges from onychomycosis, 1,2 cutaneous ‘ring worm’‐like infection, 3 plantar infection, 4 fungal keratitis, 5 endocarditis associated with valvuloplasty, 6 fungus ball in pulmonary cavities, 7 post‐traumatic endophthalmitis, 8 otomycosis, 9 and subcutaneous infections after liver transplant 10 . Recently, there have been increasing number of cases of disseminated infection causing skin lesions including a patient with acquired immune deficiency syndrome (AIDS), 11 disseminated infections after bone marrow transplant (BMT), 12–14 and after lung transplant 15 . We describe here a case of disseminated Scopulariopsis infection with skin lesions in a BMT patient.…”

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confidence: 99%

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Disseminated Scopulariopsis–culture is required to distinguish from other disseminated mould infections

Swick¹,

Reddy²,

Friedrichs³

et al. 2010

J Cutan Pathol

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Disseminated fungal infections are a major cause of mortality in severely immunocompromised bone marrow transplant (BMT) patients. Scopulariopsis is a soil saprophytic mould that is typically associated with onychomycosis and only rarely associated with disseminated infection with cutaneous findings. We describe a case of fatal disseminated Scopulariopsis infection in a 56-year-old neutropenic male with chronic myelogenous leukemia status post peripheral blood stem cell transplant that was clinically and histologically indistinguishable from disseminated Aspergillus, Fusarium or zygomycosis infection. Distinguishing the above listed fungi by tissue culture is crucial because disseminated Scopulariopsis is difficult to eradicate and associated with a high mortality rate in the immunocompromised BMT patient population.

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Fatal Scopulariopsis Infection in a Lung Transplant Recipient: A Case Report

Cited by 31 publications

References 16 publications

Fatal Invasive Infection with Fungemia Due to Microascus cirrosus after Heart and Lung Transplantation in a Patient with Cystic Fibrosis

Fatal Invasive Infection with Fungemia Due to Microascus cirrosus after Heart and Lung Transplantation in a Patient with Cystic Fibrosis

Emerging Fungal Infections in Solid Organ Transplant Recipients

Disseminated Scopulariopsis–culture is required to distinguish from other disseminated mould infections

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