Scedosporium apiospermum infection after near‐drowning

Abstract

Scedosporium apiospermum and its teleomorph (sexual form) Pseudallescheria boydii are ubiquitous saprophytic fungi, which under specific conditions, such as near-drowning, may cause therapy-refractory and life-threatening infections. We reviewed 22 cases (eight children and 14 adults) of S. apiospermum infection after near-drowning reported in the literature including an additional paediatric case from our institution. Scedosporiosis after near-drowning was associated with high mortality (16/23, 70%) even in immunocompetent hosts. It affected mainly young (mean age 24 years) and immunocompetent (83% with no apparent immune defect) males (male to female ratio 2.5 : 1). Scedosporiosis after near-drowning was a slow progressive disease (mean survival time 87 days) involving virtually all body organs. However, central nervous system (CNS) dissemination predominated (21/23, 91%) presenting mainly as multiple brain abscesses (15/23, 65%). All 23 patients showed preceding clinical and/or radiological evidence of lung disease indicating the mode of invasion. Diagnosis was delayed (median time to diagnosis 28 days) and was made by culture (16/23, 69.5%) or culture and tissue examination (7/23, 30.5%). The majority of the patients (20/23, 87%) received antifungal treatment and underwent neurosurgery. While the optimal treatment remains undefined, the most recent reports indicated voriconazole as a potentially effective option. Better knowledge of scedosporiosis after near-drowning could lead to improved intervention and ultimately to more favourable outcome.

Hydroxamate siderophores of Scedosporium apiospermum

“…Curiously, a high production level of this siderophore was also seen for strain IHEM 3817 which was recovered from a cerebrospinal fluid. However, CSN involvement is commonly seen in disseminated scedosporiosis following a primary pulmonary site of infection or colonization, for examples after lung transplantation in chronically colonized CF patients (Symoens et al 2006) or after near-drowning (Katragkou et al 2007). A retrospective analysis of a large number of cases of scedosporiosis after near-drowning always revealed preceding clinical and/or radiological evidence of lung disease indicating the mode of invasion (Katragkou et al 2007).…”

“…More recently, it has been described as an emerging pathogen causing severe and often lethal infections in immunocompromised patients, particularly lung transplant patients (Guarro et al 2006). Equally, numerous cases of disseminated scedosporiosis with cerebral involvement have been reported after neardrowning, resulting from haematogenous spread from a primary pulmonary site of infection (Katragkou et al 2007). Additionally, S. apiospermum is a therapyrefractory pathogen since it is resistant or poorly susceptible to almost all current antifungals (Hennequin et al 1997).…”

Mucormycosis, Pseudallescheriasis, and Other Uncommon Mold Infections

“…Pseudallescheriasis may cause widespread disseminated infection in patients who have received hematopoietic or solid organ transplants (52)(53)(54). Central nervous system disease has been associated with patients suffering from near-drowning episodes (55). Patients with cystic fibrosis and chronic granulomatous disease are also predisposed to developing infection with this fungus (53,54,56).…”

Experimental Models of Disseminated Scedosporiosis with Cerebral Involvement

“…Scedosporium apiospermum is a soil filamentous fungus which usually lives as a saprophyte, but can cause localized infections resulting from the traumatic inoculation of fungal elements, such as mycetoma and bone or joint infections (Steinbach and Perfect, 2003;Katragkou et al, 2007;Cortez el al., 2008). In recent decades, this fungus has been the subject of increasing attention because of several reports of its relatively high frequency as a causal agent in the airway colonization of patients with cystic fibrosis (CF).…”