In Vitro Activities of New and Conventional Antifungal Agents against ClinicalScedosporiumIsolates

Abstract

The susceptibilities of 13 clinical isolates of Scedosporium apiospermum and 55 clinical isolates of S. prolificans to new and conventional drugs belonging to three different classes of antifungal agents, the azoles (miconazole, itraconazole, voriconazole, UR-9825, posaconazole), the polyenes (amphotericin B, nystatin and liposomal nystatin), and allylamines (terbinafine), were studied by use of proposed standard M38-P of NCCLS. Low growth-inhibitory antifungal activities were found in vitro for most of the drugs tested against S. prolificans isolates, with the MICs at which 90% of isolates are inhibited (MIC 90 s) being >8 g/ml; the MIC 90 s of voriconazole and UR-9825, however, were 4 g/ml. S. apiospermum isolates were more susceptible in vitro, with the highest activity exhibited by voriconazole (MIC 90 s, 0.5 g/ml), followed by miconazole (MIC 90 s, 1 g/ml), UR-9825 and posaconazole (MIC 90 s, 2 g/ml), and itraconazole (MIC 90 s, 4 g/ml). The MICs of terbinafine, amphotericin B, and the two formulations of nystatin (for which no statistically significant differences in antifungal activities were found for the two species) for S. apiospermum isolates were high. Cross-resistance was observed among all the azoles except posaconazole and among all the polyenes except the lipid formulation. A distribution analysis was performed with the MICs of each drug and for each species. Bimodal and skewed MIC distributions were obtained, and cutoffs indicating the borders of different MIC subpopulations of the distributions were determined on the basis of the normal plot technique. These cutoffs were in many cases reproducible between 48 and 72 h.

Respiratory tract intracavitary colonization due to Scedosporium apiospermum: report of four cases

“…Differential diagnosis 1 is mandatory because of the frequent resistance of the Scedosporium to a variety of commonly used antimycotic agents 6 .…”

Scedosporium prolificans Osteomyelitis in an Immunocompetent Child Treated with Voriconazole and Caspofungin, as Well as Locally Applied Polyhexamethylene Biguanide

“…Two species are medically important: Scedosporium apiospermum (formerly Monosporium apiospermum) is the predominant asexual stage (anamorph) of Pseudallescheria boydii (formerly Petriellidium boydii, formerly Allescheria boydii), and S. prolificans (formerly Scedosporium inflatum) has no known teleomorph (58). In immunocompromised patients, these organisms can parallel the clinical manifestations of aspergillosis or fusariosis and lead to pulmonary or disseminated infection (40,44). In normal hosts, these hyaline molds often produce localized disease, such as septic arthritis or osteomyelitis after penetrating trauma, or can lead to pneumonia or meningitis after aspiration of polluted water.…”

Osteomyelitis and Discospondylitis due to Scedosporium Apiospermum in a Dog

“…In one human patient, successful treatment of a chronic, fungal, vertebral infection was achieved with a combination of surgery (abscess debridement, surgical drain placement, ostectomy, osseous autograft implantation, and vertebral stabilization), drug administration ( intravenous and oral voriconazole administration for at least 1 year), and bed rest. 8,13 In dogs, systemic scedosporiosis is usually fatal; however, localized infection such as that involving the nasal cavities may be cured with appropriate treatment. One previous study described treatment of nasal fungal infection by endoscopic removal of the fungal mass, which resulted in clinical improvement within 2 weeks.…”