Infections caused by Scedosporium/Lomentospora species: Clinical and microbiological findings in 21 cases

Abstract

The clinical and microbiological characteristics of infections caused by Scedosporium/ Lomentospora species in 21 patients are described. We searched retrospectively the records for Scedosporium/ Lomentospora species seen at the University Hospital Virgen de las Nieves from 2006 to 2017. Out of them, 16 were male; mean age at diagnosis was 57.8 (±SD 15) years; all patients had risk factors for fungal infection such as corticosteroids and/or immunosuppressive treatment in 18 (85.7%) patients, pulmonary diseases in seven (33.3%) cases, hematological malignancies in six (28.5%), and organ transplantation in three (14.2%) patients. Most patients had infection in the lung/pleura (17/80.9%); cough was present in 12 patients and dyspnea in another 12, and the mean interval until diagnosis was 13.6 days. The most frequent species was S. apiospermum/S. boydii in 14 patients (66.6%), followed by L. prolificans in seven. The diagnosis was obtained from sputum in 12 (57.1%) cases, followed by pleural fluid and bronchoalveolar lavage in two of each. The most frequently used antifungals were voriconazole and amphotericin B, but combination of more than one antifungal drug was only used in three patients. Ten patients were cured, and six patients died as a consequence of the infection; three patients had chronic infection. In general, infections caused by Scedosporium/Lomentospora species are rare, serious, and difficult to diagnose and treat, having a high index or mortality especially in those caused by L. prolificans.

Clinical characteristics and outcomes of invasive Lomentospora prolificans infections: Analysis of patients in the FungiScope® registry

“…Previous in vitro studies have shown that while some L prolificans isolates are susceptible to voriconazole, the majority have high MICs to all antifungal agents, including voriconazole, which may correlate with treatment failure with voriconazole monotherapy . Clinical studies have demonstrated the superiority of voriconazole‐based treatment regimens for L prolificans infections compared to LAmB‐based regimens, a finding that was confirmed in our study. Furthermore, recently published data from our cohort showed the highest treatment success with voriconazole when used in combination with another antifungal agent.…”

“…These findings further confirm another recent large survey of L prolificans infections, in which 63% had underlying haematological/oncological malignancy, 59% disseminated infection, and lung was the most frequently involved organ (39%) as well . Overall, 28‐day mortality rates were high with more than 50% failing antifungal treatment, similar to previous studies . Mortality rates were highest in patients with underlying haematological/oncological malignancies, with more than 80% failing antifungal treatment, and in those with disseminated infection, with 84% failing treatment.…”

“…Lomentospora prolificans are filamentous fungi commonly found in soil and polluted waters and are increasingly recognised as a cause of serious invasive fungal infections (IFIs) in Australia, California and the southern USA, and Europe . L prolificans is the causative agent in 1.6% and 0.9% of infections after haematopoetic stem cell transplant and solid organ transplantation (SOT) in the United States, respectively .…”

Non-Aspergillus Hyaline Molds: Emerging Causes of Sino-Pulmonary Fungal Infections and Other Invasive Mycoses

“…6 Profound neutropenia and T-cell immune dysregulation are predisposing factors for scedosporiosis and lomentosporiosis in patients with hematologic malignancy and HSCT recipients. 7 These observations are consistent with the known mechanisms of phagocytic innate host defense against Scedosporium spp. 8 Indeed, in a literature review of 23 HSCT recipients with Scedosporium or L. prolificans infection, 67% were neutropenic and 52% had graft-versus-host disease (GVHD).…”

An unusual case of Scedosporium apiospermum fungaemia in an immunocompetent patient with a left ventricular assist device and an implantable cardiac device

“…Of the available antifungal agents, voriconazole exhibits the greatest activity against both fungal pathogens [11]. Voriconazole monotherapy is recommended as first-line treatment for S. apiospermum infections, while voriconazole combination therapy with terbinafine is recommended for L. prolificans infection [11, 12, 20]. The mainstay of fungal identification in most routine clinical diagnostic laboratories is phenotypic identification of a positive fungal culture [12, 20, 21], which is a process that may take days to weeks.…”