Invasive infections caused by Blastoschizomyces capitatus and Scedosporium spp.

Abstract

Blastoschizomyces capitatus, Scedosporium prolificans and S. apiospermum are emerging fungal pathogens that may cause disseminated disease in neutropenic patients. They can present as fever resistant to antibiotics and to wide-spectrum antifungal agents, although they may involve almost every organ. The proportion of recovery from blood cultures is high and they are characteristically resistant to most antifungal agents. Prognosis is poor unless patients recover from neutropenia. Voriconazole has good in-vitro activity and is currently the drug of choice for these infections.

Successful Treatment of Systemic Geotrichum capitatum Infection by Liposomal Amphotericin-B, Itraconazole, and Voriconazole in a Japanese Man

“…However, it was also likely that systemic infection of G. capitatum caused secondary disseminations in lung fields, because there were multiple small lesions in bilateral lobes of lung determined by CT. The multiple nodular shadows revealed by chest CT in the present case might be similar to those of previous reports, but there has been no clear explanation for the mechanism of formation of multiple lesions in the lung (2,4). Another possibility was that G. capitatum might have invaded from skin via the central venous catheter, and then increased in the blood stream, and finally lung lesions appeared as dissemination.…”

“…This filamentous fungus is found in soil, and frequently isolated from human skin, respiratory and digestive tracts (1). Colonization in those sites sometimes leads to secondary localizations via hematogenous dissemination mainly in the lung and liver (4,6). Invasive G. capitatum infection is relatively rare, approximately 100 cases having been reported (1,3,4,7,8).…”

“…Colonization in those sites sometimes leads to secondary localizations via hematogenous dissemination mainly in the lung and liver (4,6). Invasive G. capitatum infection is relatively rare, approximately 100 cases having been reported (1,3,4,7,8). Risk factors for systemic G. capitatum infection have been reported to be prolonged neutropenia, intensive chemotherapy, the use of broad-spectrum antibacterial agents and local disruption of skin and mucosal defenses (2, 9-11).…”

“…The prognosis of disseminated G. capitatum infection has been reported to be extremely poor, with a mortality rate of approximately 50-75% despite intensive antifungal therapy with AMPH-B, ITCZ or flucytosine (1)(2)(3)(4)6). Combination treatment with AMPH-B and 5-fluorocytosine has been recommended (2), as has the use of novel antifungal agents such as VRCZ and caspofungin (8).…”

“…Invasive systemic Geotrichum capitatum (G. capitatum) infection is rare, and has been reported exclusively in immunocompromised patients, particularly those receiving intensive chemotherapies for hematological malignancies such as acute leukemia (1)(2)(3)(4). G. capitatum, formerly known as Trichosporon capitatum or Brastochizomyces capitatus, is an anamorph of Dipodascus capitatus, so that Dipodascus capitatus is a taxonomic teleomorph of G. capitatum (5).…”