Multifocal Scedosporium apiospermum spondylitis in a cystic fibrosis patient

Guignard, Sandra; Hubert, D.; Dupont, B.; Anract, P; Alioua, D.; Guérini, H.; Paugam, A.; Dougados, Maxime

doi:10.1016/j.jcf.2007.05.003

Cited by 33 publications

(25 citation statements)

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“…The moderately high MIC for caspofungin found in this study has also been reported by others (8). Despite these high in vitro MICs, both caspofungin and terbinafine have been associated with a favorable outcome in clinical practice, highlighting that the results of antifungal susceptibility testing must be considered with caution since no correlation between MIC data and clinical success has been described to date for Scedosporium/ Pseudallescheria (16,17,22). Recent advances in molecular methods have led to a revision of Scedosporium/Pseudallescheria taxonomy, revealing that Pseudallescheria boydii is a species complex.…”

Section: Vol 48 2010supporting

confidence: 80%

“…According to both in vitro and in vivo studies, voriconazole could be the most effective antifungal agent, but no recommendations regarding the optimal antifungal therapy for scedosporiosis have yet emerged (12,29). In particular, the benefit of antifungal combination therapy has not been clearly established, despite the increasing number of reports describing a favorable outcome obtained with voriconazole in combination with terbinafine and/or caspofungin (15)(16)(17)22). The in vitro study of 35 antifungal combinations against S. apiospermum and S. prolificans describing a potent synergy between azole drugs and echinocandins will probably reopen the debate on combination therapy (8,23).…”

Section: Vol 48 2010mentioning

confidence: 99%

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Disseminated Scedosporium / Pseudallescheria Infection after Double-Lung Transplantation in Patients with Cystic Fibrosis

et al. 2010

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We report a case of disseminated Scedosporium/Pseudallescheria infection due to Pseudallescheria boydii sensu stricto after lung transplantation in a patient with cystic fibrosis. Dissemination occurred under voriconazole. Despite surgery and combination therapy with voriconazole, caspofungin, and terbinafine, the patient died 8 months after transplantation. Previously reported cases are reviewed. CASE REPORTA 37-year-old woman suffering from cystic fibrosis (CF) was admitted to our institution in April 2008 for double-lung transplantation. Her medical history included diabetes mellitus since 2002 and more than 10 years of airway colonization with Aspergillus fumigatus and Scedosporium/Pseudallescheria. Starting in 2006, and while awaiting transplantation, she received oral voriconazole (250 mg, twice a day). Her postoperative course was relatively uncomplicated except for cytomegalovirus (CMV) infection due to a mismatch at the time of transplantation in spite of valganciclovir prophylactic treatment (900 mg/day). The immunosuppressive regimen included tacrolimus (therapeutic range, 12 to 13.5 ng/ml), mycophenolate mophetil (750 mg/day), and prednisone (37.5 mg/day). Oral voriconazole was continued as a long-term posttransplantation prophylaxis (250 mg twice a day). A fungal culture of a bronchial secretion obtained the day after transplantation was positive for a filamentous fungus routinely identified as Scedosporium apiospermum/P. boydii (isolate I), but several other respiratory specimens obtained over the following weeks were negative. The patient was discharged from the hospital on day 45 after transplantation, still taking voriconazole. The voriconazole serum levels, checked regularly (1.06, 1.96, and 1.69 mg/liter on days 26, 36, and 50, respectively) were within therapeutic limits (1 to 2.5 mg/liter) except for two occasions (0.16 and 0.35 mg/liter on days 18 and 64, respectively).In June (day 70), she presented at our hospital with nodules on her legs that had appeared 2 weeks previously. On examination, the nodules were fibrous, dermo-hypodermic, measuring 1 to 2 cm in diameter, and slightly pigmented on the surface. A biopsy was performed. Histopathological microscopic examination (Gomori-Grocott and periodic acid-Schiff stainings) revealed an inflammatory infiltrate along with several branched and septate hyaline hyphae (fungal cultures were not performed). Continuation of voriconazole in association with a reduced dose of corticosteroid was associated with clinical improvement. However, 3 weeks later, a new biopsy was performed and septate hyphae were again seen on direct examination. A fungal culture of this biopsy specimen was positive for S. apiospermum/P. boydii (isolate II). At this time, the results for chest computed tomography (CT) were unremarkable, no sign of dissemination was noted on brain CT, and the nodules disappeared over the following weeks.All the while, positive CMV DNAemia was still detected in spite of successive curative treatments with per os valganciclovir (1,800 mg/day fro...

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Section: Vol 48 2010supporting

confidence: 80%

Section: Vol 48 2010mentioning

confidence: 99%

Disseminated Scedosporium / Pseudallescheria Infection after Double-Lung Transplantation in Patients with Cystic Fibrosis

et al. 2010

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“…Diabetes is a common complication of CF, and lung transplantation remains the ultimate treatment of CF patients; both situations are associated with a defective immune response and a risk for a disseminated fungal infection. Considering the low susceptibility of S. apiospermum and the tendency of this fungus to disseminate in immunocompromised patients (24,44), it may be important to detect airway colonization by this fungus as early as possible and to initiate rapidly an appropriate antifungal therapy in order to eradicate it before chronic colonization can develop.…”

Section: Vol 47 2009 Molecular Detection Of Fungi In Cf Patients 149mentioning

confidence: 99%

Development of an Oligonucleotide Array for Direct Detection of Fungi in Sputum Samples from Patients with Cystic Fibrosis

Bouchara

Hsieh

Croquefer³

et al. 2009

J Clin Microbiol

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Cystic fibrosis (CF) is the most common inherited genetic disease in Caucasian populations. Besides bacteria, many species of fungi may colonize the respiratory tract of these patients, sometimes leading to true respiratory infections. In this study, an oligonucleotide array capable of identifying 20 fungal species was developed to directly detect fungi in the sputum samples of CF patients. Species-specific oligonucleotide probes were designed from the internal transcribed spacer (ITS) regions of the rRNA operon and immobilized on a nylon membrane. The fungal ITS regions were amplified by PCR and hybridized to the array for species identification. The array was validated by testing 182 target strains (strains which we aimed to identify) and 141 nontarget strains (135 species), and a sensitivity of 100% and a specificity of 99.2% were obtained. The validated array was then used for direct detection of fungi in 57 sputum samples from 39 CF patients, and the results were compared to those obtained by culture. For 16 sputum samples, the results obtained by the array corresponded with those obtained by culture. For 33 samples, the array detected more fungal species than culture did, while the reverse was found for eight samples. The accuracy of the array for fungal detection in sputum samples was confirmed (or partially confirmed) in some samples by cloning and resequencing the amplified ITS fragments. The present array is a useful tool for both the simultaneous detection of multiple fungal species present in the sputa of CF patients and the identification of fungi isolated from these patients.

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“…Scedosporium species are the second most frequently recovered fungi, after Aspergillus fumigatus (4). Although invasive scedosporiosis is reportedly rare in CF prior to lung transplantation (11), colonization may be a risk factor for invasive disease posttransplantation, with associated high mortality (14,19,(21)(22)(23). The impact of airway colonization by Scedosporium spp.…”

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confidence: 99%

Detection of Occult Scedosporium Species in Respiratory Tract Specimens from Patients with Cystic Fibrosis by Use of Selective Media

et al. 2010

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Respiratory samples from cystic fibrosis outpatients were cultured on Sabouraud's dextrose agar (SABD) containing antibiotics, Mycosel, and Scedosporium-selective medium (SceSel؉). Thirty-two (14.7%) of 218 specimens from 11/69 (15.9%) patients yielded a Scedosporium sp., most frequently Scedosporium aurantiacum (17/218). Scedosporium was recovered on SceSel؉, Mycosel, and SABD from 90.6%, 50.0%, and 46.9% of the specimens tested, respectively.Opportunistic molds are increasingly isolated in respiratory specimens from children and adults with cystic fibrosis (CF) (17). Scedosporium species are the second most frequently recovered fungi, after Aspergillus fumigatus (4). Although invasive scedosporiosis is reportedly rare in CF prior to lung transplantation (11), colonization may be a risk factor for invasive disease posttransplantation, with associated high mortality (14,19,(21)(22)(23). The impact of airway colonization by Scedosporium spp. on respiratory function has not been studied; nevertheless, as Scedosporium spp. are resistant to many antifungal agents, colonization may be a relative contraindication to transplantation (18).Isolation of multiple fungi from respiratory specimens is frequent (19). The prevalence of non-Aspergillus molds may be underestimated due to overgrowth of Aspergillus spp. on routine media (4). A medium (SceSelϩ) containing the selective antifungal agents dichloran and benomyl has been described for the recovery of Scedosporium from environmental samples (16,20), but its utility in detecting Scedosporium spp. in clinical specimens has not been determined. No commercial preparation is available. Scedosporium spp. have been identified previously in respiratory specimens from 8.6 to 10% of CF patients (4, 24). These data were published prior to recent taxonomic reassignments of Scedosporium spp. (9, 10), and selective media were not used. We therefore compared the performance of two general media and one selective medium for the isolation of Scedosporium spp. from respiratory specimens and prospectively investigated the frequency and species distribution of Scedosporium in CF patients. Plates were incubated at 30°C in air and examined twice weekly for 28 days. Suspicious colonies were identified to the species level (Aspergillus and Scedosporium spp.) or the genus level (other molds) by standard morphological/ phenotypic methods (7, 9, 10). Scedosporium strains were identified as Scedosporium prolificans, S. aurantiacum, or S. apiospermum by restriction fragment length analysis of the internal transcribed spacer (ITS) region (8). ITS sequence analysis was performed on all S. apiospermum isolates and selected S. aurantiacum isolates (8).Samples (n ϭ 218) were received from 69 patients. Filamentous fungi were detected in 142 samples (65.1%) from 56 patients (81.2%; Table 1). The majority of the fungi (83.9%) were recovered following 6 days of incubation, and 95.1% were recovered following 10 days. Aspergillus spp. were the most frequently recovered, with A. fumigatus isolated in 45.4% of t...

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Multifocal Scedosporium apiospermum spondylitis in a cystic fibrosis patient

Cited by 33 publications

References 9 publications

Disseminated Scedosporium / Pseudallescheria Infection after Double-Lung Transplantation in Patients with Cystic Fibrosis

Disseminated Scedosporium / Pseudallescheria Infection after Double-Lung Transplantation in Patients with Cystic Fibrosis

Development of an Oligonucleotide Array for Direct Detection of Fungi in Sputum Samples from Patients with Cystic Fibrosis

Detection of Occult Scedosporium Species in Respiratory Tract Specimens from Patients with Cystic Fibrosis by Use of Selective Media

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