Perspectives on Scedosporium species and Lomentospora prolificans in lung transplantation: Results of an international practice survey from ESCMID fungal infection study group and study group for infections in compromised hosts, and European Confederation of Medical Mycology

Abstract

Background: Scedosporium species and Lomentospora prolificans (S/L) are the second most common causes of invasive mold infections following Aspergillus in lung transplant recipients. Methods: We assessed the current practices on management of S/L colonization/infection of the lower respiratory tract before and after lung transplantation in a large number of lung transplant centers through an international practice survey from October 2016 to March 2017. S/L in the past 5 years. Conclusions: This survey gives an overview of the current practices regarding S/L colonization and infection in lung transplant centers worldwide and underscores the need of S/L culture procedure standardization before implementing prospective studies.

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

“…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 .…”

Scedosporium apiospermum and Lomentospora prolificans in lung transplant patients – A single center experience over 24 years

“…It remains unclear why our center did not demonstrate positive Scedosporium/Lomentospora cultures among respiratory microbiology of LTx patients prior to 2014; however, this is in keeping with internationally described emergence of these pathogens over the past 5-10 years with the increased use of posaconazole and voriconazole. 9 Treatment of fungal pathogens is not standardized, and our finding of high anti-fungal exposure prior to positive Scedosporium/Lomentospora cultures together with their increased global emergence should raise concern for other centers about the use of universal anti-fungal prophylaxis, an approach which is still common across many centers. 9 Previous criticisms of global practice have been the lack of use of Scedosporium/Lomentospora specific agar medium (eg SceSel+), multiple media being used in some centers and lack of global standardized practice for isolation.…”

“…The incidence across centers was variable, culture techniques were non-standardized and management practices were diverse. Clinical outcomes following the culture and or treatment of these pathogens in the setting of LTx has not been fully elucidated, 9 with limited data on survival following colonization, impact of therapy, and association with other infections.…”

Organ Transplantation for Cystic Fibrosis

“…51 Due to the morbidity and mortality associated with Aspergillus infections, most centers employ antifungal prophylaxis following lung transplantation, although the optimal timing and duration of therapy have not been defined. 52 Infections with fungi or other molds outside of Aspergillus are less common following transplantation, but complications due to Zygomycetes spp., Fusarium and Scedosporium spp. have been reported, particularly with Lomentospora prolificans.…”