Scedosporium apiospermum mycetoma with bone involvement successfully treated with voriconazole

Porte, Lorena; Khatibi, Sarah; Hajj, L. El; Cassaing, Sophie; Berry, Antoine; Massip, P.; Linas, M. D.; Magnaval, Jean-François; Sans, N.; Marchou, B.

doi:10.1016/j.trstmh.2005.12.010

Cited by 42 publications

(13 citation statements)

References 11 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…This could be explained by the fact that we have tested a greater number of isolates than previous studies. The poor activity of ITC agrees with the failure of this drug to resolve some clinical cases (9,13). The treatment of Pseudallescheria infections is often challenging and complex.…”

mentioning

confidence: 82%

See 1 more Smart Citation

Antifungal Susceptibilities of the Species of the Pseudallescheria boydii Complex

Gilgado

Serena

Cano

et al. 2006

Antimicrob Agents Chemother

155

102

View full text Add to dashboard Cite

Eighty-four isolates belonging to eight species that constitute the Pseudallescheria boydii complex were tested against 11 antifungal agents by using the microdilution method. There were significant differences among the species, with Scedosporium aurantiacum being the most resistant. In general, voriconazole was the most active drug, followed by posaconazole.In the last few decades, Pseudallescheria boydii sensu lato has been emerging as an important human pathogen, particularly in immunocompromised hosts (8). The optimal treatment for these infections is unknown, and the mortality rate is very high despite aggressive antifungal treatment (8). It has been repeatedly demonstrated that P. boydii sensu lato has low in vitro (6) and in vivo (3, 4, 9) susceptibilities to traditional antifungal drugs. However, the new triazoles, such as voriconazole (VRC), ravuconazole (RVC), and posaconazole (PSC), have shown some in vitro activities against this fungus (5). VRC has also shown efficacy both in animal models (3, 4) and in the clinical setting (1, 13). However, not all the strains of P. boydii tested responded equally to VRC. For instance, Capilla and Guarro (3) demonstrated that one strain that showed a VRC MIC of 0.5 to 1 g/ml was susceptible to this drug in a guinea pig model, while another strain with a VRC MIC of 8 g/ml was resistant. Similarly, some human infections have responded to treatment with this drug (1) and others have not (15). This could be explained by the fact that P. boydii does not represent a single species but instead is a complex comprising at least six known species (P. boydii, Pseudallescheria angusta, Pseudallescheria ellipsoidea, Pseudallescheria fusoidea, Pseudallescheria minutispora, and Scedosporium aurantiacum) and two cryptic species represented by clades 3 and 4 as described by Gilgado et al. (7). Since the antifungal susceptibilities of these species are unknown, we have evaluated the in vitro activities of 11 drugs against strains representing all of them.Eighty-four isolates were tested (Table 1). The isolates were stored in slant cultures of potato dextrose agar (Difco Laboratories, Detroit, Mich.) covered with paraffin oil, subcultured on potato dextrose agar plates, and incubated at 30°C for 5 to 6 days. Candida krusei ATCC 6258 and Candida parapsilosis ATCC 22019 were included as quality controls. Antifungal agents were obtained as pure powders. Amphotericin B (AMB) (USP, Rockville, MD), itraconazole (ITC) and ketoconazole (KTC) (Janssen Pharmaceutica, Beerse, Belgium), albaconazole (J. Uriach & Cía, Barcelona, Spain), VRC (Pfizer Inc., Madrid, Spain), PSC (Schering-Plough Ltd., Hertfordshire, United Kingdom), RVC (Bristol-Myers Squibb Company, New Brunswick, NJ), and terbinafine (Novartis, Basel, Switzerland) were diluted in dimethyl sulfoxide (Panreac Química S.A., Barcelona, Spain), and micafungin (MFG) (Fujisawa Pharmaceutical Co. Ltd., Osaka, Japan), flucytosine (5FC) (Sigma-Aldrich Corp., St. Louis, MO), and fluconazole (FLC) (Pfizer Inc., Madrid, Spain) were diluted in s...

show abstract

mentioning

confidence: 82%

“…However, the new triazoles, such as voriconazole (VRC), ravuconazole (RVC), and posaconazole (PSC), have shown some in vitro activities against this fungus (5). VRC has also shown efficacy both in animal models (3,4) and in the clinical setting (1,13). However, not all the strains of P. boydii tested responded equally to VRC.…”

mentioning

confidence: 99%

Antifungal Susceptibilities of the Species of the Pseudallescheria boydii Complex

Gilgado

Serena

Cano

et al. 2006

Antimicrob Agents Chemother

155

102

View full text Add to dashboard Cite

show abstract

“…Voriconazole may show fungicidal activity against S. apiospermum and is efficacious in both mouse and guinea pig models of scedosporiosis (4,5,10). In humans, numerous case reports have detailed its clinical effectiveness against Scedosporium infections, including those involving the central nervous system (CNS) and bone (6,12,13,14,20,22,23,34,35,39,40,47). Most describe the use of voriconazole as the sole antifungal agent, sometimes combined with surgery.…”

mentioning

confidence: 99%

Treatment of Scedosporiosis with Voriconazole: Clinical Experience with 107 Patients

Troke

Aguirrebengoa

Arteaga

et al. 2008

Antimicrob Agents Chemother

266

216

View full text Add to dashboard Cite

The efficacy of voriconazole in 107 patients with scedosporiosis was analyzed. Principal infection sites were the lungs/sinuses (24%), central nervous system (CNS) (20%), and bone (18%), while 21% of patients had disseminated infection. Solid organ transplantation (22%), hematological malignancy (21%), and surgery/ trauma (15%) were the predominant underlying conditions. A successful therapeutic response was achieved in 57% of patients (median, 103 therapy days), with >98% of those responding receiving >28 days of therapy. Patients receiving primary therapy showed a 61% response versus 56% for the others. The best therapeutic responses were seen for skin/subcutaneous (91%) or bone (79%) infections, and the lowest for CNS infections (43%). Patients without major immune suppression (72%) or those with solid organ transplantation (63%) or various hematological conditions (60%) showed the best responses by underlying condition. Median known survival time was 133 days (therapy successes, 252 days; failures, 21 days). In all, 43 (40%) patients died, 73% due to scedosporiosis. Patients with Scedosporium prolificans infection had significantly reduced survival times (P ‫؍‬ 0.0259) and were more likely to die from fungal infection (P ‫؍‬ 0.002) than were Scedosporium apiospermum-infected patients. In a subset of 43 patients where voriconazole baseline MICs were available, response to voriconazole was higher for S. apiospermum-infected patients (54% response; MIC 50 , 0.25 g/ml) than for S. prolificans-infected patients (40% response; MIC 50 , 4.0 g/ml). Voriconazole demonstrated clinically useful activity in the treatment of both S. apiospermum and S. prolificans infections and was well tolerated.

show abstract

“…Imidazole has been demonstrated to be effective for S. apiospermum infection in vitro, although for invasive and disseminated S. apiospermum infection, imidazole is often ineffective (17). In addition, although some case reports have demonstrated successful outcomes with itraconazole, the overall effects are poor (18,19). Troke et al (20) reported that, in 107 cases of Scedosporium infection in which the principal infection sites were the lungs/sinuses (24%), central nervous system (CNS) (20%) and bone (18%), 21% of the patients had disseminated infection, and successful therapeutic responses were observed in 57% of the patients treated with voriconazole.…”

Section: A B C Dmentioning

confidence: 99%

Dermatic Scedosporium Apiospermum Infection after Autologous Bone Marrow Transplantation

Jiang

et al. 2013

Intern. Med.

View full text Add to dashboard Cite

Infection with Scedosporium apiospermum (S. apiospermum) is rare, although it is associated with a high fatality rate, especially in immunosuppressed patients. A 23-year-old man with acute myelogenous leukemia (AML) (M2) who was pretreated with chemotherapy for autologous bone marrow transplantation developed a skin ulcer on the left groin. After a culture study demonstrated the presence of S. apiospermum, voriconazole was administered and the lesion rapidly improved. Since a diagnosis of S. apiospermum continues to depend on the results of a fungal culture and most isolates of S. apiospermum are resistant to amphotericin B, voriconazole should be considered as the first choice when "mold" is thought to be the causative organism.

show abstract

Scedosporium apiospermum mycetoma with bone involvement successfully treated with voriconazole

Cited by 42 publications

References 11 publications

Antifungal Susceptibilities of the Species of the Pseudallescheria boydii Complex

Antifungal Susceptibilities of the Species of the Pseudallescheria boydii Complex

Treatment of Scedosporiosis with Voriconazole: Clinical Experience with 107 Patients

Dermatic Scedosporium Apiospermum Infection after Autologous Bone Marrow Transplantation

Contact Info

Product

Resources

About