Scedosporium apiospermum (Pseudoallescheria boydii) Infection in Lung Transplant Recipients

Sahi, Hina; Avery, Robin K.; Minai, Omar A.; Hall, Geraldine S.; Mehta, Atul C.; Raina, Paola; Budev, Marie

doi:10.1016/j.healun.2007.01.011

Cited by 101 publications

(92 citation statements)

References 31 publications

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“…The prognosis of invasive fungal infections with emerging species is generally very poor (11,17,19). In vitro data and clinical reports suggest a low efficacy of amphotericin B deoxycholate or its lipid formulations against Trichosporon spp.…”

Section: Case Reportmentioning

confidence: 99%

Disseminated Trichosporon mycotoxinivorans, Aspergillus fumigatus, and Scedosporium apiospermum Coinfection after Lung and Liver Transplantation in a Cystic Fibrosis Patient

et al. 2012

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Trichosporon mycotoxinivorans is a novel pathogen recently found in cystic fibrosis patients. We report the first case of a disseminated fatal infection with T. mycotoxinivorans associated with invasive Aspergillus fumigatus and Scedosporium apiospermum infection after lung and liver transplantation in a cystic fibrosis patient. CASE REPORTA 35-year-old man with cystic fibrosis (CF) was admitted for rapid respiratory deterioration and high-level oxygen requirements with respiratory acidosis. He was a nonsmoker and was still working actively as a farmer until a few days before his admission. His past medical history included sinonasal polyposis and diabetes mellitus. He was in good general condition despite a severe obstructive pulmonary disease that had been stable over the previous 5 years, with a forced expiratory volume in the first second at 20% of that predicted. He also had a 5-year bronchial colonization with Pseudomonas aeruginosa and Aspergillus fumigatus.Because of respiratory deterioration despite noninvasive ventilation and antibiotics, an extracorporeal membrane oxygenation, inotropic support, and hemodialysis were started and an emergency double lung transplantation (LT) was performed. The immunosuppression included basiliximab and high-dose methylprednisolone for induction, a standard dose of tacrolimus, mycofenolate mofetil, and methylprednisolone for maintenance. Due to immediate postoperative acute liver failure, an emergency liver transplantation was performed on day 2 post-LT. Another dose of basiliximab and high dose of methylprednisolone were given. Antifungal prophylaxis with caspofungin (70 mg) started on the day of LT was discontinued the next day due to liver dysfunction. Amyloidosis AA (deposition of amyloid protein A) was diagnosed on explanted liver. The patient's condition remained stable, although invasive ventilation and hemodialysis were maintained. Routine bronchoalveolar lavage specimens at days 1 and 6 post-LT were positive for P. aeruginosa (treated with ceftazidime, ciprofloxacin, and meropenem) and A. fumigatus. Caspofungin was resumed (50 mg daily) at day 6 post-LT because an Aspergillus galactomannan detection test (Platelia Aspergillus antigen; Bio-Rad) became positive in serum.On day 9 post-LT, nonfebrile sleepiness was noted. Within 4 days, the neurologic condition worsened, with tetraparesis and coma. Cerebral magnetic resonance imaging (MRI) showed multiple foci of cortical, subcortical, and periventricular hyperinten-

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Section: Case Reportmentioning

confidence: 99%

Disseminated Trichosporon mycotoxinivorans, Aspergillus fumigatus, and Scedosporium apiospermum Coinfection after Lung and Liver Transplantation in a Cystic Fibrosis Patient

et al. 2012

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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.…”

mentioning

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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“…CASE REPORTS 1979 escheria infections remain rare in patients with CF, even in highly immunosuppressed patients such as those undergoing lung transplantation (2,5,24,26,28). Here, we present a case involving a patient who had several years of known airway colonization with S. apiospermum/P.…”

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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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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Scedosporium apiospermum (Pseudoallescheria boydii) Infection in Lung Transplant Recipients

Cited by 101 publications

References 31 publications

Disseminated Trichosporon mycotoxinivorans, Aspergillus fumigatus, and Scedosporium apiospermum Coinfection after Lung and Liver Transplantation in a Cystic Fibrosis Patient

Disseminated Trichosporon mycotoxinivorans, Aspergillus fumigatus, and Scedosporium apiospermum Coinfection after Lung and Liver Transplantation in a Cystic Fibrosis Patient

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

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

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