Scedosporium inflatum: Clinical Spectrum of a Newly Recognized Pathogen

Wilson, Craig M.; OʼRourke, Edward J.; McGinnis, Michael R.; Salkin, Ira F.

doi:10.1093/infdis/161.1.102

Cited by 104 publications

(101 citation statements)

References 3 publications

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“…Osteomyelitis, septic arthritis, or wound infections usually occur when barriers are breached secondary to trauma or surgery (253,297). There have been numerous reports of infections in immunocompetent individuals, including osteomyelitis, discitis, and arthritis (95,145,155,245,268,409,443,476), usually following deep extension of local disease. Among immunocompromised hosts, bone and articular involvement is more likely to be secondary to hematogenous dissemination of the fungus (242).…”

Section: Ii) Extrapulmonary Infections (A) Cutaneous and Subcutaneoumentioning

confidence: 99%

Infections Caused byScedosporiumspp

et al. 2008

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SUMMARY Scedosporium spp. are increasingly recognized as causes of resistant life-threatening infections in immunocompromised patients. Scedosporium spp. also cause a wide spectrum of conditions, including mycetoma, saprobic involvement and colonization of the airways, sinopulmonary infections, extrapulmonary localized infections, and disseminated infections. Invasive scedosporium infections are also associated with central nervous infection following near-drowning accidents. The most common sites of infection are the lungs, sinuses, bones, joints, eyes, and brain. Scedosporium apiospermum and Scedosporium prolificans are the two principal medically important species of this genus. Pseudallescheria boydii, the teleomorph of S. apiospermum, is recognized by the presence of cleistothecia. Recent advances in molecular taxonomy have advanced the understanding of the genus Scedosporium and have demonstrated a wider range of species than heretofore recognized. Studies of the pathogenesis of and immune response to Scedosporium spp. underscore the importance of innate host defenses in protection against these organisms. Microbiological diagnosis of Scedosporium spp. currently depends upon culture and morphological characterization. Molecular tools for clinical microbiological detection of Scedosporium spp. are currently investigational. Infections caused by S. apiospermum and P. boydii in patients and animals may respond to antifungal triazoles. By comparison, infections caused by S. prolificans seldom respond to medical therapy alone. Surgery and reversal of immunosuppression may be the only effective therapeutic options for infections caused by S. prolificans.

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Section: Ii) Extrapulmonary Infections (A) Cutaneous and Subcutaneoumentioning

confidence: 99%

Infections Caused byScedosporiumspp

et al. 2008

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“…Clinical discussion (see Clinical Syndromes and Their Management below) will be limited to S. prolificans, as related species have been extensively reviewed elsewhere (153) and may not reveal phaeoid hyphae in tissue, in contrast to the case for S. prolificans. Infection with this organism is of major concern in all settings due to its refractoriness to antifungal therapy and associated high mortality (18,29,76,96,119,153,312,475,538,664,802,806). A recent review of 162 cases reported in the literature summarizes major risk factors as malignancy (46%), cystic fibrosis (12%), and solid organ transplantation (9%) and chief clinical presentations as disseminated infection (44%) and pulmonary mycoses (29%), followed by bone and joint infections (10%) (638).…”

Section: Microascalesmentioning

confidence: 99%

Melanized Fungi in Human Disease

2010

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SUMMARY Melanized or dematiaceous fungi are associated with a wide variety of infectious syndromes. Many are soil organisms and are generally distributed worldwide, though certain species appear to have restricted geographic ranges. Though they are uncommon causes of disease, melanized fungi have been increasingly recognized as important pathogens, with most reports occurring in the past 20 years. The spectrum of diseases with which they are associated has also broadened and includes allergic disease, superficial and deep local infections, pneumonia, brain abscess, and disseminated infection. For some infections in immunocompetent individuals, such as allergic fungal sinusitis and brain abscess, they are among the most common etiologic fungi. Melanin is a likely virulence factor for these fungi. Diagnosis relies on careful microscopic and pathological examination, as well as clinical assessment of the patient, as these fungi are often considered contaminants. Therapy varies depending upon the clinical syndrome. Local infection may be cured with excision alone, while systemic disease is often refractory to therapy. Triazoles such as voriconazole, posaconazole, and itraconazole have the most consistent in vitro activity. Further studies are needed to better understand the pathogenesis and optimal treatment of these uncommon infections.

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“…The therapeutic approach for patients with S. apiospermum or S. prolificans infections involves complete surgical resection of the lesion with or without antifungal therapy, whose role is uncertain (12,37). Infections caused by S. apiospermum have been treated with amphotericin B (35), miconazole, ketoconazole (38), itraconazole (29), and voriconazole (11), with variable clinical responses.…”

mentioning

confidence: 99%

In Vitro Activities of New and Conventional Antifungal Agents against ClinicalScedosporiumIsolates

Meletiadis¹,

Meis

Mouton

et al. 2002

Antimicrob Agents Chemother

221

164

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The susceptibilities of 13 clinical isolates of Scedosporium apiospermum and 55 clinical isolates of S. prolificans to new and conventional drugs belonging to three different classes of antifungal agents, the azoles (miconazole, itraconazole, voriconazole, UR-9825, posaconazole), the polyenes (amphotericin B, nystatin and liposomal nystatin), and allylamines (terbinafine), were studied by use of proposed standard M38-P of NCCLS. Low growth-inhibitory antifungal activities were found in vitro for most of the drugs tested against S. prolificans isolates, with the MICs at which 90% of isolates are inhibited (MIC 90 s) being >8 g/ml; the MIC 90 s of voriconazole and UR-9825, however, were 4 g/ml. S. apiospermum isolates were more susceptible in vitro, with the highest activity exhibited by voriconazole (MIC 90 s, 0.5 g/ml), followed by miconazole (MIC 90 s, 1 g/ml), UR-9825 and posaconazole (MIC 90 s, 2 g/ml), and itraconazole (MIC 90 s, 4 g/ml). The MICs of terbinafine, amphotericin B, and the two formulations of nystatin (for which no statistically significant differences in antifungal activities were found for the two species) for S. apiospermum isolates were high. Cross-resistance was observed among all the azoles except posaconazole and among all the polyenes except the lipid formulation. A distribution analysis was performed with the MICs of each drug and for each species. Bimodal and skewed MIC distributions were obtained, and cutoffs indicating the borders of different MIC subpopulations of the distributions were determined on the basis of the normal plot technique. These cutoffs were in many cases reproducible between 48 and 72 h.

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Scedosporium inflatum: Clinical Spectrum of a Newly Recognized Pathogen

Cited by 104 publications

References 3 publications

Infections Caused byScedosporiumspp

Infections Caused byScedosporiumspp

Melanized Fungi in Human Disease

In Vitro Activities of New and Conventional Antifungal Agents against ClinicalScedosporiumIsolates

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