Severe prosthetic joint infection in an immunocompetent male patient due to a therapy refractory Pseudallescheria apiosperma

Abstract

SummaryProsthetic joint infections (PJI) are rarely due to fungal agents and if so they are mainly caused by Candida strains. This case represents a PJI caused by a multi-drug resistant Pseudallescheria apiosperma, with poor in vivo response to itraconazole and voriconazole. This case differs also by the way of infection, since the joint infection did not follow a penetrating trauma. In the majority of cases, Scedosporium extremity infections remain local in immunocompetent individuals. We report a persistent joint infection with multiple therapeutic failures, and subsequent amputation of the left leg. Detailed clinical data, patient history, treatment regime and outcome of a very long-lasting (>4 years) P. apiosperma prosthetic knee infection in an immunocompetent, 61-yearold male patient are presented with this case. The patient was finally cured by the combination of multiple and extensive surgical interventions and prolonged antifungal combination therapy with voriconazole and terbinafine.

Infection and colonisation due to Scedosporium in Northern Spain. An in vitro antifungal susceptibility and molecular epidemiology study of 60 isolates

“…In vitro synergistic effects of azoles combined with echinocandins were reported by Cuenca–Estrellas et al. 1 Other studies demonstrated a profound synergistic effect of azole‐terbinafin combinations 3–32 . Therefore, in addition to terbinafin, MICA should be also taken into consideration as possible combination therapy option for Scedosporium infections, preferably in combination with VOR.…”

“…During the last 5 years, several sibling species have been introduced, 1–5 which has led to the subdivision of P. boydii into the following species: S. apiospermum (teleomorph P. apiosperma ), S. aurantiacum, S. boydii (teleomorph: P. boydii ), S. dehoogii, P. fusoidea, P. ellipsoidea, P. angusta, and P. minutispora . Pseudallescheria and Scedosporium infections are difficult to treat because of their therapy‐refractory nature 6,7 . Several infections by multi‐drug resistant strains of Scedosporium species have been reported 8–11 .…”

“…Pseudallescheria and Scedosporium infections are difficult to treat because of their therapy-refractory nature. 6,7 Several infections by multi-drug resistant strains of Scedosporium species have been reported. [8][9][10][11] Among these, S. prolificans is the most frequently encountered pathogen.…”

Epidemiology of Scedosporiosis

“…Prosthetic joints are also at risk [70]. Lackner et al reported one such case affecting the lower limb due to S. apiospermum where the infection was most likely acquired during a surgical procedure or from postoperative wound contamination during the patient's work as a cattle farmer.…”

“…Lackner et al reported one such case affecting the lower limb due to S. apiospermum where the infection was most likely acquired during a surgical procedure or from postoperative wound contamination during the patient's work as a cattle farmer. The infection was treated with a combination of antifungal therapy and multiple debridements but amputation of the affected limb [70].…”