Australia-wide population-based surveillance for scedosporiosis identified 180 cases, with 118 (65.6%) cases of colonization and 62 (34.4%) cases of infection. Predisposing factors for isolation of Scedosporium spp. included chronic lung disease in 37.8% and malignancy in 21.7% of cases. Predictors of invasive disease (n=62) included haematological stem cell transplantation (n=7), leukaemia (n=16) and diabetes mellitus (n=8). Of 183 phenotypically-speciated isolates, 75 (41%) were Scedosporium prolificans (risk factors: haematologic cancer (n=17), neutropaenia (n=14)) and 108 (59%) had Scedosporium apiospermum/Pseudallescheria boydii phenotype [risk factor: diabetes (n=15)]. Scedosporium prolificans (p 0.01) and leukaemia (p 0.03) independently predicted death. Epidemiological and antifungal susceptibility profiles of Scedosporium aurantiacum (prevalence>or=15.8%) and S. apiospermum were similar. No patient with S. aurantiacum infection (n=6) died. This is the first description of clinical features associated with S. aurantiacum.

BackgroundOver the last two decades, many epidemiological studies were performed to describe risks and clinical presentations of melioidosis in endemic countries.MethodsWe performed a retrospective analysis of 158 confirmed cases of melioidosis collected from medical records from 2001 to 2015 in Hospital Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia, in order to update the current status of melioidosis clinical epidemiology in this putatively high risk region of the country.ResultsPrincipal presentations in patients were lung infection in 65 (41.1 %), skin infection in 44 (27.8 %), septic arthritis/osteomyelitis in 20 (12.7 %) and liver infection in 19 (12.0 %). Bacteremic melioidosis was seen in most of patients (n = 121, 76.6 %). Focal melioidosis was seen in 124 (78.5 %) of patients and multi-focal melioidosis was reported in 45 (28.5 %) cases. Melioidosis with no evident focus was in 34 (21.5 %) patients. Fifty-four (34.2 %) patients developed septic shock. Internal organ abscesses and secondary foci in lungs and/or soft tissue were common. A total of 67 (41 %) cases presented during the monsoonal wet season. Death due to melioidosis was reported in 52 (32.9 %) patients, while relapses were occurred in 11 (7.0 %). Twelve fatal melioidosis cases seen in this study were directly attributed to the absence of prompt acute-phase treatment. Predisposing risk factors were reported in most of patients (n = 133, 84.2 %) and included diabetes (74.7 %), immune disturbances (9.5 %), cancer (4.4 %) and chronic kidney disease (11.4 %). On multivariate analysis, the only independent predictors of mortality were the presence of at least one co-morbid factor (OR 3.0; 95 % CI 1.1–8.4), the happening of septic shock (OR 16.5; 95 % CI 6.1–44.9) and age > 40 years (OR 6.47; 95 % CI 1.7–23.8).ConclusionsMelioidosis should be recognized as an opportunistic nonfatal infection for healthy person. Prompt early diagnosis and appropriate antibiotics administration and critical care help in improved management and minimizing risks for death.

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...

Members of the Pseudallescheria/Scedosporium species complex are emerging opportunistic fungal pathogens which have the capacity to colonize patients with damaged airways, including those with cystic fibrosis (CF). Assuming human infection is acquired via inhalation of fungal spores from the environment, we performed a qualitative environmental survey encompassing 25 urban, semirural and rural sites in the greater Sydney region to determine the prevalence of Pseudallescheria/Scedosporium species. Soil sampling revealed an abundance of Pseudallescheria/Scedosporium, particularly in locations associated with high human activity. No variation was noted during repeated sampling at different times of the year. Strains of Scedosporium aurantiacum were most frequently isolated (54.6%), followed by Scedosporium prolificans (43%), P. boydii (2.1%) and S. dehoogii (0.3%). The findings coincide with the relatively high prevalence of Scedosporium infections in Australia and their presence as colonizers in CF patients. They emphasize the importance of environmental studies to assess the clinical risk of infection.

Risk factors for the association of Scedosporium in cases of cystic fibrosis (CF) and its clinical implications are poorly understood. Clinical, lung function and laboratory data of adult CF patients in Sydney (April 2008-March 2009) were prospectively analysed for such risk factors. Expectorated sputa were cultured for bacteria and examined for fungi using standard mycological and Scedosporium-selective media, and by an internal transcribed spacer region-targeted multiplex PCR assay. Scedosporium spp. (n = 4 each of Scedosporium prolificans, Scedosporium aurantiacum and Pseudallescheria boydii/ Scedosporium apiospermum complex [non-S. aurantiacum]) were recovered from 12 of 69 (17.4%) patients. Samples of 11 of the patients yielded isolates on Scedosporium- selective media (vs. 6 [8.7%] by non-selective culture) and one additional patient was noted by PCR. Of these patients, 83.3% were co-colonized with other moulds, most frequently Aspergillus fumigatus. Colonization was not associated with best FEV₁/predicted, corticosteroid or antifungal therapies. By univariate analysis, patients with Scedosporium colonization were significantly less likely to be colonized with mucoid Pseudomonas aeruginosa (P = 0.025), while prior therapy with antistaphylococcal penicillins was a risk factor for colonization (P = 0.045). Bacterial colonization and antimicrobial exposure likely influence Scedosporium colonization, which is optimally detected with selective media. Studies are required to confirm independent risk factors for Scedosporium colonization and to determine its impact on lung disease.

The prevalence of respiratory illness remains high among Malaysian hajj pilgrims despite having some practices of preventive measures. All preventive measures which include hand hygiene, wearing face masks and influenza vaccination must be practiced together as bundle of care to reduce respiratory illness effectively.

Molecular typing showed genetic diversity, dismissed 2 suspected outbreaks of scedosporiosis, and identified multiple strains of the newly described species S. aurantiacum .

When the first report of COVID-19 appeared in December 2019 from Wuhan, China, the world unknowingly perceived this as another flu-like illness. Many were surprised at the extreme steps that China had subsequently taken to seal Wuhan from the rest of the world. However, by February 2020, the SARS-CoV-2 virus, which causes COVID-19, had spread so quickly across the globe that the World Health Organization officially declared COVID-19 a pandemic. COVID-19 is not the first pandemic the world has seen, so what makes it so unique in Malaysia, is discussed to avoid a future coronacoma.