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.

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...