Scedosporium apiospermum EUMYCETOMA SUCCESSFULLY TREATED WITH ORAL VORICONAZOLE: REPORT OF A CASE AND REVIEW OF THE BRAZILIAN REPORTS ON SCEDOSPORIOSIS

Oliveira, Flávio de Mattos; Unis, Gisela; Hochhegger, Bruno; Severo, Luiz Carlos

doi:10.1590/s0036-46652013000200010

Cited by 23 publications

(15 citation statements)

References 14 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…From 1980 to 2014, the main bacterial agents identified in Brazil were Nocardia brasiliensis [15,26,27–32], Nocardia asteroides [15,33], Nocardia caviae [34], Actinomadura madurae [13,35,36], Actinomadura pelletieri [14], and Streptomyces somaliensis [15]. For eumycetoma were Madurella mycetomatis [15,25,37,38], Madurella grisea [39–45], Acremonium falciforme [46], Acremonium kiliense [47], Scedosporium apiospermum [12,18,48,49,50], Fusarium solani [51], Exophiala jeanselmei [44,52,53] and Aspergillus sp. [12].…”

Section: Discussion and Review Of The Literaturementioning

confidence: 99%

See 1 more Smart Citation

Review of 21 cases of mycetoma from 1991 to 2014 in Rio de Janeiro, Brazil

et al. 2017

View full text Add to dashboard Cite

Mycetoma is caused by the subcutaneous inoculation of filamentous fungi or aerobic filamentous bacteria that form grains in the tissue. The purpose of this study is to describe the epidemiologic, clinic, laboratory, and therapeutic characteristics of patients with mycetoma at the Oswaldo Cruz Foundation in Rio de Janeiro, Brazil, between 1991 and 2014. Twenty-one cases of mycetoma were included in the study. There was a predominance of male patients (1.3:1) and the average patient age was 46 years. The majority of the cases were from the Southeast region of Brazil and the feet were the most affected anatomical region (80.95%). Eumycetoma prevailed over actinomycetoma (61.9% and 38.1% respectively). Eumycetoma patients had positive cultures in 8 of 13 cases, with isolation of Scedosporium apiospermum species complex (n = 3), Madurella mycetomatis (n = 2) and Acremonium spp. (n = 1). Two cases presented sterile mycelium and five were negative. Six of 8 actinomycetoma cases had cultures that were identified as Nocardia spp. (n = 3), Nocardia brasiliensis (n = 2), and Nocardia asteroides (n = 1). Imaging tests were performed on all but one patients, and bone destruction was identified in 9 cases (42.68%). All eumycetoma cases were treated with itraconazole monotherapy or combined with fluconazole, terbinafine, or amphotericin B. Actinomycetoma cases were treated with sulfamethoxazole plus trimethoprim or combined with cycles of amikacin sulphate. Surgical procedures were performed in 9 (69.2%) eumycetoma and in 3 (37.5%) actinomycetoma cases, with one amputation case in each group. Clinical cure occurred in 11 cases (7 for eumycetoma and 4 for actinomycetoma), and recurrence was documented in 4 of 21 cases. No deaths were recorded during the study. Despite of the scarcity of mycetoma in our institution the cases presented reflect the wide clinical spectrum and difficulties to take care of this neglected disease.

show abstract

Section: Discussion and Review Of The Literaturementioning

confidence: 99%

“…apiospermum and Acremonium sp. [48,59–62]. They are expensive in underdeveloped countries and are not available in our institution.…”

Section: Discussion and Review Of The Literaturementioning

confidence: 99%

Review of 21 cases of mycetoma from 1991 to 2014 in Rio de Janeiro, Brazil

et al. 2017

View full text Add to dashboard Cite

show abstract

“…Posaconazole was found effective against S. apiospermum complex members in vitro. According to in vivo studies (murine models) and patient case reports, this drug is effective (34)(35)(36)(37), but in vitro susceptibility testing is mandatory due to the occurrence of resistance. Anidulafungin and micafungin may represent future therapeutic options, which, however, remain to be evaluated by in vivo experiments.…”

Section: Discussionmentioning

confidence: 99%

Susceptibility and Diversity in the Therapy-Refractory Genus Scedosporium

Lackner

Hagen

Meis

et al. 2014

Antimicrob Agents Chemother

View full text Add to dashboard Cite

Scedosporium species show decreased susceptibility to the majority of systemic antifungal drugs. Acquired resistance is likely to disseminate differentially with the mode of exchange of genetic material between lineages. Inter-and intraspecific diversities of Scedosporium species were analyzed for three partitions (rDNA internal transcribed spacer gene [ITS], partial ␤-tubulin gene, and amplified fragment length polymorphism profiles), with the aim to establish distribution of resistance between species, populations, and strains. Heterogeneity of and recombination between lineages were determined, and distances between clusters were calculated using a centroid approach. Clinical, geographic, and antifungal data were plotted on diversity networks. Scedosporium minutisporum, Scedosporium desertorum, and Scedosporium aurantiacum were distinguished unambiguously in all partitions and had differential antifungal susceptibility profiles (ASP). Pseudallescheria fusoidea and Pseudallescheria ellipsoidea were indistinguishable from Scedosporium boydii. Pseudallescheria angusta took an intermediate position between Scedosporium apiospermum and S. boydii. Scedosporium boydii and S. apiospermum had identical ASP. Differences in (multi)resistance were linked to individual strains. S. apiospermum and S. boydii showed limited interbreeding and were recognized as valid, sympatric species. The S. apiospermum/S. boydii group, comprising the main clinically relevant Scedosporium species, consists of separate lineages and is interpreted as a complex undergoing sympatric evolution with incomplete lineage sorting. In routine diagnostics, the lineages in S. apiospermum/S. boydii are indicated with the umbrella descriptor "S. apiospermum complex"; individual species can be identified with rDNA ITS with 96.3% confidence. Voriconazole is recommended as the first-line treatment; resistance against this compound is rare.

show abstract

“…In addition to antifungal therapy, a surgical debridement is recommended. Recently, a white‐grain eumycetoma due to Scedosporium apiospermum in a patient from Brazil has been successfully treated by oral voriconazole …”

Section: Treatment Of Mycetomasmentioning

confidence: 99%

Eumycetoma and actinomycetoma – an update on causative agents, epidemiology, pathogenesis, diagnostics and therapy

Nenoff

Sande

Fahal

et al. 2015

Acad Dermatol Venereol

101

118

View full text Add to dashboard Cite

Mycetoma is a chronic putrid infection of the cutaneous and subcutaneous tissue concerning predominantly the feet, and more rarely other body parts. Mycetoma can be caused by both fungi (eumycetoma) and bacteria (actinomycetoma). Mode of infection is an inoculation of the causative microorganism via small injuries of the skin. The clinical correlate of both forms of mycetoma is tumescence with abscesses, painless nodules, sinuses and discharge. The latter is commonly serous-purulent and contains grains (filamentous granules) which can be expressed for diagnostic purposes. Distinctive for both eumycetoma and actinomycetoma, are the formation of grains. Grains represent microcolonies of the microorganism in vivo in the vital tissue. The most successful treatment option for eumycetomas offers itraconazole in a dosage of 200 mg twice daily. This triazole antifungal is considered as 'gold standard' for eumycetomas. Alternatively, the cheaper ketoconazole was widely used, however, it was currently stopped by the FDA. Actinomycetomas should be treated by the combination of trimethoprim-sulphamethoxazole (co-trimoxazole 80/400 to 160/800 mg per day) and amikacin 15 mg/kg body weight per day. Mycetomas are neglected infections of the poor. They are more than a medical challenge. In rural areas of Africa, Asia and South America mycetomas lead to socio-economic consequences involving the affected patients, their families and the society in general.

show abstract

Scedosporium apiospermum EUMYCETOMA SUCCESSFULLY TREATED WITH ORAL VORICONAZOLE: REPORT OF A CASE AND REVIEW OF THE BRAZILIAN REPORTS ON SCEDOSPORIOSIS

Abstract: SUMMARYWe describe a case of white-grain eumycetoma caused by Scedosporium apiospermum in an immunocompetent host that was successfully treated with oral voriconazole, and we review the Brazilian reports on scedosporiosis.

Cited by 23 publications

References 14 publications

Review of 21 cases of mycetoma from 1991 to 2014 in Rio de Janeiro, Brazil

Review of 21 cases of mycetoma from 1991 to 2014 in Rio de Janeiro, Brazil

Susceptibility and Diversity in the Therapy-Refractory Genus Scedosporium

Eumycetoma and actinomycetoma – an update on causative agents, epidemiology, pathogenesis, diagnostics and therapy

Contact Info

Product

Resources

About